末期腎不全のサルコペニア

末期腎不全の高齢者におけるサルコペニアの有病割合と関連要因に関する論文を紹介します。

Jwa-Kyung Kim, et al. Prevalence of and factors associated with sarcopenia in elderly patients with end-stage renal disease. Clinical Nutrition, http://dx.doi.org/10.1016/j.clnu.2013.04.002

対象は50歳以上の末期腎不全95人で横断研究です。サルコペニアは筋肉量と筋力で評価しています。結果ですが、平均年齢64歳、半数強が糖尿病を合併していました。サルコペニアは男性で37％、女性で29.3％に認めました。

SGA（栄養スクリーニング）の結果、炎症マーカー、β2マイクログロブリンがサルコペニアの有無と関連していました。また、抑うつと軽度認知障害を認める場合に、サルコペニアが多かったです。末期腎不全ではサルコペニアが多く、これらが関連因子という結論です。

平均年齢64歳ですので高齢者と言えるかどうか微妙なレベルですが、それでも3人に1人はサルコペニア（より正確に言うと腎不全や糖尿病による二次性サルコペニア）を認めるのですね。抑うつと認知障害は低栄養からの二次性サルコペニアに関連しているかもしれません。

Summary

Background & aims

We investigated the prevalence of sarcopenia in elderly patients with end-stage renal disease (ESRD) and its relationship with various markers of nutrition, cognitive function, depressive symptoms, inflammation and β2-microglobulin.

Methods

A cross-sectional study was conducted with 95 patients having ESRD aged over 50 years. Sarcopenia was defined as a decline in both muscle mass and strength.

Results

The mean age was 63.9 ± 10.0 years; 56.8% were men and 52.6% had diabetes. Sarcopenia was highly prevalent in elderly patients with ESRD (37.0% in men and 29.3% in women). Subjective Global Assessment (SGA), inflammatory markers and β2-microglobulin levels were significantly associated with sarcopenia, even after adjustment for age, gender, diabetes, and body mass index. Additionally, patients with depressive symptoms showed a higher risk of sarcopenia relative to those without depressive symptoms (odds ratio, OR = 6.87, 95% confidence interval, CI = 2.06–22.96) and sarcopenia was more likely to be present in patients with mild cognitive dysfunction (OR = 6.35, 95% CI = 1.62–34.96).

Conclusions

Sarcopenia is highly prevalent in elderly patients with ESRD and is closely associated with SGA, inflammatory markers, β2-microglobulin, depression and cognitive dysfunction.