{"title":"血液透析患者运动后迷走神经功能障碍与蛋白质能量消耗和非心血管结局的关联:一项回顾性队列研究","authors":"Naoto Usui RPT, MSc , Junichiro Nakata MD, PhD , Akimi Uehata MD, PhD , Sho Kojima RPT, MSc , Hideki Hisadome MD , Shuji Ando PhD , Masakazu Saitoh RPT, PhD , Akihito Inatsu MD, PhD , Takahiko Tsuchiya MD , Takayuki Mawatari MD , Yusuke Suzuki MD, PhD","doi":"10.1053/j.jrn.2023.11.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Postexercise vagal dysfunction is linked to noncardiovascular mortality in hemodialysis patients, but the mechanism is unknown. This study aimed to determine the association of cardiovagal neuropathy with systemic inflammation, protein-energy wasting, and noncardiovascular hospitalization.</p></div><div><h3>Methods</h3><p>This 2-center retrospective cohort study analyzed data from 280 hemodialysis patients who underwent exercise test. Patients were assessed for heart rate (HR) recovery (bpm) for 1 minute after exercise, a marker of vagal function, and were divided into 3 categories (Low: ≤ 6, Mid: 7-11, High: ≥ 12 bpm). We followed 1-year changes in the systemic inflammation-based prognostic score (Glasgow Prognostic Score [GPS]), body weight, and creatinine generation rate (CGR), an indicator of muscle mass, as well as 2-year hospitalization.</p></div><div><h3>Results</h3><p>The HR recovery category was associated with serum C-reactive protein and albumin levels and GPS. After 1 year, the low HR recovery category was associated with worsening in GPS (low, 0 [0-0.5]; mid, 0 [0-1]; high, 0 [0-0]), weight (low, 100.0 [96.1-102.5]; mid, 101.3 [98.9-105.0]; high, 100.5 [98.2-102.9]%), and CGR (low, 97.0 [88.5-111.4]; mid, 110.2 [90.9-124.8]; high, 106.2 [95.5-115.5]%), and the correlations with GPS and CGR remained consistent after adjusting for confounders such as exercise capacity and hospitalization during the follow-up period. There were 117 patients hospitalized. Compared to the high HR recovery category, the mid (hazard ratio: 1.8, 95% confidence interval [CI]: 1.1-3.1, <em>P</em> = .02) and low (hazard ratio: 2.4, 95% CI: 1.5-4.0, <em>P</em> = .001) categories were independently associated with an increased risk of all-cause hospitalization. For noncardiovascular disease hospitalization, the low HR recovery category was independently associated with increased risk of hospitalization (hazard ratio: 2.1, 95% CI: 1.2-3.7, <em>P</em> = .007).</p></div><div><h3>Conclusions</h3><p>Vagal neuropathy in this population can contribute to adverse outcomes associated with systemic inflammation and protein-energy wasting.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Postexercise Vagal Dysfunction With Protein-Energy Wasting and Noncardiovascular Outcomes in Patients Receiving Hemodialysis: A Retrospective Cohort Study\",\"authors\":\"Naoto Usui RPT, MSc , Junichiro Nakata MD, PhD , Akimi Uehata MD, PhD , Sho Kojima RPT, MSc , Hideki Hisadome MD , Shuji Ando PhD , Masakazu Saitoh RPT, PhD , Akihito Inatsu MD, PhD , Takahiko Tsuchiya MD , Takayuki Mawatari MD , Yusuke Suzuki MD, PhD\",\"doi\":\"10.1053/j.jrn.2023.11.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Postexercise vagal dysfunction is linked to noncardiovascular mortality in hemodialysis patients, but the mechanism is unknown. This study aimed to determine the association of cardiovagal neuropathy with systemic inflammation, protein-energy wasting, and noncardiovascular hospitalization.</p></div><div><h3>Methods</h3><p>This 2-center retrospective cohort study analyzed data from 280 hemodialysis patients who underwent exercise test. Patients were assessed for heart rate (HR) recovery (bpm) for 1 minute after exercise, a marker of vagal function, and were divided into 3 categories (Low: ≤ 6, Mid: 7-11, High: ≥ 12 bpm). We followed 1-year changes in the systemic inflammation-based prognostic score (Glasgow Prognostic Score [GPS]), body weight, and creatinine generation rate (CGR), an indicator of muscle mass, as well as 2-year hospitalization.</p></div><div><h3>Results</h3><p>The HR recovery category was associated with serum C-reactive protein and albumin levels and GPS. After 1 year, the low HR recovery category was associated with worsening in GPS (low, 0 [0-0.5]; mid, 0 [0-1]; high, 0 [0-0]), weight (low, 100.0 [96.1-102.5]; mid, 101.3 [98.9-105.0]; high, 100.5 [98.2-102.9]%), and CGR (low, 97.0 [88.5-111.4]; mid, 110.2 [90.9-124.8]; high, 106.2 [95.5-115.5]%), and the correlations with GPS and CGR remained consistent after adjusting for confounders such as exercise capacity and hospitalization during the follow-up period. There were 117 patients hospitalized. Compared to the high HR recovery category, the mid (hazard ratio: 1.8, 95% confidence interval [CI]: 1.1-3.1, <em>P</em> = .02) and low (hazard ratio: 2.4, 95% CI: 1.5-4.0, <em>P</em> = .001) categories were independently associated with an increased risk of all-cause hospitalization. For noncardiovascular disease hospitalization, the low HR recovery category was independently associated with increased risk of hospitalization (hazard ratio: 2.1, 95% CI: 1.2-3.7, <em>P</em> = .007).</p></div><div><h3>Conclusions</h3><p>Vagal neuropathy in this population can contribute to adverse outcomes associated with systemic inflammation and protein-energy wasting.</p></div>\",\"PeriodicalId\":50066,\"journal\":{\"name\":\"Journal of Renal Nutrition\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Renal Nutrition\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1051227623002091\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Renal Nutrition","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1051227623002091","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:运动后迷走神经功能障碍与血液透析患者的非心血管死亡率有关，但其机制尚不清楚。本研究旨在确定心血管神经病变与全身性炎症、蛋白质-能量消耗(PEW)和非心血管住院的关系。方法:本双中心回顾性队列研究分析了280例接受运动试验的血液透析患者的资料。评估患者运动后1分钟的心率(HR)恢复(bpm)，这是迷走神经功能的标志，并将其分为三类(低:≤6，中:7-11，高:≥12 bpm)。我们随访了1年的系统性炎症预后评分(格拉斯哥预后评分，GPS)、体重和肌酐生成率(肌肉质量指标)的变化，以及2年的住院情况。结果:HR恢复类别与血清c反应蛋白和白蛋白水平及GPS相关。一年后，低心率恢复类别与GPS恶化相关(低，0 [0-0.5];中，0 [0-1];高，0[0-0])，重(低，100.0 [96.1-102.5];Mid, 101.3 [98.9-105.0];高,100.5 (98.2 - -102.9)%),CGR(低,97.0 (88.5 - -111.4);Mid, 110.2 [90.9-124.8];高，106.2[95.5-115.5]%)，在调整了运动能力和随访期间住院等混杂因素后，与GPS和CGR的相关性保持一致。117名患者住院治疗。与高HR恢复类别相比，中(风险比:1.8,95% CI: 1.1-3.1, p = 0.02)和低(风险比:2.4,95% CI: 1.5-4.0, p = 0.001)类别与全因住院风险增加独立相关。对于非心血管疾病住院，低HR恢复类别与住院风险增加独立相关(风险比:2.1,95% CI: 1.2-3.7, p = 0.007)。结论:该人群的迷走神经病变可导致与全身性炎症和PEW相关的不良结果。
Association of Postexercise Vagal Dysfunction With Protein-Energy Wasting and Noncardiovascular Outcomes in Patients Receiving Hemodialysis: A Retrospective Cohort Study
Objective
Postexercise vagal dysfunction is linked to noncardiovascular mortality in hemodialysis patients, but the mechanism is unknown. This study aimed to determine the association of cardiovagal neuropathy with systemic inflammation, protein-energy wasting, and noncardiovascular hospitalization.
Methods
This 2-center retrospective cohort study analyzed data from 280 hemodialysis patients who underwent exercise test. Patients were assessed for heart rate (HR) recovery (bpm) for 1 minute after exercise, a marker of vagal function, and were divided into 3 categories (Low: ≤ 6, Mid: 7-11, High: ≥ 12 bpm). We followed 1-year changes in the systemic inflammation-based prognostic score (Glasgow Prognostic Score [GPS]), body weight, and creatinine generation rate (CGR), an indicator of muscle mass, as well as 2-year hospitalization.
Results
The HR recovery category was associated with serum C-reactive protein and albumin levels and GPS. After 1 year, the low HR recovery category was associated with worsening in GPS (low, 0 [0-0.5]; mid, 0 [0-1]; high, 0 [0-0]), weight (low, 100.0 [96.1-102.5]; mid, 101.3 [98.9-105.0]; high, 100.5 [98.2-102.9]%), and CGR (low, 97.0 [88.5-111.4]; mid, 110.2 [90.9-124.8]; high, 106.2 [95.5-115.5]%), and the correlations with GPS and CGR remained consistent after adjusting for confounders such as exercise capacity and hospitalization during the follow-up period. There were 117 patients hospitalized. Compared to the high HR recovery category, the mid (hazard ratio: 1.8, 95% confidence interval [CI]: 1.1-3.1, P = .02) and low (hazard ratio: 2.4, 95% CI: 1.5-4.0, P = .001) categories were independently associated with an increased risk of all-cause hospitalization. For noncardiovascular disease hospitalization, the low HR recovery category was independently associated with increased risk of hospitalization (hazard ratio: 2.1, 95% CI: 1.2-3.7, P = .007).
Conclusions
Vagal neuropathy in this population can contribute to adverse outcomes associated with systemic inflammation and protein-energy wasting.
期刊介绍：
The Journal of Renal Nutrition is devoted exclusively to renal nutrition science and renal dietetics. Its content is appropriate for nutritionists, physicians and researchers working in nephrology. Each issue contains a state-of-the-art review, original research, articles on the clinical management and education of patients, a current literature review, and nutritional analysis of food products that have clinical relevance.
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