Abstract
Cross-sectional studies in dialysis demonstrate muscle wasting associated with loss of function, increased morbidity and mortality. The relative drivers are poorly understood. There is a paucity of data regarding interval change in muscle in pre-dialysis and dialysis-dependant patients. This study aimed to examine muscle and fat mass change and elucidate associations with muscle wasting in advanced CKD.134 patients were studied (60 HD, 28 PD, 46 CKD 4–5) and followed up for two years. Groups were similar in age, sex and diabetes prevalence. Soft tissue cross-sectional area (CSA) was measured annually on 3 occasions by a standardised multi-slice CT thigh. Potential determinants of muscle and fat CSA were assessed. Functional ability was assessed by sit-to-stand testing.88 patients completed follow-up (40 HD, 16 PD, 32 CKD). There was a significant difference in percentage change in muscle CSA (MCSA) over year 1, dependant on treatment modality (χ2 = 6.46; p = 0.039). Muscle loss was most pronounced in pre-dialysis patients. Muscle loss during year 1 was partially reversed in year 2 in 39%. Incident dialysis patients significantly lost MCSA during the year which they commenced dialysis, but not the subsequent year. Baseline MCSA, change in MCSA during year 1 and dialysis modality predicted year 2 change in MCSA (adjusted R2 = 0.77, p<0.001). There was no correlation between muscle or fat CSA change and any other factors. MCSA correlated with functional testing, although MCSA change correlated poorly with change in functional ability.These data demonstrate marked variability in MCSA over 2 years. Loss of MCSA in both pre-dialysis and established dialysis patients is reversible. Factors previously cross-sectionally shown to correlate with MCSA did not correlate with wasting progression. The higher rate of muscle loss in undialysed CKD patients, and its reversal after dialysis commencement, suggests that conventional indicators may not result in optimal timing of dialysis initiation.
Highlights
Significant muscle atrophy [1,2] and associated weakness [3] is seen in both dialysis patients and in patients with chronic kidney disease (CKD) stages 3–4
Muscle atrophy can be assessed via various methods, and previous work in our group has shown good correlation between muscle cross-sectional area and functional performance, serum albumin, age and inflammatory status in CKD stages 4–5, haemodialysis (HD) and peritoneal dialysis (PD) [13]
Reduced muscle and fat mass evidenced by anthropomorphic assessment appears able to predict mortality in haemodialysis populations [14,15]
Summary
Significant muscle atrophy [1,2] and associated weakness [3] is seen in both dialysis patients and in patients with chronic kidney disease (CKD) stages 3–4. This is associated with increased morbidity and mortality [4,5]. There are many associations already reported as being associated on a cross sectional study basis with muscle wasting These include decreasing glomerular filtration rate (GFR) [6], dialysis [7], age [8] and diabetes [9,10]. Reduced muscle and fat mass evidenced by anthropomorphic assessment (mid-arm circumference, triceps skinfold) appears able to predict mortality in haemodialysis populations [14,15]
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