Sarcopenia and cardiovascular risk indices in patients with chronic kidney disease on conservative and replacement therapy

Lai, Silvia; Muscaritoli, Maurizio; Andrea, Paola; Sgreccia, Alessandro; Leo, Sabrina; Mazzaferro, Sandro; Mitterhofer, Anna Paola; Pasquali, Marzia; Parini, Paolo; Spagnoli, Alessandra; Amabile, Maria Ida; Molfino, Alessio

doi:10.1016/j.nut.2018.12.005

Cited by 60 publications

(55 citation statements)

References 40 publications

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“…In addition, low protein intake, metabolic acidosis, lack of exercise, oxidative stress and inflammation often occur in CKD patients, which affect muscle quality and increase the incidence of sarcopenia in this population, and may also be a factor leading to the decline of ADL. 58 Although the association between CKD and functional decline has been widely studied, more studies are needed in the future to further explore the biological mechanism of functional decline in patients with CKD.…”

Section: Discussionmentioning

confidence: 99%

<p>Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3–5: A Case–Control Study</p>

Chang¹,

Hou²,

Wang³

et al. 2020

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Introduction: Elderly people are at increased risk of falls, disability and death due to reduced functional reserve, decline in multiple systems functions, which affects their activities of daily living (ADL) and eventually develop into frailty. The ADL assessment is conducive to early detection to avoid further serious situations. Previous studies on patients' activities of daily living with chronic kidney disease (CKD) are mainly focused on dialysis patients. Little information is available on non-dialysis patients. Patients and Methods: A total of 303 elderly patients with CKD stage 3-5 who were admitted to our hospital were selected. ADL evaluation was performed on patients at admission, with Barthel index (BI) as the evaluation tool. They were divided into two groups based on BI (≥60 and <60). Demographic information, lifestyle and clinical profile were collected. The risk factors related to ADL were analyzed by univariate and multivariate models. Results: The data of 303 patients enrolled in this study were analyzed. The average age of patients was 84.48± 7.14 years and 62.05% were male. There were 88 patients (29.04%) in BI <60 group and 215 patients (70.96%) in the BI ≥60 group. The average age of subjects in the two groups was 87.47 ± 5.85 years and 83.26± 7.28 years, respectively. On univariate analysis, ADL impairment was associated with many factors, such as age, body mass index, blood lipid, heart rate, smoking history, Charlson comorbidity index (CCI), hemoglobin, serum albumin, BNP, eGFR, etc. Multivariate logistic regression showed that age (OR 1.08, 95% CI 1.00-1.17, P=0.0390), Charlson comorbidity index (OR 4.75, 95% CI 1.17-19.30, P=0.0295), and serum albumin (OR 0.80, 95% CI 0.70-0.92, P=0.0012) were the independent risk factors of ADL impairment. Conclusion: Decline of ADL in CKD patients was independently correlated with age, Charlson comorbidity index and serum albumin. ADL and its influential factors in the elderly CKD patients deserve further attention.

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Section: Discussionmentioning

confidence: 99%

<p>Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3–5: A Case–Control Study</p>

Chang¹,

Hou²,

Wang³

et al. 2020

CIA

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“…Similar to PEW in CKD, nephrotic syndrome associated PEW is associated with an acceleration in atherosclerosis development, even in children [ 32 ]. Not only sarcopenia contributes to it, but also lipid disorders, increased activation of platelets, hypercoagulability, associated hormonal disorders, progressive renal failure [ 33 – 37 ]. Moreover, as we have discovered, hyperphosphatemia and hyperuricemia, recognized independent risk factors of cardiovascular events, were present in patients with severe NS [ 38 – 40 ].…”

Section: Discussionmentioning

confidence: 99%

Protein energy-wasting associated with nephrotic syndrome – the comparison of metabolic pattern in severe nephrosis to different stages of chronic kidney disease

et al. 2020

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Background: Nephrotic syndrome (NS) is associated with a hypercatabolic state expressed as an exacerbated degradation of muscle mass. However, the clinical significance of this phenomenon has not yet been investigated. The aim of the study was to evaluate the nutritional status of patients with severe NS (defined as nephrotic range proteinuria with hypoalbuminemia ≤2.5 g/dL) and estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m 2 in comparison to patients in different stages of chronic kidney disease (CKD). Methods: Twenty men with severe NS (NS group) and 40 men without proteinuria similar in term of serum creatinine (control group) were included into the study. A retrospective cohort of 40 men with CKD stage G4 (PreD group) and 20 haemodialysis men (HD group) were added to the analysis after matching for age, height and weight using propensity score matching. The bioimpedance spectroscopy and biochemical nutritional markers were evaluated. Results: Nephrotic patients had a significantly lower lean tissue mass (LTM; p = 0.035) and index (a quotient of LTM over height squared, LTI; p = 0.068), with an expected deficiency of LTM by 3.2 kg, and LTI by 0.9 kg/m 2 when compared to the control group. A significant lean tissue deficit (defined as LTI below the lower limit of the reference range by 1.0 kg/m 2) was observed in 12.5% of patients in the control group in comparison to 31.7% with advanced CKD (PreD+HD; p = 0.032) and 50% with NS (p = 0.003). NS group presented with higher phosphorus (p = 0.029), uric acid (p = 0.002) and blood urea (p = 0.049) than the control group. Blood urea was strongly negatively correlated with LTM in NS (r = − 0.64, p = 0.002). Nine nephrotic patients (45%) were identified as hypercatabolic based on severe hyperphosphatemia (> 5.0 mg/dL) and/or hyperuricemia (> 8.0 mg/dL), and were characterized by higher blood urea and lower prealbumin, as well as LTM lower by 5.6 kg than in less catabolic individuals. Conclusions: In term of lean tissue amount, NS group was more similar to advanced CKD than to the control group. We concluded that specific metabolic pattern with elevated phosphorus, uric acid and blood urea, and lean tissue deficiency may be defined as protein-energy wasting associated with nephrotic syndrome (neph-PEW).

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“…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.…”

Section: Prevalence Of Sarcopenia In Ckd: the Role Of Different Operamentioning

confidence: 99%

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

et al. 2020

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The term sarcopenia was first introduced in 1988 by Irwin Rosenberg to define a condition of muscle loss that occurs in the elderly. Since then, a broader definition comprising not only loss of muscle mass, but also loss of muscle strength and low physical performance due to ageing or other conditions, was developed and published in consensus papers from geriatric societies. Sarcopenia was proposed to be diagnosed based on operational criteria using two components of muscle abnormalities, low muscle mass and low muscle function. This brought awareness of an important nutritional derangement with adverse outcomes for the overall health. In parallel, many studies in patients with chronic kidney disease (CKD) have shown that sarcopenia is a prevalent condition, mainly among patients with end stage kidney disease (ESKD) on hemodialysis (HD). In CKD, sarcopenia is not necessarily age-related as it occurs as a result of the accelerated protein catabolism from the disease and from the dialysis procedure per se combined with low energy and protein intakes. Observational studies showed that sarcopenia and especially low muscle strength is associated with worse clinical outcomes, including worse quality of life (QoL) and higher hospitalization and mortality rates. This review aims to discuss the differences in conceptual definition of sarcopenia in the elderly and in CKD, as well as to describe etiology of sarcopenia, prevalence, outcome, and interventions that attempted to reverse the loss of muscle mass, strength and mobility in CKD and ESKD patients.

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Sarcopenia and cardiovascular risk indices in patients with chronic kidney disease on conservative and replacement therapy

Cited by 60 publications

References 40 publications

<p>Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3–5: A Case–Control Study</p>

<p>Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3–5: A Case–Control Study</p>

Protein energy-wasting associated with nephrotic syndrome – the comparison of metabolic pattern in severe nephrosis to different stages of chronic kidney disease

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

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