背景:本研究旨在验证早期移植后标准化相位角(SPhA)是否根据不同的营养指标确定血液透析患者的营养状况,并预测肾移植后6个月的握力(HGS)。
方法:共有82名接受维持性血液透析治疗的肾移植受者进入本研究。在肾移植前评估营养状况,在出院日期,6个月后。我们使用生物电阻抗分析(BIA),三种不同的营养不良筛查工具,HGS,和人体测量。收集人口统计学特征和生化营养标记物。SPhA值,调整了年龄和BMI,在我们的研究中使用。
结果:在移植后早期,肾移植受者失去了肌肉质量,脂肪增加,并且大部分发展为阴性的SPhA,伴有显著降低的白蛋白水平。低于中位数(<-1.46)SphAdis[针对住院时间和基线SphA调整的SPhA(出院时)]的受试者显示白蛋白浓度值较低(43.4vs.45.1g/l,p=0.010),血红蛋白(124vs.133克/升,p=0.016),GNRI(113vs.118,p=0.041),和HGS(30vs.33公斤,p=0.043)。这些患者的铁蛋白浓度较高(420vs.258mkmol/l,p=0.026),住院时间更长(32vs.21天,p<0.001),和更高的MIS分数(3vs.1,p=0.001)。
结论:在出院时,低于中位数的SPhA与蛋白质能量消耗有关,表现为较低浓度的营养生物标志物和活跃的炎症反应。肾移植前较高的SPhA预测肾移植后6个月的HGS,尤其是女性。
BACKGROUND: This study was designed to verify whether early posttransplant standardized phase angle (SPhA) determines nutrition status of hemodialysis patients in regard to different nutritional markers and predicts handgrip strength (HGS) 6 months after kidney transplantation.
METHODS: A total of 82 kidney transplant recipients on maintenance hemodialysis treatment entered the study. Nutritional status was evaluated before kidney transplantation, at the hospital discharge date, and 6 months after. We used bioelectrical impedance analysis (BIA), three different malnutrition screening tools, HGS, and anthropometric measurements. Demographic profiles and biochemical nutritional markers were collected. SPhA values, adjusted for age and BMI, were used in our study.
RESULTS: In the early posttransplant period, kidney transplant recipients lost muscle mass, gained fat mass, and developed mostly negative SPhA, accompanied by significantly lower albumin levels. The subjects with lower than median (<-1.46) SPhAdis [the SPhA (at discharge) adjusted for hospitalization time and the baseline SPhA] displayed lower values of albumin concentration (43.4 vs. 45.1 g/l, p = 0.010), hemoglobin (124 vs. 133 g/l, p = 0.016), GNRI (113 vs. 118, p = 0.041), and HGS (30 vs. 33 kg, p = 0.043). These patients had higher ferritin concentrations (420 vs. 258 mkmol/l, p = 0.026), longer inpatient stays (32 vs. 21 days, p < 0.001), and higher MIS scores (3 vs. 1, p = 0.001).
CONCLUSIONS: At the moment of hospital discharge, lower than the median SPhA is related to protein-energy wasting, represented as lower concentrations of nutrition biomarkers and an active inflammatory response. Higher SPhA before kidney transplantation predicts HGS 6 months after kidney transplantation, especially in women.