Abstract
BackgroundMalnutrition and muscle wasting are common in haemodialysis (HD) patients. Their pathogenesis is complex and involves many molecules including Myostatin (Mstn), which acts as a negative regulator of skeletal muscle. The characterisation of Mstn as a biomarker of malnutrition could be useful in the prevention and management of this condition. Previous studies have reported no conclusive results on the actual relationship between serum Mstn and wasting and malnutrition. So, in this study, we evaluated Mstn profile in a cohort of regular HD patients.MethodsWe performed a cross-sectional study, enrolling 37 patients undergoing bicarbonate-HD (BHD) or haemodiafiltration (HDF) at least for six months. 20 sex-matched healthy subjects comprised the control group. Mstn serum levels were evaluated by ELISA before and after HD. We collected clinical and biochemical data, evaluated insulin resistance, body composition, malnutrition [by Malnutrition Inflammation Score (MIS)] and tested muscle function (by hand-grip strength, six-minute walking test and a questionnaire on fatigue).ResultsMstn levels were not significantly different between HD patients and controls (4.7 ± 2.8 vs 4.5 ± 1.3 ng/ml). In addition, while a decrease in Mstn was observed after HD treatment, there were no differences between BHD and HDF. In whole group of HD patients Mstn was positively correlated with muscle mass (r = 0.82, p < 0.001) and inversely correlated with age (r = − 0.63, p < 0.01) and MIS (r = − 0.39, p = 0.01). No correlations were found between Mstn and insulin resistance, such as between Mstn levels and parameters of muscle strength and fatigue. In multivariate analysis, Mstn resulted inversely correlated with fat body content (β = − 1.055, p = 0.002).ConclusionsCirculating Mstn is related to muscle mass and nutritional status in HD patients, suggesting that it may have a role in the regulation of skeletal muscle and metabolic processes. However, also considering the lack of difference of serum Mstn between healthy controls and HD patients and the absence of correlations with muscle function tests, our findings do not support the use of circulating Mstn as a biomarker of muscle wasting and malnutrition in HD.
Highlights
Malnutrition and muscle wasting are common in haemodialysis (HD) patients
Patients suffering from chronic kidney disease (CKD), mainly those undergoing hemodialysis (HD), often present malnutrition and muscle wasting, which directly correlate with morbidity and mortality [1]
Basing on the known inhibitory effects of Mstn on skeletal muscle growth, we investigated the hypothetical use of serum Mstn level as a biomarker for muscle wasting, a very common condition in HD patients, significantly related to relevant clinical consequences
Summary
Malnutrition and muscle wasting are common in haemodialysis (HD) patients Their pathogenesis is complex and involves many molecules including Myostatin (Mstn), which acts as a negative regulator of skeletal muscle. Myokines are molecules produced and released by skeletal muscle cells with systemic and paracrine actions, related to the activation of intracellular signalling pathways. These molecules, which include Myostatin, Irisin and IL-6, may have positive or negative effects on muscle growth and regulate relevant processes, such as increase fat oxidation, insulin sensitivity and inflammation [5]
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