Sarcopenia In Hemodialysis Patients Research Articles

Exploring the association of anorexia with frailty and sarcopenia in hemodialysis patients

Rationale: Nutrition related problems and malnutirition are common and a major risk factor of morbidity and mortality in end stage renal disease patients. The aim of the study was to explore possible nutrition related factors that could affect sarcopenia and frailty in a sample of patients in hemodialysis (HD).

The clinical applicability of ultrasound technique for diagnosis of sarcopenia in hemodialysis patients

We examined the validity of ultrasound technique assessing muscle mass and reflecting muscle strength and physical performance, and the clinical applicability of ultrasound as a diagnostic tool of sarcopenia in patients on hemodialysis. This study included outpatients who were undergoing maintenance hemodialysis 3-time a week. Muscle mass, muscle strength and physical performance were assessed at the time of the patients' entry into the study. Ultrasound technique and bioelectrical impedance analysis (BIA) were used to estimate muscle mass. The cross-sectional area (CSA) of the rectus femoris was calculated using an ultrasound device built-in planimeter. A total of 58 hemodialysis patients were included in the analyses. Ultrasound-derived muscle mass was strongly correlated with BIA-derived measurements and independently associated with handgrip strength (β=4.22, 95% confidence interval [CI]=2.23-6.20, P<0.001), gait speed (β=0.15, 95% CI=0.05-0.26, P=0.006), chair stand time (β=-4.33, 95% CI=-7.34 to-1.31, P=0.006), and SPPB score (β=1.81, 95% CI=0.46-3.15, P=0.010) even after adjustment of patient characteristics. The discrimination ability of CSA of rectus femoris for muscle loss was high. Of the patients who were diagnosed with sarcopenia by the ultrasound-based criteria, 96% met the BIA-based criteria. Ultrasound identified the patients at higher risk of skeletal muscle loss and sarcopenia with good discriminatory power. Ultrasound could be a valid and feasible technique for dialysis populations in clinical settings.

MYOSTATIN LEVEL IN CRF PATIENTS WITH AND WITHOUT POST-HCV CIRRHOSIS AND ITS CORRELATION WITH BMI

Chronic kidney disease (CKD) is a progressive condition that may negatively affect musculoskeletalhealth. Secondary sarcopenia due to CKD may be associated with mobility limitationsand elevated fall risk. Thus, it is important to investigate surrogate methods that enablethe assessment of muscle mass. Myostatin regulates synthesis and degradation of skeletal muscleproteins and is associated with the development of sarcopenia. This study assessed the myostatinlevel in CKD patients and correlated with body mass index. This a prospective casecontrol study, carried out on 30 Egyptian patients with CKD (15 have post-HCV cirrhosis) attendedfor dialysis in Al-Hammoul Central Hospital and 15 healthy controls. All patients weresubjected to detailed medical history and through clinical examination, abdominal ultrasoundand determination of serum myostatin level. The mean, standard deviation and chi-square werecalculated by SPSS. ROC curves were conducted to test the discriminative value of myostatinlevel on sarcopenia and to detect the cut-off points. The results showed significant increase inthe serum myostatin level in hemodialysis patients. Myostatin level in post-HCV cirrhotic patientswas insignificantly higher than in non-cirrhotic patients. There was a significant negativecorrelation between serum myostatin level and BMI and skeletal muscle index (SMI). ROCcurve showed that a cut off value of 39.05ng/ml can detect sarcopenia in hemodialysis patients.

MYOSTATIN LEVEL IN CRF PATIENTS WITH AND WITHOUT POST-HCV CIRRHOSIS AND ITS CORRELATION WITH BMI

Chronic kidney disease (CKD) is a progressive condition that may negatively affect musculoskeletalhealth. Secondary sarcopenia due to CKD may be associated with mobility limitationsand elevated fall risk. Thus, it is important to investigate surrogate methods that enablethe assessment of muscle mass. Myostatin regulates synthesis and degradation of skeletal muscleproteins and is associated with the development of sarcopenia. This study assessed the myostatinlevel in CKD patients and correlated with body mass index. This a prospective casecontrol study, carried out on 30 Egyptian patients with CKD (15 have post-HCV cirrhosis) attendedfor dialysis in Al-Hammoul Central Hospital and 15 healthy controls. All patients weresubjected to detailed medical history and through clinical examination, abdominal ultrasoundand determination of serum myostatin level. The mean, standard deviation and chi-square werecalculated by SPSS. ROC curves were conducted to test the discriminative value of myostatinlevel on sarcopenia and to detect the cut-off points. The results showed significant increase inthe serum myostatin level in hemodialysis patients. Myostatin level in post-HCV cirrhotic patientswas insignificantly higher than in non-cirrhotic patients. There was a significant negativecorrelation between serum myostatin level and BMI and skeletal muscle index (SMI). ROCcurve showed that a cut off value of 39.05ng/ml can detect sarcopenia in hemodialysis patients.

Serum Sclerostin, Body Composition, and Sarcopenia in Hemodialysis Patients with Diabetes.

Sclerostin (Scl) is an osteoblast-inhibiting glycoprotein that is secreted mainly by osteocytes and is regulated by hormonal changes and skeletal loading. Decreased physical function and high serum Scl concentrations have been reported in chronic renal failure patients but little is known to date about the differences between diabetic and non-diabetic patients on hemodialysis who are susceptible to both sarcopenia and bone fragility. Objective.To determine the prevalence of sarcopenia and its association with serum Scl concentrations and metabolic parameters in 92 patients on hemodialysis. Anthropometric data and physical performance were evaluated in this study. Blood samples were collected for Scl, glucose, cholesterol, triglycerides, calcium, phosphate, PTH, and 25 OH-vitamin D measurements. Lean mass was evaluated using multifrequency electro-bioimpedance after dialysis session. Results. Mean age was 63.3 ± 13.6 years, 63% of patients were male, and 44.6% had diabetes. Mean body mass index (BMI) was higher in diabetics (26.6 ± 5.2 vs. 24.1 ± 3.7; p=0.01) and there were no differences in gait speed and handgrip strength between diabetic and non-diabetic subjects. A low skeletal muscle mass index (SMI) was identified in 65.2% of the participants, and among them 76.7% were men and 36.7% were diabetics. Mean serum Scl was 86.9 ± 39.0 pmol/L, which was higher in men (94.6 ± 41.7; p=0.017), in those individuals with low SMI (94.9 ± 40.7; p < 0.001), and in diabetics (97.2 ± 46.6; p < 0.003). After multivariate analysis and adjustments for potential confounders, high serum Scl was independently associated with low SMI and with the presence of diabetes. The following variables correlated positively with diabetes: blood pressure; BMI; waist circumference; waist/hip ratio; plasma glucose; serum Scl; and fat mass. Conclusions. We found higher serum Scl concentrations in hemodialysis patients with diabetes and these were inversely related to muscle mass.

The effect of an arteriovenous fistula and haemodialysis on anthropometric measurements of the upper arm.

Haemodialysis (HD) patients are at increased risk of sarcopenia. Measurements of triceps skinfold thickness (TSFT) and mid-upper arm circumference (MUAC) are used to estimate muscle mass. An arteriovenous fistula is the preferred vascular access for HD patients, and we wished to determine whether anthropometric measurements were affected by the fistula and HD treatment. One hundred and forty-four HD patients, 90 (62.5%) males, mean age 63.1 ± 15.4 years, had measurements pre- and post-HD. TSFT was similar in the arms, whereas MUAC and corrected mid-upper arm muscle circumference (CMUAMC) were greater in the fistula compared with the non-fistula arm (MUAC pre-HD 30.0 ± 5.2 vs 29.2 ± 4.7 and post-HD 29.6 ± 5.1 vs 28.5 ± 4.7, p < 0.001; MUAMC 23.5 ± 4.0 vs 22.5 ± 4.1, and post-HD 22.9 ± 4.0, and 22.0 ± 3.7 cm p < 0.01). Following HD; TSFT did not change, but MUAC and CMUAMC fell significantly in both arms (p < 0.01). When screening for sarcopenia in HD patients, anthropometric measurements should be taken post-HD in the non-fistula arm.

Estimating the Prevalence of Muscle Wasting, Weakness, and Sarcopenia in Hemodialysis Patients

Haemodialysis (HD) patients suffer from nutritional problems, which include muscle wasting, weakness, and cachexia, and are associated with poor clinical outcomes. The European Working Group for Sarcopenia in Older People (EWGSOP) and Foundations for the National Institute of Health (FNIH) have developed criteria for the assessment of sarcopenia, including the use of non-invasive techniques such as bioelectrical impedance assessment (BIA), anthropometry, and hand grip strength (HGS) dynamometry. This study investigated the prevalence of muscle wasting, weakness, and sarcopenia using the EWGSOP and FNIH criteria. BIA was performed in 24 females (f) and 63 males (m) in the post-dialysis period. Total skeletal muscle mass and appendicular skeletal muscle mass were estimated and index values (i.e., muscle mass divided by height2 [kg/m2]) were calculated (Total Skeletal Muscle Index (TSMI) and Appendicular Skeletal Muscle Index (ASMI)). Mid-arm circumference and triceps skin-fold thickness were measured and mid-upper arm muscle circumference (MUAMC) calculated. HGS was measured using a standard protocol and Jamar dynamometer. Suggested cut-points for low muscle mass and grip strength were utilized using the EWGSOP and FNIH criteria with prevalence estimated, including sarcopenia. The prevalence varied depending on methodology: low TSMI (moderate and severe sarcopenia combined) was 55% for whole group: 21% (f) and 68% (m). Low ASMI was 32% for whole group: 25% (f) and 35% (m). Low MUAMC was 25% for whole group: 0% (f) and 30% (m). ASMI highly correlated with Body Mass Index (r=0.78, P<.001) and MUAMC (r=0.68, P<.001). Muscle weakness was high regardless of cut-points used (50-71% (f); 60-79% (m)). Internationally, this is the first study comparing measures of muscle mass (TSMM and ASMM by BIA and MUAMC) and muscle strength (HGS) using this specific methodology in a hemodialysis population. Future work is required to confirm findings.

SAT-065 LOW NATURAL KILLER CELL ACTIVITY MAY CONTRIBUTE TO DEVELOPMENT OF SARCOPENIA IN HEMODIALYSIS PATIENTS

Natural killer (NK) cells are lymphocytes of innate immune system that function to guard against tumors and infection. Reduced NK cell activities have been suggested in patients undergoing hemodialysis (HD). Sarcopenia, a syndrome of reduction of skeletal muscle mass and function, is quite common in HD patients and has been reported to associate with decrease immune system responsiveness. The aim of this study is to determine the relationship between NK cells activity and sarcopenia in HD patients. We enrolled 77 clinically stable HD patients who volunteered for the study. Patients with active malignancy or those taking immunosuppressant drugs were excluded. Baseline clinical characteristics and hemodialysis data were collected from electronic medical chart review. NK cell activity was assessed using NK Vue™ assay (ATGen Co., Seoul, Korea) that uses serum of ex vivo stimulated whole blood to detect interferon (IFN)-γ secreted from NK cells as an indicator of NK cell activity. The body composition was evaluated by bioimpedance analysis (Inbody S10) and the diagnosis of sarcopenia was made according to the guidelines of Asian Working Group for Sarcopenia (AWGS). The mean age was 63.2 years and 58.4% were men. A total of 22 patients (28.6%) were diagnosed as sarcopenia among 77 HD patients, and sarcopenic HD patients were significantly older (69.2 +/- 13.8 vs. 60.8 +/- 15.4 years, P<0.01), whereas showed lower BMI (20.7 +/- 3.8 vs. 23.4 +/- 6.2 kg/m2, P=0.01), lower appendicular lean muscle mass (ALM, 8.26 +/- 2.8 vs. 9.83 +/- 4.5 kg/m2, P<0.01), and lower activity of NK cell (296 +/- 111 vs. 480 +/- 225 pg/mL, P=0.03). Low NK cell activity had a significant correlation with sarcopenia, and the statistical significance was maintained even after adjustment for age, sex, BMI, ALM in multivariate regression analysis. Our results show that the NK cell activity of sarcopenic HD patients is significantly decreased and such low NK cell activity may contribute to development of sarcopenia in HD patients.

534-P: Serum Sclerostin, Body Composition, and Sarcopenia in Hemodialysis Patients with Diabetes

Sclerostin (Scl) is an osteoblast inhibiting glycoprotein secreted mainly by osteocytes which is regulated by hormonal changes and skeletal loading. Decreased physical function and high serum Scl concentrations have been reported in chronic renal failure patients but little is known about the differences among diabetic and nondiabetic patients on hemodyalisis who are susceptible to both sarcopenia and bone fragility. Objective: To determine the prevalence of sarcopenia and its association with serum sclerostin concentrations and metabolic parameters in 92 patients on hemodyalisis. Anthropometric data and physical performance were evaluated. Blood sample were collected for sclerostin, glucose, cholesterol, triglycerides, calcium, phosphate, PTH e 25OH-vitamin D measurements. Lean mass was evaluated using multifrequency electro-bioimpedance at a “dry weight” time (after dialysis session). Results: Mean age was 63.3±13.6 years, 63% were male and 44.6% had diabetes. Mean BMI was higher in diabetics (26.6±5.2 vs. 24.1±3.7; p=0.01) and there were no differences in gait speed and hand grip strength between diabetic and nondiabetic subjects. A low skeletal muscle mass index (SMI) was identified in 65.2% of the participants, and among them 76.7% were men and 36.7% diabetics. Mean serum sclerostin was 86.9 ± 39.0 pmol/L, which was higher in men (94.6 ± 41.7; p = 0.017), in individuals with low SMI (94.9 ± 40.7; p &amp;lt; 0.001) and in diabetics (97.2 ± 46.6; p &amp;lt; 0.003). After multivariate analysis and adjustments for potential confounders, high serum sclerostin was independently associated with low SMI and with the presence of diabetes. The following variables correlated positively with diabetes: blood pressure, body mass index (BMI) waist circumference, waist/hip ratio, plasma glucose, serum sclerostin and fat mass. Conclusions: We found higher serum sclerostin concentrations in hemodialysis patients with diabetes which were inversely related to muscle mass. Disclosure F. Bandeira: None. M.W. Medeiros: None. M.H. Junior: None. N.R. Silva: None. M. Bandeira Farias: None. L. Farias: None. Funding Arab Society for Paediatric Endocrinology and Diabetes

Differences in the prevalence of sarcopenia in haemodialysis patients: the effects of gender and ethnicity.

There is no universal consensus definition of sarcopenia, although there is agreement that sarcopenia is a risk factor for mortality in haemodialysis (HD) patients. We aimed to determine the effect of using different operational definitions in a multiracial group of HD patients. We measured hand grip strength (HGS) and appendicular lean mass (ALM) by segmental bioimpedance using the Foundation for the National Institutes of Health Sarcopenia Project (FNIH), European Working Group on Sarcopenia (EWGS) and Asian Working Group on Sarcopenia definitions for HGS weakness and loss of appendicular lean mass. In total, there were 600 HD patients: 373 men (62.2%), mean (SD) age 66.3 (14.7) years, 45.6% diabetic, ethnicity: 281 (48.5%) White, 167 (27.8%) Asian and 149 (24.8%) Black. On HGS criteria, 90.5% of Asian women and 88.5% of Asian men were weak according to EWGS compared to 62.3% of Black women and 52.5% of Black men and 64.5% of White women and 69.1% of White men by FNIH criteria (P < 0.001). On adding appendicular lean mass, the prevalence of sarcopenia was 68.3% for Asian, 27.1% for Black and 36.6% for White women by FNIH and 59.6% Asian, 21.3% Black and 39.9% White men by EWGS criteria. Current definitions of sarcopenia report a greater prevalence of muscle weakness compared to appendicular muscle loss in female compared to male HD patients and this is greater for Asian compared to Black and White patients. Because HGS weakness is a greater risk for death, definitions of sarcopenia may underestimate risk in HD patients.

The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients.

Sarcopenia is a well-known complication of protein energy wasting in hemodialysis patients. Its diagnosis requires measurements of muscle mass and muscle function. Few studies have reported its prevalence in hemodialysis patients. In this study, we report the prevalence of sarcopenia in this population and evaluate the performance of other parameters for its diagnosis. In this observational cross-sectional study, data from hemodialysis patients from our nephrology department were recorded. Body composition measured by bioimpedancemetry analysis and muscle strength measured by handgrip were recorded. Normal values for sarcopenia were those recommended by the European Working Group on Sarcopenia in Older People (EWGSOP). The median age (interquartile range) of the 111 patients was 77.5 (70.8-84.8) years. A large majority of 88.3% (n=98) of patients had a low muscle strength; a low muscle mass index was present in 33.3% (n=37) of the population. Finally, 31.5% (n=35) of patients had sarcopenia. These latter were older, had longer dialysis vintage, lower BMI, mid-arm circumference and mid-leg circumference, and a lower prealbumin. The best parameter predicting sarcopenia was BMI (ROC curve AUC of 0.79 [0.68-0.91] (p<0.001) in men and 0.81 [0.68-0.93] (p=0.003) in women). Mid-arm circumference predicted sarcopenia, but was less accurate than BMI. Mid-leg circumference predicted sarcopenia only in men. Predialysis creatinine or creatinine index could not predict sarcopenia. We report a 31.5% prevalence of sarcopenia in hemodialysis patients. The diagnosis of sarcopenia was mainly driven by muscle mass measurement because muscle strength is low in the large majority of hemodialysis patients.