Sarcopenia in patients with chronic kidney disease not yet on dialysis: Analysis of the prevalence and associated factors

Abstract

IntroductionSarcopenia is a chronic condition that is associated with aging and characterized by a reduction of muscle mass, strength, and function. Sarcopenia is prevalent in patients with chronic kidney disease (CKD) and associated with increased morbidity and mortality, as well as cardiovascular complications.ObjectivesTo investigate the prevalence of sarcopenia in patients with CKD not yet on dialysis and its correlation with clinical and laboratory variables and inflammatory markers.MethodsA total of 100 patients of both sexes aged over 18 were evaluated. Sarcopenia was defined using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. Sociodemographic and clinical data, activities of daily living, functional capacity, and physical activity were also evaluated. Inflammation was assessed by the serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin (IL) 4 and 6.ResultsThe prevalence of sarcopenia was 11.9% and 28.7% using the EWGSOP and FNIH criteria, respectively. Sarcopenia was more prevalent in the more advanced stages of CKD (34.5% in stages 2 and 3A; and 65.5% in stages 3B, 4, and 5) and associated with worse performance in activities of daily living (p = 0.049), lower walking speeds (p < 0.001), and higher body mass indexes (BMIs) (p = 0.001) in the non-adjusted model. In addition, patients with sarcopenia had lower functional capacity (p = 0.012) and higher prevalence of physical inactivity (p = 0.041) compared with patients without sarcopenia. After adjustment for confounding variables, sarcopenia was still significantly correlated with walking speed (p = 0.004) and BMI (p = 0.002). HsCRP levels were inversely correlated with appendicular lean mass adjusted for BMI (p = 0.007) and were also positively associated with BMI (p = 0.001). IL4 levels were positively correlated with walking speed (p = 0.007) and lean mass in the lower limbs (p = 0.022).ConclusionsSarcopenia is common in patients with CKD, particularly in the most advanced stages of the disease. We observed an association between the levels of inflammatory markers and peripheral lean body mass, physical performance, and BMI. This association between sarcopenia and modifiable factors highlights the importance of early diagnosis and the implementation of therapeutic measures to minimize adverse outcomes in patients with CKD not yet on dialysis.

Relative sarcopenia and mortality and the modifying effects of chronic kidney disease and adiposity

“…A reduction in skeletal muscle mass and strength, sarcopenia, can gradually occur with age 1,2 and is associated with mortality across many populations 3,4 including patients with end stage renal disease, 5,6 among whom more than 20% have sarcopenia. 7,8 Patients with chronic kidney disease (CKD) not requiring dialysis also have a high prevalence of sarcopenia [9][10][11] although previous studies evaluating associations between sarcopenia and mortality in CKD have shown inconsistent results. [12][13][14] Muscle mass is directly correlated with fat mass such that with higher fat mass, there is generally a compensatory increase in muscle mass.…”

Wasting in Chronic Kidney Disease – a Complex Issue

“…Furthermore, some patients with chronic conditions such as CKD may have overt muscle wasting and be at risk of frailty but not always show any significant weight loss (due to changes in body fat and body water), and hence not termed as having cachexia or PEW. This is highlighted in the sarcopenia study by Souza et al where it would appear that participants are suffering from sarcopenic obesity (27). This could be the effects of the illness combined with dietary protein restriction (therapeutic treatment for CKD) and lack of physical activity, thus having an unfavourable effect on muscle protein turnover and overall muscle mass.…”

“…This is something that requires further discussion by consensus groups. Souza et al investigated the prevalence of sarcopenia in CKD patients not yet on dialysis (n=100) in Brazil and used the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Foundation for National Institutes of Health (FNIH) Sarcopenia Project (27). The mean age of the group was 73.59 years.…”

“…It may be that this group which was not on dialysis may have symptoms which precede overt wasting accompanied with the highly catabolic dialysis phase. A further important point highlighted by Souza et al is that sarcopenia may develop at earlier stages of CKD (27). This would indicate the importance of assessing muscle mass, strength and physical function early on in CKD diagnosis as patients could be greater risk of developing frailty and disability.…”

Hyperlipidemia and Statins Use for the Risk of New Diagnosed Sarcopenia in Patients with Chronic Kidney: A Population-Based Study

“…Previous research have pointed out that patients with chronic kidney disease often suffer from metabolic acidosis, which may lead to increase in protein catabolism, decrease in protein synthesis, insulin resistance, chronic inflammation, decrease in serum leptin concentration that may cause increase in the breakdown of branched amino acids and muscle proteins, thus inhibiting muscle protein synthesis [21][22][23][24] and resulting in increased occurrences of sarcopenia in late stage patients with chronic kidney disease [25]. However, there has been no research related to the exploration on the usage of statins in patients with chronic kidney disease and the incidence risk of sarcopenia.…”