| 제목 |
Renal Function Evaluation in Spinal Cord Injury Patients of Various Body Compositions |
| 소속 |
Severance Hospital, Yonsei University College of Medicine, Department and Research Institute of Rehabilitation Medicine1, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Department of Rehabilitation Medicine2 |
| 저자 |
Ji Cheol Shin1†, Sang Hee Im1, Dahn Kim1, Min Cheol Ha1, Yu Sang Jung1, Seok Young Chung2, Su Hyun Cho1* |
Objective
Patients with spinal cord injuries(SCI) have an increased risk of renal deterioration and physicians agree that SCI patients should have their renal function evaluated regularly. The serum cystatin C was already known as a convenient and reliable marker of renal function in SCI patients. However, some studies have suggested cystatin C is affected by body mass index(BMI) and body fat in general population. The aim of this study is to investigate the correlation between serum cystatin C level and Tc-99m MAG3 renal scintigraphy which is utilized as sensitive indicator of renal function in SCI patients of selected in groups of defined BMI.
Methods
The medical charts of 68 SCI patients who were admitted to a tertiary university hospital for rehabilitation treatment between October 2019 and May 2020 were reviewed. Patients with prior history of kidney disease or any medical conditions which may affect renal function were excluded.
Cystatin C-based eGFR was estimated by CKD-EPI Cystatin C-based Equation. Effective renal plasma flow (ERPF) was derived from Tc-99m MAG3 renal scintigraphy, and ERPF average was calculated by the values of the right and the left kidney. Body composition was assessed by a body composition analyzer (InBody S10, Biospace, Seoul, Korea).
The SCI patients were classified into two groups; obese (BMI≥22) group and non-obese (BMI<22) group. Another two groups were classified according to the percentage body fat(PBF); high body fat (PBF≥25% in males and ≥35% in females.) group and low body fat (PBF<35% in females and <25% in males) group.
The correlation between cystatin C based eGFR and ERPF average was analyzed. The contribution of BMI, PBF, injury type and age to the eGFR and ERPF were also studied. The statistical analyses were conducted by Pearson’s correlation analysis with SPSS Statistics version 25(IBM, Chicago, IL, USA).
Results
Total 68 SCI patients were evaluated in this study. The demographics and clinical characteristics are on Table 1. The cystatin C based eGFR showed significant correlation with ERPF average from MAG3 renal scintigraphy (r=0.369, p=0.003) in all SCI patients in this study (Figure 1). This correlation was maintained in obese group (n=34, r=0.440, p=0.009) and high body fat group (n=35, r=0.454, p=0.006) (Figure 2). However, there was no significant correlation in other subgroup analyses.
Conclusion
This study showed a significant correlation of cystatin C based eGFR and ERPF average from MAG3 renal scintigraphy in SCI patients. Therefore, cystatin C based eGFR can be an alternative indicator for renal function in SCI patients for renal function follow-up or for whom renal scintigraphy are unavailable. The cystatin C based eGFR can still be a valuable predictor for renal function in SCI patients with high BMI or high body fat mass. However, it should be carefully interpreted in non-obese or low body fat groups. Further studies are needed with a bigger sample size in the future. |
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Table 1. Demographics and clinical characteristics
Fig 1. Correlation between cystatin C based eGFR and ERPF average in all SCI patients.
Fig 2. Correlation between cystatin C based eGFR and ERPF average in (A) obese group(BMI≥22) (B) high body fat group(PBF≥35% in females and ≥25% in males).
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