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Abstract
Background: Sarcopenia is a widespread concern in chronic kidney disease (CKD) as well in elderly patients and is one of the main reasons why low-protein diets for this population are controversial. The aim of this study was to assess the prevalence and correlates of sarcopenia among elderly male patients affected by CKD followed up in an outpatient nephrology clinic, where moderate protein restriction (0.6–0.8 g/Kg/day) is routinely recommended to patients in CKD stage 3b-5 not on dialysis. Methods: This observational study included 80 clinically-stable male out-patients aged >60, affected by stage 3b-4 CKD. Forty patients aged ≥75 (older seniors) were compared to the other forty patients aged 60–74 (younger seniors). All patients underwent a comprehensive nutritional and functional assessment. Results: Older seniors showed lower serum albumin, hand-grip strength, body mass index (BMI), skeletal muscle mass, and resting energy expenditure. Protein intake was significantly lower in older seniors whereas energy intake was similar. Average daily physical activity was lower in the older seniors than in the younger ones. Sarcopenia was more prevalent in older than in younger seniors. Among older seniors, sarcopenic and non-sarcopenic ones differed in age and performance on the Six-Minute Walk test, whereas the estimated glomerular filtration rate (eGFR), biochemistry, dietary protein, and energy intakes were similar. Conclusions: Older senior CKD male patients have lower muscle mass, muscle strength, and physical capacity and activity levels, with a higher prevalence of sarcopenia than younger patients. This occurs at the same residual renal function and metabolic profile and protein intake. Energy intake was at the target in both subgroups. In this CKD cohort, sarcopenia was associated with age and physical capacity, but not with eGFR or dietary intakes.
Highlights
In the context of the overall prevalence of chronic kidney disease (CKD), averaged at roughly10–15% in most highly resourced countries, CKD prevalence increases with age, and affects up to one-third of individuals aged over 60
No differences were observed in the metabolic profile for blood urea nitrogen (BUN), bicarbonate, phosphate, parathyroid hormone (PTH), hematocrit, or potassium, which overall indicates good metabolic control of CKD, in keeping with the choice of analyzing clinically-stable patients
Our study found a high prevalence of sarcopenia in younger and older seniors, as diagnosed from reduced muscle mass and strength assessed, in keeping with the EWGSOP guidelines, using bio-impedance analysis (BIA)
Summary
In the context of the overall prevalence of chronic kidney disease (CKD), averaged at roughly10–15% in most highly resourced countries, CKD prevalence increases with age, and affects up to one-third of individuals aged over 60. Independent of protein restrictions, the prevalence of PEW in non-dialyzed patients ranges from 6 to 10% in people with mild to moderate CKD (depending on the method used to assess body composition) and increases to 20–40% in dialyzed patients. The aim of this study was to assess the prevalence and correlates of sarcopenia among elderly male patients affected by CKD followed up in an outpatient nephrology clinic, where moderate protein restriction (0.6–0.8 g/Kg/day) is routinely recommended to patients in CKD stage 3b-5 not on dialysis. Conclusions: Older senior CKD male patients have lower muscle mass, muscle strength, and physical capacity and activity levels, with a higher prevalence of sarcopenia than younger patients. This occurs at the same residual renal function and metabolic profile and protein intake.
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