Estimation of Muscle Mass in the Integrated Assessment of Patients on Hemodialysis

Sabatino, Alice; Broers, Natascha J. H.; Sande, Frank M. van der; Hemmelder, Marc H; Fiaccadori, Enrico; Kooman, Jeroen P.

doi:10.3389/fnut.2021.697523

Cited by 12 publications

(6 citation statements)

References 70 publications

(94 reference statements)

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“…Third, although the creatinine‐derived index is affected by day‐to‐day dietary protein intake, 37 we did not collect data on meal content. Finally, the modified creatinine index is affected by residual renal function 38 . However, because we did not collect data on the daily urine volume, we are not certain that we completely accounted for the effect of residual renal function in our analysis.…”

Section: Discussionmentioning

confidence: 99%

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Simplified discriminant parameters for sarcopenia among patients undergoing haemodialysis

Kakita

Matsuzawa

Yamamoto

et al. 2022

J cachexia sarcopenia muscle

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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.

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Section: Discussionmentioning

confidence: 99%

“…Finally, the modified creatinine index is affected by residual renal function. 38 However, because we did not collect data on the daily urine volume, we are not certain that we completely accounted for the effect of residual renal function in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Simplified discriminant parameters for sarcopenia among patients undergoing haemodialysis

Kakita

Matsuzawa

Yamamoto

et al. 2022

J cachexia sarcopenia muscle

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“…Ensuring adequate dialysis therapy is necessary for maintaining patients' overall health and muscle status. 40 In addition, Chronic inflammation is prevalent in patients with end-stage kidney disease. 41 Inflammatory cytokines and oxidative stress can impair muscle function and contribute to muscle catabolism.…”

Section: Discussionmentioning

confidence: 99%

The relationship between skeletal muscle mass and exercise capacity in patients undergoing hemodialysis: An exploratory secondary‐analysis

Zhang,

Zhuang,

Qin

et al. 2023

Hemodialysis International

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BackgroundProtein‐energy wasting is commonly observed in patients undergoing hemodialysis, leading to reduced muscle mass and, in severe cases, sarcopenia, which significantly impacts the patients' quality of life and clinical outcomes. Exercise interventions are frequently employed to address muscle loss in these patients. However, the relationship between exercise capacity and skeletal muscle mass in this context remains uncertain. In this study, researchers conducted a series of body composition analysis and exercise capacity test to explore the relationship between exercise capacity and skeletal muscle mass.MethodsThis study recruited 32 patients undergoing hemodialysis and analyzed their demographic and clinical parameters. To assess aerobic exercise capacity, the incremental shuttle walking test (ISWT) was conducted, while the handgrip strength test was used to evaluate muscle strength. The patients' body compositions were assessed using the Fresenius Body Composition Monitor, and the appendicular skeletal muscle was scanned using a GE Healthcare Lunar iDXA scanner. Three sequential linear models were employed to model the relationship between ISWT and skeletal muscle mass. Model 1 regressed ISWT against gender and age; Model 2 added handgrip strength, fat tissue index, and Davies comorbidity scores as additional predictors; and Model 3 further included the appendicular skeletal muscle index (appendicular skeletal muscle/height).FindingsAfter controlling for age and gender (Model 1: R2 = 0.373), and subsequently including handgrip strength, fat tissue index, and Davies comorbidity score effects (Model 2: R2 = 0.581), the impact of appendicular skeletal muscle on ISWT was found to be non‐significant (Model 3: R2 = 0.600).ConclusionThere was no significant correlation observed between exercise capacity and skeletal muscle mass in patients undergoing hemodialysis, indicating the factors influencing exercise capacity in this patient population are complex and that increasing skeletal muscle mass may not necessarily involve solely addressing the improvement of exercise capacity.

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“…HD patients were measured 30 min after dialysis treatment to allow for re-equilibration on a midweek session [ 12 , 13 ]. Based on published data [ 14 ], subjects were required to reach dry weight(DW) with a post-dialysis ECW/TBW (Extracellular water/total body water) ≤0.40 (suggested by the manufacturer, Biospace, Seoul, South Korea).…”

Section: Methodsmentioning

confidence: 99%

Interrelationships between sarcopenia, bone turnover markers and low bone mineral density in patients on hemodialysis

Wang

et al. 2023

Renal Failure

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Background Hemodialysis (HD) patients are at risk for sarcopenia (SP) and bone loss, which may impact falls and bone fragility and lead to poor prognosis. Patients with HD and those with osteoporosis (OP) are still underdiagnosed and untreated. The aims of the present study were to evaluate the factors that affect bone mineral density (BMD) loss in HD patients, and explore traditional and novel approaches to manage chronic kidney disease–mineral-bone disorder (CKD-MBD). Methods Patients who underwent regular HD at the First Affiliated Hospital of Soochow University were retrospectively evaluated. According to the WHO osteoporosis criteria, patients were categorized into three groups: normal BMD, osteopenia, and osteoporosis. Demographic and clinical data, skeletal muscle mass, and bone turnover markers(BTM) were compared between the three groups. The correlation between bone density and muscle mass was calculated, and related risk factors were analyzed. Results This study enrolled 130 HD patients, 36 patients were diagnosed with sarcopenia (27.7%), 44 patients were diagnosed with osteopenia (33.8%), 19 patients were diagnosed with osteoporosis (14.6%), and 23 patients were diagnosed with osteosarcopenia (17.7%). The SMI was positively correlated with the BMD of the lumbar spine ( r = 0.23, p < 0.01) and femoral neck ( r = 0.22, p < 0.05). In ordinal logistic regression analysis, the odds ratio (OR) for low BMD was high for patients with sarcopenia (OR = 5.894, 95% CI 1.592–21.830, p < 0.01), older age (OR = 1.095, 95% CI 1.041–1.153, p < 0.001), higher TRACP-5b levels (OR = 1.597, 95% CI 1.230–2.072, p < 0.01), and lower 25-OH vitamin D levels (OR = 0.631, 95% CI 0.544–0.733, p < 0.001). Conclusion The preservation of skeletal muscle mass could be important to prevent a BMD decrease in HD patients. Adequate intake of vitamin D and control of TRACP-5b levels will help reduce the occurrence and progression of osteopenia/sarcopenia in HD patients.

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Estimation of Muscle Mass in the Integrated Assessment of Patients on Hemodialysis

Cited by 12 publications

References 70 publications

Simplified discriminant parameters for sarcopenia among patients undergoing haemodialysis

Simplified discriminant parameters for sarcopenia among patients undergoing haemodialysis

The relationship between skeletal muscle mass and exercise capacity in patients undergoing hemodialysis: An exploratory secondary‐analysis

Interrelationships between sarcopenia, bone turnover markers and low bone mineral density in patients on hemodialysis

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