SARCOPENIC OBESITY IN PATIENTS RECEIVING TREATMENT WITH PROGRAMMED HEMODIALYSIS

Abstract

BACKGROUND . The term "sarcopenic obesity" has been used not so long ago. The epidemiology of this phenomenon during renal replacement therapy in the Russian Federation has not been studied. THE AIM : to assess the prevalence of sarcopenic obesity in patients on hemodialysis (HD). PATIENTS AND METHODS . 140 patients receiving treatment with programmed bicarbonate HD in 2 dialysis centers of St. Petersburg were examined, among them 68 women and 72 men, the average age was 56.8±12.8 years. The main cause of the development of terminal renal insufficiency was chronic glomerulonephritis – in 43, autosomal dominant polycystic kidney disease – in 14, chronic pyelonephritis – in 9, hypertension – in 15, chronic tubulointerstitial nephritis – in 6 and other diseases – in 53 people. The prevalence of these pathological conditions in men and women did not differ. To assess the component composition of the patient's body, we used: 8–point tactile tetrapolar multi–frequency bioimpedance (BIM) on the InBody device (South Korea) with a frequency range of 1 – 1000 kHz, 10 measurements for each of 6 frequencies for each of 5 body segments (right and left arm, right and left leg, torso), followed by the calculation of the index of appendicular skeletal muscles. The criteria of RN. Baumgartner (2000) were used to diagnose sarcopenic obesity. RESULTS . Sarcopenic obesity was detected in 62 patients (44.3 %). There was no correlation with the underlying pathology. Patients with sarcopenic obesity were distinguished by a longer period of renal replacement therapy, the lowest concentration of serum creatinine and the number of points of the physical component of the SF-36 scale, higher levels of C-reactive protein, parathyroid hormone, HOMA-IR index, Charleson index. Also in this group, the lowest score on the IPAQ scale of motor activity and the worst results in the 6-minute walking test were noted. CONCLUSION . Currently, it is not entirely clear what is the primary link in the development of sarcopenic obesity and whether it is realistic to isolate it in a particular patient. We believe that the main cause of the development of this syndrome is obesity, which causes the expression of pro-inflammatory cytokines and insulin resistance. The most important modifiable risk factor for obesity is considered to be the hypercaloric intake of patients, which is due to the lack of nutritionists with experience in the field of nephrology and indexing the amount of calories indicated in clinical recommendations to the real, and not to the recommended body weight.