Calf Circumference Is Associated with Malnutrition in Elderly Patients on Hemodialysis

Abstract

Background and objectivesChronic kidney disease (CKD) is considered a world health problem and is associated with a high mortality rate, particularly among elderly patients. With the aging population, there has been an increase in elderly patients starting hemodialysis. Elderly patients are subject to a high burden of comorbidities and the risk of falls and fractures is a concern since it can lead to hospitalization and death. Falls occur as a consequence of clinical pathologies and are aggravated by hemodialysis‐associated hypotension. Sarcopenia, defined as the loss of muscle mass and strength that occurs with aging is commonly seen in these patients. Measurement of calf circumference (CC) is an easy and not expensive tool to assess muscle mass. The objective of this study was to test the association between CC, a marker of sarcopenia, and the risk of falls and fractures in elderly patients on hemodialysis.MethodsThis is a cross‐sectional study that included clinically stable patients ≥ 65 years, on maintenance hemodialysis. The same observer measured the calf circumference in the non‐dominant leg. Clinical and biochemical data were collected from the charts.ResultsPreliminary results of 96 patients (age 73 ± 6 years, % mean) showed a CC of 32.7 ±3.5 and 31.5 ± 4.6 cm in men and women, respectively, p=0,143). History of falls was found in 20 patients (40.6% with low CC vs. 36.8% with normal CC, p=0.789). Patients with low CC according to gender presented lower body mass index (p=0.0001) and had lower weight gain between dialysis sessions (p=0.008). They did not differ from patients with normal CC according to age, gender, race, blood pressure, serum albumin, and presence of comorbidities such as hypertension, diabetes, and congestive heart failure.ConclusionsAlthough the measurement of CC did not predict falls in elderly patients on hemodialysis, it did identify patients with low body mass index, which is probably related to sarcopenia. Further studies are necessary to definitely conclude the lack of association between CC and falls.