Abstract
BackgroundMuscle weakness is associated with increased mortality risk in chronic haemodialysis (CHD) patients. Protein energy wasting (PEW) and low physical activity could impair muscle quality and contribute to muscle weakness beyond muscle wasting in these patients. Aim of this study was to assess clinical and biological parameters involved in the reduction of muscle strength of CHD patients.MethodsOne hundred and twenty-three CHD patients (80 males, 43 females; 68,8 [57.9–78.8] y.o.) were included in this study. Maximal voluntary force (MVF) of quadriceps was assessed using a belt-stabilized hand-held dynamometer. Muscle quality was evaluated by muscle specific torque, defined as the strength per unit of muscle mass. Muscle mass was estimated using lean tissue index (LTI), skeletal muscle mass (SMM) assessed by bioelectrical impedance analysis and creatinine index (CI). Voorrips questionnaire was used to estimate physical activity. Criteria for the diagnosis of PEW were serum albumin, body mass index < 23 kg/m2, creatinine index < 18.82 mg/kg/d and low dietary protein intake estimated by nPCR < 0.80g/kg/d.ResultsMVF was 76.1 [58.2–111.7] N.m. and was associated with CI (β = 5.3 [2.2–8.4], p = 0.001), LTI (β = 2.8 [0.6–5.1], p = 0.013), Voorrips score (β = 17.4 [2.9–31.9], p = 0.02) and serum albumin (β = 1.9 [0.5–3.2], p = 0.006). Only serum albumin (β = 0.09 [0.03–0.15], p = 0.003), Voorrips score (β = 0.8 [0.2–1.5], p = 0.005) and CI (β = 0.2 [0.1–0.3], p<0.001) remained associated with muscle specific torque. Thirty patients have dynapenia defined as impaired MVF with maintained SMM and were younger with high hs-CRP (p = 0.001), PEW criteria (p<0.001) and low Voorrips score (p = 0.001), and reduced dialysis vintage (p<0.046).ConclusionsBeyond atrophy, physical inactivity and PEW conspire to impair muscle strength and specific torque in CHD patients and could be related to muscle quality.Trial registrationClinicalTrials.gov NCT02806089
Highlights
Criteria for the diagnosis of Protein energy wasting (PEW) were serum albumin, body mass index < 23 kg/m2, creatinine index < 18.82 mg/kg/d and low dietary protein intake estimated by Normalised protein catabolism rate (nPCR) < 0.80g/kg/d
Sarcopenia, defined as skeletal muscle weakness associated with reduced muscle mass [1,2], appears as an emerging risk factor in chronic haemodialysis (CHD) patients due to high prevalence [3,4] and increased mortality [5]
Criteria for the clinical diagnosis of PEW were !3 out of the 4 items: serum albumin < 38g/l, body mass index < 23 kg/m2, creatinine index < 18.82mg/kg/d, low dietary protein intake estimated by nPCR < 0.80g/kg/d [10,25]
Summary
Sarcopenia, defined as skeletal muscle weakness associated with reduced muscle mass [1,2], appears as an emerging risk factor in chronic haemodialysis (CHD) patients due to high prevalence [3,4] and increased mortality [5]. Muscle strength determinants have been poorly investigated in this population whereas muscle strength appears as a better mortality prognosis factor than muscle mass [3] It influences the independence in activities of daily living in these patients [6]. Malnutrition and other factors including inflammation, metabolic acidosis, insulin resistance, hormones and uremic milieu may be involved in muscle weakness of CHD patients [7,8,9] All these factors, which are related to protein energy wasting (PEW), characterized by a loss of systematic proteins, an hypercatabolic status, uremic toxins, malnutrition [10,11], could play a role in both muscle mass and strength reduction. Aim of this study was to assess clinical and biological parameters involved in the reduction of muscle strength of CHD patients
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