Analysis of related factors of sarcopenia in type 2 diabetic nephropathy patients on maintenance hemodialysis

doi:10.16138/j.1673-6087.2024.02.03

Abstract

Abstract:

Objective To analyze related factors of sarcopenia in type 2 diabetic nephropathy patients on maintenance hemodialysis (MHD), in order to reduce the incidence of sarcopenia. Methods The clinical data of 237 patients with MHD complicated with sarcopenia were collected from the Blood Purification Center of the Affiliated People’s Hospital of Xinxiang Medical College from September 2021 to April 2023 retrospectively and analyzed. The patients were divided into type 2 diabetic nephropathy group (100 cases) and non-diabetic nephropathy group (137 cases), and the clinical data and the result of bioelectrical impedance analysis (BIA) were compared between the two groups. Multivariate Logistic regression model was used to analyze the related factors affecting sarcopenia in MHD patients with diabetic nephropathy. Results There were significant differences in gender, fasting blood glucose, serum creatinine, albumin, prealbumin, 25-hydroxyvitamin D, body mass index (BMI), fat mass (FM), arm circumference (AC), visceral fat area (VFA) and 50 kHz phase angle between the two groups(all P<0.05). Multivariate Logistic regression analysis showed that gender, fasting blood glucose, albumin and BMI were independent influencing factors of sarcopenia in MHD diabetic nephropathy patients (odds ratio =0.372, 1.350, 0.925, 1.451, all P<0.05). Conclusions Male, hypoalbuminemia, hyperglycemia and high BMI patients with MHD are more likely to have sarcopenia among diabetic nephropathy patients with MHD.

Key words: Maintenance hemodialysis, Type 2 diabetic nephropathy, Sarcopenia

CLC Number:

R587
R459.5

WU Mengmeng, YANG Fuyan, LIU Yuchen, LU Xuke, GAO Jingge, YE Ziling. Analysis of related factors of sarcopenia in type 2 diabetic nephropathy patients on maintenance hemodialysis[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(02): 102-106.

Figures/Tables 4

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项目	非糖尿病肾病组(n=137)	糖尿病肾病组(n=100)	χ²/Z	P
男性[n(%)]	63(46.0)	62(62.0)	5.948	0.015
年龄(岁)	63(51,75)	64(56,72)	-0.563	0.573
透析方式[n(%)]			2.811	0.245
血液透析	110(80.3)	85(85.0)
血液滤过	10(7.3)	9(9.0)
血液透析联合血液灌流	17(12.4)	6(6.0)
透析龄(月)	48(18,90)	45(24,85)	-0.238	0.812
抗凝剂类型[n(%)]			0.693	0.707
低分子肝素钠	109(79.6)	75(75.0)
普通肝素	9(6.6)	8(8.0)
无肝素	19(13.8)	17(17.0)
血管通路[n (%)]			6.591	0.010
动静脉内瘘	51(37.2)	54(54.0)
深静脉置管	86(62.8)	46(46.0)
BMI(kg/m²)	20.2(18.4,22.5)	21.6(20.2,23.1)	-3.868	<0.001
Kt/V	1.3(1.2,1.4)	1.3(1.1,1.4)	-1.515	0.130

项目	非糖尿病肾病组(n=137)	糖尿病肾病组(n=100)	t/Z	P
血红蛋白(g/L)	110(90,123)	102±23	-1.310	0.190
空腹血糖(mmol/L)	5.10(4.32,6.08)	7.28(5.32,12.14)	-6.292	<0.001
ALP(U/L)	93(68,120)	96(75,120)	-1.237	0.216
血清肌酐(μmol/L)	653(458,859)	540(394,752)	-2.235	0.025
血清尿素氮(mmol/L)	21.11(14.45,27.90)	19.43(14.64,27.97)	-0.326	0.744
血清磷(mmol/L)	1.72(1.37,2.21)	1.66(1.24,1.98)	-1.525	0.127
IPTH(ng/L)	22.21(11.17,41.55)	21.19(11.88,43.28)	-0.125	0.901
白蛋白(g/L)	38.3±5.3	36.0(32.3,39.7)	-3.688	<0.001
前白蛋白(g/L)	243±87	194(132,261)	-3.545	<0.001
25-羟维生素D(μg/L)	18.13(10.44,27.94)	13.89(8.27,21.72)	-2.160	0.031
TC(mmol/L)	3.56(2.94,4.44)	3.38(2.70,4.15)	-1.495	0.135
TG(mmol/L)	1.28(0.85,1.94)	1.28(0.99,1.94)	-0.756	0.450
HDL(mmol/L)	1.11(0.80,1.49)	1.03(0.75,1.49)	-0.764	0.445
LDL(mmol/L)	0.99(0.59,1.71)	1.13(0.70,1.49)	-0.759	0.448
CRP(mg/L)	13.73(3.41,50.11)	12.26(4.08,51.52)	-0.582	0.560
hs-CRP(mg/L)	6.69(2.57,15.83)	7.32(2.65,15.08)	-0.488	0.625

项目	非糖尿病肾病组(n=137)	糖尿病肾病组(n=100)	t/Z	P
蛋白质(kg)	7.4±1.2	7.9(6.7,8.5)	-1.550	0.121
无机盐(kg)	2.81±0.40	2.86(2.64,3.16)	-1.481	0.139
FM(kg)	14.4(10.9,19.2)	17.7(13.4,20.9)	-2.926	0.003
FFM(kg)	39.0±6.3	40.4±6.5	-1.715	0.088
PBF(%)	28.0±9.6	30.2±9.1	-1.845	0.066
SMM(kg)	20.4±3.7	21.8(18.2,23.8)	-1.467	0.142
BMR[kJ/(m²·h) ]	1 213.2±135.9	1 245.3±141.1	-1.768	0.078
VFA(cm²)	80.3(61.0,116.4)	96.8(75.1,128.2)	-3.036	0.002
AC(cm)	26.8(24,7,28.6)	27.5±2.1	-2.091	0.036
AMC(cm)	23.6±1.9	24.0±1.7	-1.485	0.139
SMI(%)	5.7(5.0,6.4)	6.0(5.2,6.5)	-1.847	0.065
50 kHz相位角(rad)	4.3±1.2	3.9±1.1	2.684	0.008

因素	β	SE	Wald χ²	P	OR	95% CI
性别	-0.990	0.448	4.877	0.027	0.372	0.154~0.895
空腹血糖	0.300	0.063	22.933	<0.001	1.350	1.194~1.527
血清肌酐	0.000	0.001	0.023	0.880	1.000	0.999~1.001
白蛋白	-0.078	0.036	4.606	0.032	0.925	0.861~0.993
前白蛋白	0.000	0.002	0.032	0.858	1.000	0.995~1.004
25-羟维生素D	-0.016	0.014	1.245	0.265	0.984	0.957~1.012
FM	0.133	0.116	1.333	0.248	1.143	0.911~1.433
BMI	0.373	0.186	4.011	0.045	1.451	1.008~2.090
VFA	-0.015	0.015	1.049	0.306	0.985	0.957~1.014
AC	-0.272	0.192	2.017	0.156	0.762	0.523~1.109
50 kHz相位角	-0.223	0.190	1.384	0.239	0.800	0.552~1.160