Natural History of Skeletal Muscle Mass Changes in Chronic Kidney Disease Stage 4 and 5 Patients: An Observational Study

Abstract

Cross-sectional studies in dialysis demonstrate muscle wasting associated with loss of function, increased morbidity and mortality. The relative drivers are poorly understood. There is a paucity of data regarding interval change in muscle in pre-dialysis and dialysis-dependant patients. This study aimed to examine muscle and fat mass change and elucidate associations with muscle wasting in advanced CKD.134 patients were studied (60 HD, 28 PD, 46 CKD 4–5) and followed up for two years. Groups were similar in age, sex and diabetes prevalence. Soft tissue cross-sectional area (CSA) was measured annually on 3 occasions by a standardised multi-slice CT thigh. Potential determinants of muscle and fat CSA were assessed. Functional ability was assessed by sit-to-stand testing.88 patients completed follow-up (40 HD, 16 PD, 32 CKD). There was a significant difference in percentage change in muscle CSA (MCSA) over year 1, dependant on treatment modality (χ2 = 6.46; p = 0.039). Muscle loss was most pronounced in pre-dialysis patients. Muscle loss during year 1 was partially reversed in year 2 in 39%. Incident dialysis patients significantly lost MCSA during the year which they commenced dialysis, but not the subsequent year. Baseline MCSA, change in MCSA during year 1 and dialysis modality predicted year 2 change in MCSA (adjusted R2 = 0.77, p<0.001). There was no correlation between muscle or fat CSA change and any other factors. MCSA correlated with functional testing, although MCSA change correlated poorly with change in functional ability.These data demonstrate marked variability in MCSA over 2 years. Loss of MCSA in both pre-dialysis and established dialysis patients is reversible. Factors previously cross-sectionally shown to correlate with MCSA did not correlate with wasting progression. The higher rate of muscle loss in undialysed CKD patients, and its reversal after dialysis commencement, suggests that conventional indicators may not result in optimal timing of dialysis initiation.

Changes in Body Composition in the Two Years after Initiation of Haemodialysis: A Retrospective Cohort Study

“…The differences with the results presented here could be explained by the relatively small size of our study in comparison and the chance of it being underpowered. John et al used CT measurements of muscle cross sectional area around HD initiation which also showed similar trends as this data [26]. Interestingly, this study showed that pre-dialysis patients exhibited an even greater rate of muscle loss and that dialysis initiation actually reduced the rate of muscle loss.…”

Latest consensus and update on protein-energy wasting in chronic kidney disease

“…The Chronic Renal Insufficiency Cohort (CRIC) study revealed that the prevalence of frailty and pre-frailty in stage G2–4 CKD was 7% and 43%, respectively, and that lower kidney function was associated with frailty [32]. Another study showed that muscle mass, evaluated by multi-slice CT, longitudinally declined with time especially in nondialysis-dependent patients and incident hemodialysis patients [33]. …”

Does Inspiratory Muscle Trainer Have an Effect on Diaphragmatic Excursion in Hemodialytic Patients?

“…5(3), 1224-1229 1225 Several decades of research efforts devoted to studying the patterns of chronic kidney disease-end stage renal disease (CKD-ESRD) progression as well as the impact of acute kidney injury (AKI) on this continuum of CKD-ESRD evolution but the full understanding of the process (es) of CKD-ESRD progression remains elusive 2 .Significant muscle weakness and associated atrophy is seen in both dialysis patients and in patients with chronic kidney disease (CKD) stages 3-4. This is associated with increased morbidity and mortality 3, 4 .…”