Morphological, Electrophysiological, and Metabolic Characteristics of Skeletal Muscle in People with End-Stage Renal Disease: A Critical Review

Abstract

Purpose: Fatigue is one of the most frequent debilitating symptoms reported by people with end-stage renal disease (ESRD) on haemodialysis (HD) therapy. A wide range of underlying abnormalities, including skeletal muscle weakness, have been implicated as causes of this fatigue. Skeletal muscle weakness is well established in this population, and such muscle weakness is amenable to physical therapy treatment. The purpose of this review was to identify morphological, electrophysiological, and metabolic characteristics of skeletal muscles in people with ESRD/HD that may cause skeletal muscle weakness. Method: Electronic databases were searched for relevant literature from inception to March 2010. Inclusion criteria were English language; adult subjects with ESRD/HD; and the use of muscle biopsy, electromyography, and nuclear magnetic spectroscopy ( 31 P-NMRS) techniques to evaluate muscle characteristics. Results: In total, 38 studies were included. All studies of morphological characteristics reported type II fibre atrophy. Electrophysiological characteristics included both neuropathic and myopathic skeletal muscle changes. Studies of metabolic characteristics revealed higher cytosolic inorganic phosphate levels and reduced effective muscle mass. Conclusion:The results indicate an array of changes in the morphological, electrophysiological, and metabolic characteristics of skeletal muscle structure in people with ESRD/HD that may lead to muscle weakness. RÉ SUMÉObjectif : La fatigue est l'un des symptô mes dé bilitants signalé s chez les personnes aux prises avec une insuffisance ré nale chronique au stade ultime avec l'hé modialyse (IRSU/HD). Un large é ventail d'anomalies sous-jacentes, y compris de la faiblesse du muscle squelettique, ont é té mises en cause dans cette fatigue. La faiblesse du muscle squelettique est courante au sein de cette population; une telle faiblesse musculaire peut faire l'objet de traitements en physiothé rapie. L'objectif de cette analyse é tait d'identifier les caracté ristiques morphologiques, é lectrophysiologiques et mé taboliques des muscles squelettiques qui pourraient susciter une faiblesse du muscle squelettique chez les personnes avec IRSU/HD. Mé thode : Une recherche a é té ré alisé e dans les bases de donné es é lectroniques de leur cré ation à mars 2010 afin de ré pertorier la documentation pertinente. Les critè res d'inclusion é taient que ces documents soient en anglais, qu'ils concernent des adultes avec IRSU/HD et que des techniques de biopsie musculaire, d'é lectromyographie et de spectroscopie magné tique nuclé aire ( 31 P-NMRS) avaient é té utilisé es pour é valuer les caracté ristiques des muscles concerné s. Ré sultats : Au total, 38 documents ont é té ré pertorié s et utilisé s. Toutes les é tudes des caracté ristiques morphologiques faisaient é tat d'atrophie des fibres de type II. Les caracté ristiques é lectrophysiologiques incluaient à la fois les changements né vropathiques et myopathiques. Les é tudes des caracté ristiques mé taboliques ont ré vé l...

Evidence of functional deficits at the single muscle fiber level in experimentally-induced renal insufficiency

“…Together these and our results [in a larger species and a muscle expressing >95% IIX(IId) myosin, (Aigner et al, 1993;Hämäläinen and Pette, 1993)] could indicate a muscle type specificity of fiber atrophy in the early stages of CRI. Our findings are consistent with human studies reporting muscle atrophy in advanced kidney patients (Johansen et al, 2003;Sakkas et al, 2003a;Sawant et al, 2011) and suggest that atrophy could appreciably affect fast muscles which are normally tasked to provide high levels of muscle power, earlier during the disease progress.…”

“…We observed significantly smaller CSAs in UREM psoas fibers compared to CON (by ~11%) in agreement to human studies. In end-stage disease, muscle atrophy is ~ 27% (Sakkas et al, 2003b) affecting mostly the fast type IIA and IIX muscle fibers (Sakkas et al, 2003a;Sawant et al, 2011). Recently Acevedo et al, (Acevedo et al, 2015) reported no evident atrophy in the tibialis cranialis (a mixed fast hindlimb muscle) of surgically-induced uremic rats.…”

“…We used permeabilized (skinned) single muscle fibers to assess the contractile machinery per se independently of metabolic and neural factors in vitro (Cooke and Bialek, 1979), under variable conditions of pH and temperature (Karatzaferi et al, 2008(Karatzaferi et al, , 2004. We studied fibers from psoas muscle which is characterized by its homogeneity in fast IIX (IId) fibers (Aigner et al, 1993;Hämäläinen and Pette, 1993) because the fast/glycolytic fibers, especially the most powerful ones expressing the IIX myosin heavy chain isoform, are more prone to atrophy in renal disease (Sakkas et al, 2003a;Sawant et al, 2011).…”

Toward a Unified Model of Passive Drug Permeation II: The Physiochemical Determinants of Unbound Tissue Distribution with Applications to the Design of Hepatoselective Glucokinase Activators

“…The relevant parameters (voltage, pH, and fractional volume) for estimating the unbound partitioning within muscle (Guderley et al, 2006;Sawant et al, 2011), liver (Peters, 1984;Saito et al, 1992;Plettenberg et al, 2008), and the pancreas (Nishiyama and Petersen, 1974;Morgan et al, 1986;Taga et al, 1993) are provided in Table 1. The key approximation that will be made within this framework is that the transmembrane permeation is similar across various cell and organelle types and that fu is a whole tissue parameter.…”

Serum Creatinine and Albumin Decline Predict the Contraction of Nosocomial Aspiration Pneumonia in Patients Undergoing Hemodialysis

“…An array of changes in the morphological, electrophysiological and metabolic characteristics of skeletal muscle structure in patients with HD lead to muscle weakness. These changes include myopathic, neuropathic, and mixed changes existing independently . Additionally, atrophy of type II fibers was observed in the patients with HD in several studies .…”