Frailty, appendicular lean mass, osteoporosis and osteosarcopenia in peritoneal dialysis patients

Abstract

Introduction The pattern of chronic kidney disease mineral bone disorder (CKD-MBD) is changing with increasing numbers of elderly patients now treated by dialysis. The risk of falls and bone fractures increases with frailty and sarcopenia. As such we wished to review the association between osteoporosis and frailty and loss of appendicular lean mass (ALM). Methods Dual-energy X-ray absorptiometry (DXA) was used to measure lumbar spine and femoral neck bone mineral density (BMD) and body composition. Osteoporosis and osteopenia were defined according to T scores. ALM was indexed to height (ALMI). Frailty was classified using the clinical frailty scale (CFS). Results DXA scans from 573 patients, 57.8% male, 36.8% diabetic, mean age 61.0 ± 15.8 years, with a median 6.0 (2–20) months of treatment with PD were reviewed. Forty-two (7.3%) were classified as clinically frail, 115 (20%) osteoporotic, and 198 (34.6%) ALMI meeting sarcopenic criteria, with 43% of osteoporotic patients being osteosarcopenic. In a multivariable model, femoral neck BMD was associated with weight, standardised β (St β) 0.29, p = 0.004, ALM St β 0.11, p = 0.03 and Black vs other ethnicities St β 0.19, p = 0.02, and negatively with age St β −0.24, p < 0.001, and frailty St β −2.1, p = 0.04. Z scores (adjusted for gender and age) were associated with ALMI (r = 0.18, p < 0.001). Discussion Osteoporosis is increasing with the numbers of elderly dialysis patients. As frailty and sarcopenia increase with age, then the risk of falls and bone fractures increases with osteosarcopenia. Whether interventions with exercise and nutrition can improve bone heath remains to be determined. Graphical abstract

Bone mineral density and related clinical and laboratory factors in peritoneal dialysis patients: Implications for bone health management

“…This study reported no significant difference between patients on hemodialysis or peritoneal dialysis, but it acknowledged that the small sample size of PD patients may limit this result. One regional multicenter study that included 292 PD patients found that 19% of patients had osteoporosis and 36% had osteopenia [22], somewhat similar to what other studies have demonstrated [23][24][25][26]. In addition, these studies found an increased risk of reduced BMD with lower Body Mass Index (BMI).…”

Predictive Diagnostics of Risk Factors for the Development of Sarcopenia in Early Patients with Type 2 Diabetes

“…Среди хронических заболеваний, следует отметить хроническую болезнью почек (ХБП) тяжёлой степени, где приём белка снижается до 0,2-0,5 г/кг в сутки (при СКФ <30 мл/мин/1,73 м²) для профилактики метаболического ацидоза [35]. К недостатку минеральной плотности костной ткани может приводить дефицит витамина Д и диабетическая болезнь почек [36]. Вероятно, приём витамина Д в профилактических дозировках будет способствовать сохранению костной массы [37].…”

Malnutrition, protein energy wasting and sarcopenia in patients attending a haemodialysis centre in sub-Saharan Africa

“…As dialysis is now offered to more older patients with advanced CKD, and those with additional co-morbidities in economically advanced countries, then more patients with degrees of frailty are now receiving dialysis [8]. Frail patients tend to be less physically active and have lower muscle mass [9,10] and are greater risk of both sarcopenia and PEW [10].…”