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

Abstract

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 Analysis (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 (TSMM) and appendicular skeletal muscle mass (ASMM) were estimated and index values (i.e., muscle mass divided by height 2 [kg/m 2 ]) 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 HGS were utilized from 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 (BMI) (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 haemodialysis population. Future work is required to confirm findings.

Sarcopenia in chronic kidney disease: what have we learned so far?

“…In CKD, the first studies assessing the prevalence of sarcopenia are from 2013 and 2014 [54][55][56][57][58], and only in the last couple of years the scientific literature in this area received many more contributions (Table 3). Up to now, the most used sarcopenia operational criteria was the EWGSOP 1, which was applied in 12 studies [52,55,[57][58][59][60][61][62][63][64][65][66] (sarcopenia prevalence 4-49%), while 4 studies defined sarcopenia only by low muscle mass, not assessing muscle strength or performance [54,[67][68][69]. An important finding in these studies is that sarcopenia, understood as concomitant low muscle mass and low muscle strength, is a feature of muscle changes in CKD.…”

Energy Requirement of Patients Undergoing Hemodialysis: A Cross-Sectional Study in Multiple Centers

“…ird, this study uses sarcopenia criteria for general population but not for HD patients. ere are no sarcopenia criteria for HD patients, and criteria for general population are used to calculate the prevalence of sarcopenia in HD patients [34]. Fourth, this study did not investigate other factors that can influence energy requirement, and future studies should include these factors in larger-scale empirical investigations.…”

Hemodialysis—Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses Be the Sharpest “Sword of Damocles”?

“…Total cholesterol < 100 mg/dL and decreases in non-HDL-cholesterol and non-HDL/HDL cholesterol ratio (including triglyceride-rich lipoproteins) have been paradoxically associated with increased all-cause and cardiovascular mortality in patients undergoing incident hemodialysis [ 34 ]. However, numerous other indicators may also not constitute reliable indicators, as an example: (a) low serum transferrin, estimated by total iron-binding capacity (TIBC) is influenced by iron deficiency, inflammation, poor quality of life in patients on hemodialysis [ 35 ], (b) creatinine is heavily influenced by muscle mass volume, hemodialysis adequacy, residual renal clearance, hypercatabolism by dialysis, protein food intake prior to sampling (e.g., previous meal), particularly when blood is drawn following the longer interdialytic period or during afternoon HD sessions [ 36 ], (c) serum leptin is one of the parameters underlying the onset of anorexia in hemodialysis patients, but cannot be considered an important correlation factor due to significant association with inflammation [ 37 , 38 ], (d) metabolic acidosis, together with low caloric intake, elicits muscle proteolysis, reducing the sensitivity of cells to insulin, boosting the presence of molecules such as ghrelin and leptin that act on the central nervous system (CNS), which in turn increase resting energy expenditure [ 39 ], and (e) lymphocytopenia may represent a confounding factor due to the frequent presence in HD patients of a sub-chronical disease-causing a decrease in lymphocyte count, including primary immune deficiencies and immune deficiencies secondary to malnutrition or zinc deprivation, excess catabolism, immunosuppressive therapy, HIV infection, systemic lupus erythematosus, certain viral infections, lymphoma, renal insufficiency, and idiopathic CD4 lymphocytopenia [ 40 ].…”