Abstract
With expanding kidney transplantation programs, remaining hemodialysis patients are more likely to have a high comorbidity burden and may therefore be more prone to lose muscle mass. Our aim was to analyze risk factors for muscle loss in hemodialysis patients with high comorbidity. Fifty-four chronic hemodialysis patients (Charlson Comorbidity Index 9.0 ± 3.4) were followed for 20 weeks using 4-weekly measurements of lean tissue mass, intracellular water, and body cell mass (proxies for muscle mass), handgrip strength (HGS), and biochemical parameters. Mixed models were used to analyze covariate effects on LTM. LTM (−6.4 kg, interquartile range [IQR] −8.1 to −4.8), HGS (−1.9 kg, IQR −3.1 to −0.7), intracellular water (−2.11 L, IQR −2.9 to −1.4) and body cell mass (−4.30 kg, IQR −5.9 to −2.9) decreased in all patients. Conversely, adipose tissue mass increased (4.5 kg, IQR 2.7 to 6.2), resulting in no significant change in body weight (−0.5 kg, IQR −1.0 to 0.1). Independent risk factors for LTM loss over time were male sex (−0.26 kg/week, 95% CI −0.33 to −0.19), C-reactive protein above median (−0.1 kg/week, 95% CI −0.2 to −0.001), and baseline lean tissue index ≥10th percentile (−1.6 kg/week, 95% CI −2.1 to −1.0). Age, dialysis vintage, serum albumin, comorbidity index, and diabetes did not significantly affect LTM loss over time. In this cohort with high comorbidity, we found universal and prominent muscle loss, which was further accelerated by male sex and inflammation. Stable body weight may mask muscle loss because of concurrent fat gain. Our data emphasize the need to assess body composition in all hemodialysis patients and call for studies to analyze whether intervention with nutrition or exercise may curtail muscle loss in the most vulnerable hemodialysis patients.
Highlights
In patients with chronic kidney disease (CKD) who undergo chronic hemodialysis, nutritional status, body composition, and especially muscle mass, are closely linked to morbidity, mortality, and quality of life [1,2,3]
With progression of CKD, there is a decline in protein intake [4], and anorexia is reported in approximately one-third of hemodialysis patients [5]
The results show that all patients experienced muscle loss and that on average this loss was very pronounced (−6.4 kg in 20 weeks or ~1.3 kg/month)
Summary
In patients with chronic kidney disease (CKD) who undergo chronic hemodialysis, nutritional status, body composition, and especially muscle mass, are closely linked to morbidity, mortality, and quality of life [1,2,3]. There are multiple factors that lead to muscle mass loss in patients undergoing hemodialysis. With progression of CKD, there is a decline in protein intake [4], and anorexia is reported in approximately one-third of hemodialysis patients [5]. Nutrients 2020, 12, 2494 the catabolic state due to decreased protein synthesis and increased proteolysis [7,8]. Additional catabolic factors may be present that lead to muscle mass loss in hemodialysis patients including acidosis, comorbidity, inflammation, corticosteroid use, and sedentary lifestyle [9,10]
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