Background Patients with end-stage renal disease (ESRD) are at an increased risk of developing sarcopenia, which can lead to various adverse health outcomes. Although the diagnosis of sarcopenia is essential for clinical management, it is not feasible in routine clinical practice for populations undergoing haemodialysis because it is time-consuming and resources are limited. Serum creatinine levels in patients with ESRD have been gaining attention as a screening parameter for sarcopenia because serum creatinine is a routinely measured byproduct of skeletal muscle metabolism. This study aimed to evaluate the discriminative ability of the creatinine-derived index for sarcopenia in patients undergoing haemodialysis. Methods We diagnosed sarcopenia according to the Asian Working Group for Sarcopenia (AWGS) 2 criteria in 356 clinically stable outpatients with ESRD enrolled from three dialysis facilities. We adopted the modified creatinine index as a simplified discriminant parameter for sarcopenia in addition to the calf circumference, SARC-F score, and combination of both (i.e. SARC-CalF score), which are recommended by the AWGS. Receiver operating characteristic analysis and logistic regression analysis were conducted to evaluate the discriminative ability of the modified creatinine index for sarcopenia. Results Of the study participants, 142 (39.9%) were diagnosed with sarcopenia. The areas under the curve of the modified creatinine index against sarcopenia in the male and female participants were 0.77 (95% confidence interval [CI]: 0.71 to 0.83) and 0.77 (95% CI: 0.69 to 0.85), respectively. All simplified discriminant parameters were significantly associated with sarcopenia, even after adjusting for patient characteristics and centre. In the comparison of the odds ratios for sarcopenia for 1-standard deviation change in the simplified discriminant parameters, the odds ratio of the modified creatinine index was 1.92 (95% CI: 1.15 to 3.19), which was lower than that of the calf circumference (odds ratio: 6.58, 95% CI: 3.32 to 13.0) and similar to that of the SARC-F (odds ratio: 1.57, 95% CI: 1.14 to 2.16) and SARC-CalF scores (odds ratio: 2.36, 95% CI: 1.60 to 3.47). Conclusions This study revealed a strong association between the creatinine-derived index and sarcopenia in patients undergoing haemodialysis. The modified creatinine index was equal or superior to those of SARC-F and SARC-CalF score in discriminability for sarcopenia. However, the ability of the calf circumference to discriminate sarcopenia is extremely high, and further study is needed to determine whether it can be used to detect deterioration of muscle mass and function over time.
An aging population and the prevalence of lifestyle-related ailments have led to a worldwide increase in the rate of chronic kidney disease requiring renal replacement therapy. The mean age of people requiring dialysis has been rising, and Japanese patients are aging more rapidly than those in the United States and Europe. Compared to people with normal kidney function, those undergoing hemodialysis are at increased risk of sarcopenia or frailty and serious health problems that limit access to kidney transplantation and lead to adverse health outcomes such as functional dependence, hospitalization, and death in patients on dialysis treatment. The Japanese Society of Renal Rehabilitation, established in 2011, published a clinical practice guideline for renal rehabilitation in 2019. Although the concept has become widely known among kidney health providers in recent years, efforts have still not focused on routine clinical care for patients with chronic kidney disease. In this review, the theory and clinical application of renal rehabilitation for patients undergoing daily hemodialysis were investigated.
Background and Aims Protein-energy wasting (PEW), debilitating nutritional and metabolic disorder marked by a systemic reduction in protein and energy store, is prevalent among patients with end stage renal disease (ESRD). The magnitude of malnutrition among patients undergoing hemodialysis has been positively associated with, the risk of all-cause mortality, particularly due to cardiovascular disease and infections. Additionally, inadequate nutritional status has been implicated in the development of sarcopenia, characterized by decreased muscle mass, weakened muscle strength, and impaired physical function. As such, routine management of nutritional status may be crucial aspect of care for these patients. In addition to the nutritional risk index for Japanese hemodialysis patients (NRI-JH), developed for the diagnosis of PEW, the geriatric nutritional risk index (GNRI) and mini nutritional assessment short-form (MNA-SF) are frequently utilized as nutritional indices in patients on hemodialysis. However, few studies have compared the magnitude of associations between these nutritional measure and sarcopenia in patients undergoing hemodialysis. This study aimed to evaluate the degree of association between nutritional assessments and sarcopenia in this patient population. Method The current cross-sectional study recruited outpatients receiving maintenance hemodialysis between June 2019 and December 2021. The study collected patient information, including age, gender, body mass index, dialysis duration, primary kidney diseases, 11 comorbid conditions, and laboratory parameters (such as serum albumin, serum creatinine, and total cholesterol), from medical records. Physical therapists assessed muscle mass (skeletal muscle index [SMI]), muscle strength (handgrip strength), and physical performance (short physical performance battery [SPPB]), and sarcopenia was diagnosed when patients presented with low muscle mass (SMI <7.0 kg/m2 for males, <5.7 kg/m2 for females) and low muscle strength (handgrip strength <28.0kg for males, <18 kg for females) or low physical performance (SPPB ≤9) based on the Asian Working Group for Sarcopenia 2019 criteria. The study employed the NRI-JH, GNRI, and MNA-SF as markers of nutritional status. The NRI-JH was calculated based on body mass index, serum albumin, serum creatinine, and total cholesterol. Logistic regression analysis was performed to examine the associations of NRI-JH, GNRI, and MNA-SF with sarcopenia among patients on hemodialysis. Results Sixty-five patients undergoing hemodialysis were analyzed in this study. The mean age of the patients was 78.3 ± 10.7 years, with 36.9% being female. The average duration of dialysis was 6.4 ± 3.9 years. The most frequently observed underlying kidney disease was diabetes mellitus, followed by hypertension. The prevalence of sarcopenia was found to be 60.0%. After adjustment for the effects of age, gender, dialysis duration, and comorbidity index, patients with a lower score on the NRI-JH were significantly more prone to sarcopenia (odds ratio per 1-point increase, 1.33; 95% confidence interval, 1.04–1.69). The NRI-JH was demonstrated to have a stronger association with sarcopenia compared to the others (Table 1). Conclusion The NRI-JH and GNRI were significantly associated with risk of sarcopenia. The NRI-JH demonstrated a stronger association with the risk of sarcopenia compared to the GNRI.
Background and Aims The mean age of Japanese patients undergoing hemodialysis at the end of 2018 was 68.75 years, demonstrating a 15-year increase since 1985. The healthcare management of the geriatric patients presents significant challenges, encompassing both clinical and societal aspects, as they often experience overlapping comorbidities while undergoing hemodialysis. A systematic review and meta-analysis published in 2022 reported that sarcopenia was associated with heightened mortality rates in patients undergoing dialysis therapy. However, only a limited number of studies have investigated this association among Asian populations, whose differences in body composition, nutritional status, and socio-economic background distinguish them from those in the United States and Europe. Notably, no studies have targeted the older demographic, who constitute the majority of Asian patients on hemodialysis and possess numerous risk factors for death. This study categorized Japanese patients undergoing hemodialysis by age, <75 and 75≤, and examined the impact of sarcopenia on mortality according to age. Method This multicenter prospective cohort study enrolled 404 outpatients undergoing hemodialysis from three facilities in Japan and followed them up for three years. At baseline, information on age, sex, dialysis vintage, body mass index, primary kidney diseases, comorbid conditions, and laboratory parameters (serum albumin, serum hemoglobin, and hematocrit) were collected from medical records. The geriatric nutritional risk index (GNRI) was calculated based on the patient's serum albumin level and body weight. Sarcopenia was diagnosed in patients who had low muscle mass (skeletal muscle mass index <7.0 kg/m² for males and <5.7 kg/m² for females) and low muscle strength (handgrip strength <28.0kg for males and <18 kg for females) or low physical performance (short physical performance battery score ≤9), according to the Asian Working Group for Sarcopenia 2019 criteria. The Kaplan-Meier method and Cox proportional hazard analysis were used to evaluate the independent association between sarcopenia and mortality after adjusting for baseline characteristics in patients aged <75 and ≥75 years. Results A total of 404 patients participated in this study, with a mean follow-up period of 30 months, during which 50 (12.4%) patients died. Participants had a mean age of 68.4 ± 12.6 years and 62.6% of them were male and the mean GNRI was 91.1 ± 21.2. Diabetes mellitus was the most prevalent underlying kidney disease among the study cohort (38.1%). The prevalence of sarcopenia in all patients, those under 75 years of age, and those 75 years and older was 37.6%, 22.7%, and 63.1%, respectively. Kaplan-Meier analyses indicated a higher mortality rate among patients with sarcopenia compared to those without. In the subgroup analysis for patients aged <75 years, sarcopenia was significantly associated with increased mortality risk after full adjustment (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.05–5.95). Conversely, in the subgroup of patients 75 years and older, sarcopenia was not significantly associated with all-cause mortality (HR, 0.69; 95% CI, 0.28–1.68), and only a low GNRI was independently associated with poor survival (HR, 0.98; 95% CI, 0.96–1.00). Conclusion This present study determined that the impact of sarcopenia on mortality among patients undergoing hemodialysis may be altered by their age. Specifically, among those aged 75 years and above, malnutrition was found to be a strong predictor of poor survival, rather than sarcopenia.
Background and Aims Frailty is widely acknowledged as an age-related fragile state characterized by physiological vulnerability to stress, and it is prevalent among patients undergoing maintenance hemodialysis therapy. Various factors are interconnected and can be theoretically consolidated into a cycle of frailty, with malnutrition and sarcopenia at the core. These can result in numerous negative health outcomes in patients on hemodialysis and prompt identification and treatment are necessary. However, limited research has investigated the impact of the overlap between malnutrition and sarcopenia on mortality in this patient population. In this study, we examined the association of the overlap between malnutrition and sarcopenia with all-cause mortality in patients undergoing maintenance hemodialysis. Method The present prospective cohort study recruited outpatients on hemodialysis from three facilities in Japan. At the study baseline, data on patients' characteristics including age, gender, body mass index, duration of dialysis, primary kidney diseases, 11 comorbid conditions, and laboratory parameters (including serum albumin level) were collected from medical records. In addition, muscle mass (skeletal muscle index [SMI]), muscle strength (handgrip strength), and physical performance (short physical performance battery [SPPB]) were measured by physical therapists. A comorbidity index was used to quantify the severity of comorbid illnesses, which was calculated based on primary kidney diseases and the 11 comorbidities. Malnutrition was identified based on geriatric nutritional risk index <98, which was calculated using the serum albumin level and body weight. Sarcopenia was diagnosed when patients had low muscle mass (SMI <7.0 kg/m2 for males and <5.7 kg/m2 for females) and low muscle strength (handgrip strength <28.0kg for males and <18 kg for females) or low physical performance (SPPB ≤9), in accordance with the Asian Working Group for Sarcopenia 2019 criteria. After classifying the study participants into four groups based on the absence or presence of malnutrition and sarcopenia, the mortality risk was evaluated using the Kaplan-Meier method and Cox proportional hazard analysis. This study was approved by the Research Ethics Committee and conducted in accordance with the principles of the Declaration of Helsinki. Results A total of 379 patients on hemodialysis were included in the analysis. The mean age of the patients was 69.5±12.6 years, and 40.2% of the cohort being female. The mean duration of dialysis was 7.9±4.5 years. The most prevalent underlying kidney disease was diabetes mellitus. At baseline, the prevalence rates of malnutrition and sarcopenia were 32.7% and 28.2%, respectively. Over a mean follow-up period of 4.3 years, 23 patients died. The Kaplan-Meier analysis demonstrated a lower cumulative survival rate in patients with malnutrition and/or sarcopenia. After adjustment for the effect of age, gender, duration of dialysis, and comorbidity index, the hazard ratio in patients with both malnutrition and sarcopenia was significantly higher than in patients without both (hazard ratio [HR] 5.78, 95% confidence interval [CI] 1.86-17.94). However, the hazard ratios in patients suffering from either malnutrition or sarcopenia alone were not significantly different (Table 1). Conclusion The present study has demonstrated the strong association of a state of co-occurrence between malnutrition and sarcopenia, which implies starvation and muscle wasting, with a poor prognosis in patients undergoing hemodialysis. The findings of this study have accentuated the significance of addressing both malnutrition and sarcopenia in routine clinical practice for patients undergoing maintenance hemodialysis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.