| BackgroundChronic kidney disease(CKD)is a serious public health problem worldwide.A large number of CKD patients eventually enter the uremic stage,and maintenance dialysis(MD)is a relatively safe and widely used treatment method for uremic patients.In recent years,a large number of studies have begun to focus on MD with sarcopenia.Sarcopenia is a common complication in MD patients and is closely related to their quality of life and clinical prognosis.The treatment of MD with sarcopenia in modern medicine often starts from the perspective of nutrition and exercise.Due to factors such as research scale and quality,there is still controversy over how to standardize the clinical use of nutrition and exercise methods to treat this disease.ObjectivesBy screening MD patients for sarcopenia,collecting their traditional Chinese medicine(TCM)syndrome scores and clinical data,exploring the risk factors and TCM syndrome characteristics of sarcopenia in MD patients,and providing clinical basis for the prevention and treatment of MD sarcopenia with TCM.MethodA cross-sectional study was conducted to screen MD patients in the nephrology department and hemodialysis room of the China Academy of Chinese Medical Sciences Guang’anmen Hospital Headquarters,South District and Fangshan Hospital of Traditional Chinese Medicine from December 2021 to May 2022.General data,anthropometry data,laboratory indicators and TCM syndrome scores were collected from patients who met the inclusion criteria,and 12 months of follow-up was conducted.Using statistical analysis,compare the correlation and differences in clinical data,traditional Chinese medicine syndromes,and mortality rates among different groups of patients.Results(1)General information:A total of 319 maintenance dialysis patients were included in this study,including 50 PD patients and 269 HD patients.The prevalence of sarcopenia in PD patients is 20%,with a prevalence of severe sarcopenia of 16%;The prevalence of sarcopenia in HD patients is 35.2%,with a prevalence of 32.6%for severe sarcopenia.In the PD group,the BMI of patients with sarcopenia was lower than that of non sarcopenia group(P=0.002).Patients in the sarcopenia group have a higher history of heart failure(P=0.003)and coronary heart disease(P=0.009).In the HD group,patients with sarcopenia were older than those without sarcopenia(P=0.001).The BMI of patients with sarcopenia was lower than that of non sarcopenia group(P<0.001).Patients in the sarcopenia group have a higher history of heart failure(P<0.001),coronary heart disease(P=0.013),and cerebral infarction(P<0.001).There was no statistically significant difference between the PD sarcopenia group and the HD sarcopenia group in general data(P>0.05).(2)Anthropometry data:In the PD group,the limb skeletal muscle volume,limb skeletal muscle index,grip strength,6-meter pace and SARC-F score in the myopenia group were lower than those in the non myopenia group,with a statistically significant difference(P<0.05).In the HD group,the skeletal muscle mass,limb skeletal muscle index,grip strength,6meter walking speed,and S ARC-F score of the sarcopenia group were lower than those of the non sarcopenia group,with statistically significant differences(P<0.05).There was no statistical difference between PD myopenia group and HD myopenia group in all anthropometry variables.(3)TCM Score:In the PD group,patients with muscle deficiency syndrome had higher scores for heart qi deficiency,spleen qi deficiency,blood stasis,and turbid toxin syndrome than those without muscle deficiency syndrome,with statistically significant differences(P<0.05).There was no statistically significant difference in the scores of kidney yin deficiency,kidney yang deficiency,phlegm dampness syndrome,and dampness heat syndrome between the two groups(P>0.05).In the HD group,the scores of heart qi deficiency syndrome,spleen qi deficiency syndrome,blood stasis syndrome,and turbid toxin syndrome in the sarcopenia group were higher than those in the non sarcopenia group,with statistical significance(P<0.05).There was no statistically significant difference in the scores of kidney yin deficiency,kidney yang deficiency,phlegm dampness syndrome,and dampness heat syndrome between the two groups(P>0.05).Compared with the HD sarcopenia group,the HD sarcopenia group had higher scores of heart qi deficiency syndrome,spleen qi deficiency syndrome,blood stasis syndrome,and turbid toxin syndrome than the PD sarcopenia group(P<0.05).There was no statistically significant difference in the scores of kidney yin deficiency,kidney yang deficiency,phlegm dampness syndrome,and dampness heat syndrome between the two groups(P>0.05).(4)Laboratory indicators:In the PD group,cTNI and NT proBNP in the sarcopenia group were higher than those in the non sarcopenia group,with statistically significant differences(P<0.05).The ALB level in the sarcopenia group was lower than that in the non sarcopenia group,and the difference was statistically significant(P<0.05).In the HD group,the HGB,SCR,ALB,and blood Ca levels in the sarcopenia group were lower than those in the non sarcopenia group,with statistically significant differences(P<0.05).The CRP,cTNI,NT proBNP,and D-Dimer levels in the sarcopenia group were higher than those in the non sarcopenia group,with statistically significant differences(P<0.05).Compared with the HD sarcopenia group,the HD sarcopenia group had higher levels of CRP,BUN,ALB,NT proBNP,blood K,and D-Dimer,with statistically significant differences(P<0.05).The HCO3-and blood Ca levels in the HD sarcopenia group were lower than those in the PD sarcopenia group,with statistically significant differences(P<0.001).(5)Cardiac ultrasound indicators:Compared with the HD sarcopenia group,the LVEF of the HD sarcopenia group was higher than that of the PD sarcopenia group,and the difference was statistically significant(P<0.05).(6)Correlation analysis:Low ALB(OR(95%CI):0.71(0.54,0.94),P=0.015)and NT proBNP>10000pg/ml(OR(95%CI):17.17(2.14137.69),P=0.007)are independent risk factors for sarcopenia in PD patients.Low BMI(OR(95%CI):0.72(0.63,0.83),P<0.001),low HGB(OR(95%CI):0.94(0.91,0.98),P=0.001),concomitant cerebral infarction(OR(95%CI):3.21(1.08,9.57),P=0.036),and NT proBNP>10000pg/ml(OR(95%CI):14.34(5.60,36.70),P<0.001)are independent risk factors for sarcopenia in HD patients.The dialysis method(OR(95%CI):1.56(0.58,4.22),P=0.383)was not associated with the incidence of sarcopenia in MD patients.Low ALB(OR(95%CI):0.83(0.75,0.91),P<0.001)and NT proBNP>10000pg/ml(OR(95%CI):25.84(12.68,52.65),P<0.001)are independent risk factors for sarcopenia in MD patients.(7)Survival analysis:The 12 month survival rate of MD patients was 89.7%.The rate of PD non sarcopenia was 100%,and the difference was statistically significant(P=0.005).The 12 month survival rate in the HD sarcopenia group was 82.3%,while in the HD non sarcopenia group it was 91.9%,with a statistically significant difference(P=0.015).Conclusions(1)Low ALB and high NT-proBNP are independent risk factors for sarcopenia in PD patients.(2)Low BMI,low HGB,concomitant cerebral infarction,and high NT proBNP are independent risk factors for sarcopenia in HD patients.(3)MD sarcopenia patients mainly have heart qi deficiency syndrome and spleen qi deficiency syndrome,while pathogenic excess is mainly caused by blood stasis and turbid toxin.(4)Muscle deficiency affects the death outcome of MD patients. |
