Physical inactivity and protein energy wasting play independent roles in muscle weakness in maintenance haemodialysis patients

Abstract

BackgroundMuscle weakness is associated with increased mortality risk in chronic haemodialysis (CHD) patients. Protein energy wasting (PEW) and low physical activity could impair muscle quality and contribute to muscle weakness beyond muscle wasting in these patients. Aim of this study was to assess clinical and biological parameters involved in the reduction of muscle strength of CHD patients.MethodsOne hundred and twenty-three CHD patients (80 males, 43 females; 68,8 [57.9–78.8] y.o.) were included in this study. Maximal voluntary force (MVF) of quadriceps was assessed using a belt-stabilized hand-held dynamometer. Muscle quality was evaluated by muscle specific torque, defined as the strength per unit of muscle mass. Muscle mass was estimated using lean tissue index (LTI), skeletal muscle mass (SMM) assessed by bioelectrical impedance analysis and creatinine index (CI). Voorrips questionnaire was used to estimate physical activity. Criteria for the diagnosis of PEW were serum albumin, body mass index < 23 kg/m2, creatinine index < 18.82 mg/kg/d and low dietary protein intake estimated by nPCR < 0.80g/kg/d.ResultsMVF was 76.1 [58.2–111.7] N.m. and was associated with CI (β = 5.3 [2.2–8.4], p = 0.001), LTI (β = 2.8 [0.6–5.1], p = 0.013), Voorrips score (β = 17.4 [2.9–31.9], p = 0.02) and serum albumin (β = 1.9 [0.5–3.2], p = 0.006). Only serum albumin (β = 0.09 [0.03–0.15], p = 0.003), Voorrips score (β = 0.8 [0.2–1.5], p = 0.005) and CI (β = 0.2 [0.1–0.3], p<0.001) remained associated with muscle specific torque. Thirty patients have dynapenia defined as impaired MVF with maintained SMM and were younger with high hs-CRP (p = 0.001), PEW criteria (p<0.001) and low Voorrips score (p = 0.001), and reduced dialysis vintage (p<0.046).ConclusionsBeyond atrophy, physical inactivity and PEW conspire to impair muscle strength and specific torque in CHD patients and could be related to muscle quality.Trial registrationClinicalTrials.gov NCT02806089

Real-time shear wave ultrasound elastography: a new tool for the evaluation of diaphragm and limb muscle stiffness in critically ill patients

“…Diaphragm weakness has also been associated with poor outcome such as dependency on mechanical ventilation, prolonged ICU length of stay and mortality [4,[12][13][14]. Muscle weakness is related to muscle mass but beyond mass, loss of muscle function and muscle quality without atrophy has been observed in the elderly and in chronic hemodialysis patient populations, [15,16] a condition labeled as dynapenia. At the ICU bedside, ultrasonography (US) is an inexpensive, user-friendly, nonvolitional and non-invasive tool widely used by intensivists.…”

Effect of a pedometer-based walking intervention on body composition in patients with ESRD: a randomized controlled trial

“…It is possible that activity of even low to moderate intensity could result in reduced protein-energy wasting for a period of time even after cessation of activity. Indeed, sedentary behavior and protein-energy wasting have independent but synergistic effects on muscle [49].…”

Effect of a Pedometer-based Walking Intervention on Body Composition in Patients with ESRD: A Randomized Controlled Trial

“…Indeed, sedentary behavior and protein-energy wasting have independent but synergistic effects on muscle. 50 This study has several limitations. We acknowledge that more detailed information on the trajectory of step counts between 3 and 6 months as well as data on other types of activity that patients engaged in would be valuable in answering questions about the appropriate dose and duration of activity that we should recommend to patients.…”