目的:慢性肾脏病(CKD)和低骨密度(BMD)非常普遍,可以共存。矿物质代谢参数与CKD的BMD有关,但其他因素也可能有所贡献。这项研究的目的是评估非透析依赖性CKD(NDD-CKD)患者BMD及其决定因素的变化。
方法:在一项以医院为基础的NDD-CKD患者的回顾性队列研究中评估了身体成分和生化特征。BMD,瘦软组织(LST),阑尾LST(ALST),和脂肪质量百分比通过双能X射线吸收法(DXA)进行评估。ALST指数(ALSTI,计算ALST/高度2)和负载能力指数(LCI,脂肪量/LST)。低BMD定义为t评分≤-1.0。
结果:评估之间的平均时间为2.8±1.3年,包括46例患者。观察到肾功能下降。身体成分的变化包括ALST的减少(p=0.031),ALSTI(p=0.021)和BMD趋势(p=0.053);以及脂肪质量百分比(p=0.044)和LCI(p=0.032)的增加。女性BMD降低(p=0.034),ALST(p=0.026),和ALSTI(p=0.037)。基线时具有低BMD的患者具有较低的LST(p=0.013),ALST(p=0.023),和脂肪质量百分比(p=0.037)比正常骨密度。此外,LST降低(p=0.041),ALST(p=0.006),和ALSTI(p=0.008)在基线时具有低BMD的患者中观察到,而在基线BMD正常的人群中没有观察到身体成分的显着变化。基线时的以下身体成分参数是随访时BMD状态的决定因素:LST(OR:0.899,95CI:0.829-0.976,p=0.010),ALST(OR:0.825,95CI:0.704-0.967,p=0.017),和ALSTI(OR:0.586,95CI:0.354-0.968,p=0.037),独立于脂肪量,LCI。
结论:观察到有害的身体成分变化,而体重没有变化;这些在女性中更为显著。此外,这是第一项纵向研究,显示LST对NDD-CKD患者BMD丢失具有保护作用.
OBJECTIVE: Chronic kidney disease (CKD) and low bone mineral density (BMD) are highly prevalent and can co-exist. Parameters of mineral metabolism are associated with BMD in CKD, but other contributing factors may contribute. The aim of this study was to assess changes in BMD and its determinants in patients with nondialysis-dependent CKD (NDD-CKD).
METHODS: Body composition and biochemical profiles were assessed in a retrospective hospital-based cohort study of patients with NDD-CKD. BMD, lean soft tissue (LST), appendicular LST (ALST), and percentage fat mass were assessed by dual-energy X-ray absorptiometry. The ALST index (ALSTI, ALST/height2) and load-capacity index (LCI, fat mass/LST) were calculated. Low BMD was defined as T-score ≤ -1.0.
RESULTS: The mean time between assessments was 2.8 ± 1.3 years; 46 patients were included. A reduction in renal function was observed. Changes in body composition included reductions in ALST (P = .031), ALSTI (P = .021), a trend for BMD (P = .053), and an increase in percentage fat mass (P = .044) and LCI (P = .032). Females had a reduction in BMD (P = .034), ALST (P = .026), and ALSTI (P = .037). Patients with low BMD at baseline had lower LST (P = .013), ALST (P = .023), and percentage fat mass (P = .037) than those with normal BMD. Additionally, reductions in LST (P = .041), ALST (P = .006), and ALSTI (P = .008) were observed in patients who had low BMD at baseline, while no significant changes in body composition were observed in those with normal BMD at baseline. The following body composition parameters at baseline were determinants of BMD status at follow-up: LST (odds ratio [OR]: 0.899, 95% confidence interval [CI]: 0.829-0.976, P = .010), ALST (OR: 0.825, 95% CI: 0.704-0.967, P = .017), and ALSTI (OR: 0.586, 95% CI: 0.354-0.968, P = .037), independent of fat mass and LCI.
CONCLUSIONS: Detrimental body composition changes were observed without changes in body weight; these were more significant in females. Moreover, this is the first longitudinal study showing a protective effect of LST against BMD loss in patients with NDD-CKD.