Importance of Considering Malnutrition and Sarcopenia in Order to Improve the QOL of Elderly Hemodialysis Patients in Japan in the Era of 100-Year Life

Abstract

In the current aging society of Japan, malnutrition and resultant sarcopenia have been widely identified as important symptomatic indicators of ill health and can cause impairments of longevity and quality of life in older individuals. Elderly individuals are recommended to have sufficient calorie and protein intake so as to enjoy a satisfactory quality of life, including maintaining activities of daily living in order to avoid emaciation and sarcopenia. The prevalence of emaciation and sarcopenia in elderly hemodialysis (HD) patients in Japan is higher than in non-HD elderly subjects due to the presence of malnutrition and sarcopenia associated with chronic kidney disease (CKD). Furthermore, comorbidities, such as diabetes and osteoporosis, induce malnutrition and sarcopenia in HD patients. This review presents findings regarding the mechanisms of the development of these early symptomatic conditions and their significance for impaired QOL and increased mortality in elderly HD patients.

Comparison of three nutritional screening tools for detecting sarcopenia in patients with maintenance hemodialysis

“…Consistently, previous studies found that malnutrition was significantly associated with sarcopenia in patients with MHD ( 26 ). With regard to the indicators used for nutritional assessment, studies have shown that the GNRI ( 27 ) and MIS ( 10 ) were associated with sarcopenia in patients with MHD.…”

“…First, it highlights that screening poor nutrition status is usually highly predictive of sarcopenia in patients with MHD. Second, it is strongly recommended to maintain sufficient calorie and protein intake especially physical therapy to avoid or reverse sarcopenia ( 26 ). However, efforts to increase food intake in patients with MHD with sarcopenia often are unsuccessful because of the persistent anorexia arising from sarcopenia-related inflammatory status ( 30 ).…”

Association between the appendicular lean mass index or handgrip strength and bone mineral density in patients undergoing peritoneal dialysis

“…This is an emerging complication associated with quality of life and mortality in patients undergoing long-term PD [18,19]. Although the muscle-bone interaction is complex and the associations are not fully understood, previous studies have shown that the interaction between muscle and bone is mediated by mechanical stresses or paracrine effects by secretory mediators [6,[20][21][22]. Consequently, muscle health is directly or indirectly helpful in maintaining BMD.…”

“…Muscle mass is closely related to the bone both anatomically and physiologically, and recent studies have shown that muscle mass or strength is associated with bone health and vice-versa [5,6]. Stretching of muscles places a load on bones to which muscles are attached, and such mechanical stresses increase the cortical bone thickness.…”

Extension of Healthy Life Span of Dialysis Patients in the Era of a 100-Year Life

“…With both the elongation of hemodialysis (HD) duration resulting from the sophistication of HD technology and the increasing age at the time of HD initiation due to the aging society of Japan, the mean age of prevalent HD patients is increasing at an accelerating rate [ 1 ]. Along with the aging of HD patients, presymptomatic conditions such as malnutrition, frailty, sarcopenia, and inflammation have been focused on as important states to help to improve the condition of patients, both those living independently and those requiring physical support or nursing care [ 1 , 2 ], as in the general elderly population. In addition, it should be emphasized that such presymptomatic conditions can often act as a trigger, causing critical events, such as cardiovascular disease (CVD), falls, and fragile fractures, which significantly impair quality of life (QOL) [ 1 ].…”