Sarcopenia in Chronic Kidney Disease

Souza, Viviane Angelina de; Oliveira, Dílmerson de; Mansur, Henrique; Fernandes, Natália; Bastos, Marcus Gomes

doi:10.5935/0101-2800.20150014

Cited by 66 publications

(55 citation statements)

References 59 publications

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“…Osteomalacia is a well-known cause of proximal myopathy predominantly with atrophy of type II muscle fibers [97]. Sarcopenia is highly prevalent among CKD patients and is associated with increased morbidity and mortality [98,99]. Nevertheless, the role of lower 25(OH)-VD levels in the pathogenesis of CKD-related sarcopenia remains unclear.…”

Section: Vd and Ckd: Human Studiesmentioning

confidence: 99%

Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies

Gois

Wolley

Ranganathan

et al. 2018

IJERPH

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Vitamin D (VD) is a pro-hormone essential for life in higher animals. It is present in few types of foods and is produced endogenously in the skin by a photochemical reaction. The final step of VD activation occurs in the kidneys involving a second hydroxylation reaction to generate the biologically active metabolite 1,25(OH)2-VD. Extrarenal 1α-hydroxylation has also been described to have an important role in autocrine and paracrine signaling. Vitamin D deficiency (VDD) has been in the spotlight as a major public healthcare issue with an estimated prevalence of more than a billion people worldwide. Among individuals with chronic kidney disease (CKD), VDD prevalence has been reported to be as high as 80%. Classically, VD plays a pivotal role in calcium and phosphorus homeostasis. Nevertheless, there is a growing body of evidence supporting the importance of VD in many vital non-skeletal biological processes such as endothelial function, renin-angiotensin-aldosterone system modulation, redox balance and innate and adaptive immunity. In individuals with CKD, VDD has been associated with albuminuria, faster progression of kidney disease and increased all-cause mortality. Recent guidelines support VD supplementation in CKD based on extrapolation from cohorts conducted in the general population. In this review, we discuss new insights on the multifactorial pathophysiology of VDD in CKD as well as how it may negatively modulate different organs and systems. We also critically review the latest evidence and controversies of VD monitoring and supplementation in CKD patients.

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Section: Vd and Ckd: Human Studiesmentioning

confidence: 99%

Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies

Gois

Wolley

Ranganathan

et al. 2018

IJERPH

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“…The aetiology of uremic myopathy is multifactorial ( Table 2), including physical inactivity, reduced protein intake, vitamin D deficiency, hyperparathyroidism, metabolic acidosis, electrolyte disorder, low serum levels of testosterone, resistance to growth hormone and insulin, accumulation of uremic toxins, and carnitine deficiency, which can lead to mitochondrial dysfunction 105, 106. Observational studies have shown an inverse correlation between muscle mass and blood levels of IL‐6 and C reactive protein in CKD patients,12, 107, 108 postulating inflammation as an additional cause of muscle wasting in this population 109, 110, 111.…”

Section: Bone and Musculoskeletal Abnormalities In Chronic Kidney Dismentioning

confidence: 99%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

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The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

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“…A high prevalence of sarcopenia has been reported in developed and developing countries, and this disorder affects both healthy individuals and individuals with chronic diseases, including hypertension, diabetes, and chronic kidney disease (CKD) [7–9]. …”

Section: Introductionmentioning

confidence: 99%

Sarcopenia in patients with chronic kidney disease not yet on dialysis: Analysis of the prevalence and associated factors

Oliveira²,

et al. 2017

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IntroductionSarcopenia is a chronic condition that is associated with aging and characterized by a reduction of muscle mass, strength, and function. Sarcopenia is prevalent in patients with chronic kidney disease (CKD) and associated with increased morbidity and mortality, as well as cardiovascular complications.ObjectivesTo investigate the prevalence of sarcopenia in patients with CKD not yet on dialysis and its correlation with clinical and laboratory variables and inflammatory markers.MethodsA total of 100 patients of both sexes aged over 18 were evaluated. Sarcopenia was defined using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. Sociodemographic and clinical data, activities of daily living, functional capacity, and physical activity were also evaluated. Inflammation was assessed by the serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin (IL) 4 and 6.ResultsThe prevalence of sarcopenia was 11.9% and 28.7% using the EWGSOP and FNIH criteria, respectively. Sarcopenia was more prevalent in the more advanced stages of CKD (34.5% in stages 2 and 3A; and 65.5% in stages 3B, 4, and 5) and associated with worse performance in activities of daily living (p = 0.049), lower walking speeds (p < 0.001), and higher body mass indexes (BMIs) (p = 0.001) in the non-adjusted model. In addition, patients with sarcopenia had lower functional capacity (p = 0.012) and higher prevalence of physical inactivity (p = 0.041) compared with patients without sarcopenia. After adjustment for confounding variables, sarcopenia was still significantly correlated with walking speed (p = 0.004) and BMI (p = 0.002). HsCRP levels were inversely correlated with appendicular lean mass adjusted for BMI (p = 0.007) and were also positively associated with BMI (p = 0.001). IL4 levels were positively correlated with walking speed (p = 0.007) and lean mass in the lower limbs (p = 0.022).ConclusionsSarcopenia is common in patients with CKD, particularly in the most advanced stages of the disease. We observed an association between the levels of inflammatory markers and peripheral lean body mass, physical performance, and BMI. This association between sarcopenia and modifiable factors highlights the importance of early diagnosis and the implementation of therapeutic measures to minimize adverse outcomes in patients with CKD not yet on dialysis.

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Sarcopenia in Chronic Kidney Disease

Cited by 66 publications

References 59 publications

Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies

Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Sarcopenia in patients with chronic kidney disease not yet on dialysis: Analysis of the prevalence and associated factors

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