Prevalence and Correlates of Sarcopenia among Elderly CKD Outpatients on Tertiary Care

Abstract

Background: Sarcopenia is a widespread concern in chronic kidney disease (CKD) as well in elderly patients and is one of the main reasons why low-protein diets for this population are controversial. The aim of this study was to assess the prevalence and correlates of sarcopenia among elderly male patients affected by CKD followed up in an outpatient nephrology clinic, where moderate protein restriction (0.6–0.8 g/Kg/day) is routinely recommended to patients in CKD stage 3b-5 not on dialysis. Methods: This observational study included 80 clinically-stable male out-patients aged >60, affected by stage 3b-4 CKD. Forty patients aged ≥75 (older seniors) were compared to the other forty patients aged 60–74 (younger seniors). All patients underwent a comprehensive nutritional and functional assessment. Results: Older seniors showed lower serum albumin, hand-grip strength, body mass index (BMI), skeletal muscle mass, and resting energy expenditure. Protein intake was significantly lower in older seniors whereas energy intake was similar. Average daily physical activity was lower in the older seniors than in the younger ones. Sarcopenia was more prevalent in older than in younger seniors. Among older seniors, sarcopenic and non-sarcopenic ones differed in age and performance on the Six-Minute Walk test, whereas the estimated glomerular filtration rate (eGFR), biochemistry, dietary protein, and energy intakes were similar. Conclusions: Older senior CKD male patients have lower muscle mass, muscle strength, and physical capacity and activity levels, with a higher prevalence of sarcopenia than younger patients. This occurs at the same residual renal function and metabolic profile and protein intake. Energy intake was at the target in both subgroups. In this CKD cohort, sarcopenia was associated with age and physical capacity, but not with eGFR or dietary intakes.

Prevalence of sarcopenia in community-dwelling older adults using the updated EWGSOP2 definition according to kidney function and albuminuria

“…In this regard, our study found a higher prevalence among women across virtually all CKD stages. Other studies in CKD patients have observed variable prevalence rates of sarcopenia: 34.5% (stages 2-3a) and 65.5% (stages 3b-5) [14]; 37% (stages 3-5) [41]; 14% (stages 3-5) greater in men (16%) than in women (8%) and with a significant positive relationship between ASM and GFR [15]; and 12.5% (stages 3b-4 in men aged 60-74) or 55% (stages 3b-4 in men aged > 75) [42].…”

Sarcopenia in chronic kidney disease: what have we learned so far?

“…Since the CKD population is getting older, ageing is a prominent cause of sarcopenia in ESKD; however, it is likely that this group is more vulnerable to muscle changes than their non-CKD counterparts, but also in comparison to the younger CKD population. This was demonstrated by Çelik et al [51] who noticed that HD patients aged 65 years and older had lower FFM index, serum creatinine and dry body weight than the younger patients (< 65 years) and by D'Alessandro et al [52] who showed that sarcopenia was more prevalent in older (> 75 years) than in younger (65-74 years) seniors with CKD stage 3a and 4 (prevalence 55% vs 12.5%, respectively). Of note, the latter study showed that the three components of sarcopeniaskeletal muscle index, handgrip strength (HGS) and performance tests (sit-to-stand-chair-test and 6-min-walk-test) were significantly lower in the older senior CKD patients [52].…”

“…This was demonstrated by Çelik et al [51] who noticed that HD patients aged 65 years and older had lower FFM index, serum creatinine and dry body weight than the younger patients (< 65 years) and by D'Alessandro et al [52] who showed that sarcopenia was more prevalent in older (> 75 years) than in younger (65-74 years) seniors with CKD stage 3a and 4 (prevalence 55% vs 12.5%, respectively). Of note, the latter study showed that the three components of sarcopeniaskeletal muscle index, handgrip strength (HGS) and performance tests (sit-to-stand-chair-test and 6-min-walk-test) were significantly lower in the older senior CKD patients [52]. A study based on the EQUAL study (n = 1334) showed that the risk of PEW in CKD patients with eGFR < 20 ml/ In order to minimize influence from fluid retention, special care is advised for dialysis patients when assessing fat free mass.…”

“…In CKD, the first studies assessing the prevalence of sarcopenia are from 2013 and 2014 [54][55][56][57][58], and only in the last couple of years the scientific literature in this area received many more contributions (Table 3). Up to now, the most used sarcopenia operational criteria was the EWGSOP 1, which was applied in 12 studies [52,55,[57][58][59][60][61][62][63][64][65][66] (sarcopenia prevalence 4-49%), while 4 studies defined sarcopenia only by low muscle mass, not assessing muscle strength or performance [54,[67][68][69]. An important finding in these studies is that sarcopenia, understood as concomitant low muscle mass and low muscle strength, is a feature of muscle changes in CKD.…”

Comprehensive geriatric assessment in nephrology

“…Prevalence of sarcopenia in CKD is high, increases with age and severity of the disease. Several physiopathological models of sarcopenia in CKD have been suggested but protein intake restriction probably plays an important role 20 .…”