The Effect of Antihypertensive Therapy on Skeletal Muscle Mass and Bone Mineral Density in Patients With End-Stage Kidney Disease

Abstract

ObjectiveSarcopenia and osteoporosis substantially influence health and lifespan. However, the variables affecting skeletal muscle mass (SMM) or bone mineral density (BMD) remain unknown. Design and MethodsFrom August 1, 2018, to July 31, 2019, we conducted a single-center, observational cohort study with 291 Japanese adult patients on maintenance hemodialysis due to end-stage kidney disease (ESKD), who had their femoral neck BMD measured using dual-energy X-ray absorptiometry. After 1-year follow-up, we measured annual changes of BMD (ΔBMD) and SMM (ΔSMM), which was calculated through a modified creatinine index (mg/kg/day) using age, sex, serum creatinine, and single-pooled Kt/V for urea. The factors associated with ΔSMM/ΔBMD or progressive loss of SMM/BMD, defined as ΔSMM/ΔBMD <0 per year respectively, were analyzed with multivariable, linear regression or logistic regression models. ResultsThe median age of the patients was 66 years and 33% were female. Dialysis vintage and β-blocker-use were inversely correlated to ΔSMM. In comparison to nonusers, β-blockers users had 2.5-fold-higher SMM loss odd ratios [95% confidence interval (CI), 1.3–4.8]. The risk for SMM loss caused by β-blockers was not increased in users of renin-angiotensin system inhibitors (RASis). The ΔBMD was negatively correlated to the usage of calcium channel blockers (CCBs). The risk of developing osteosarcopenia, which was defined as annual loss of both SMM and BMD, increased in CCBs users. ConclusionThe use of β-blockers is associated with an elevated risk of developing sarcopenia, whereas RASis may minimize this effect in patients with ESKD. The CCB therapy was associated with a faster decline of BMD.