Sarcopenia is Associated with Malnutrition but Not with Systemic Inflammation in Older Persons with Advanced CKD

Abstract

Background: In patients with chronic kidney disease (CKD), sarcopenia can be determined by a wide spectrum of risk factors. We evaluated the association of sarcopenia with nutritional, behavioral and inflammatory patterns in older patients with advanced CKD. Methods: we cross-sectionally evaluated 113 patients with CKD stages 3b-5. Sarcopenia was defined according to the EWGSOP2 criteria. We assessed: anthropometry, bioelectrical impedance analysis, physical, and psychological performance. Nutritional status was assessed using the Malnutrition Inflammation Score (MIS) and by verifying the eventual presence Protein Energy Wasting syndrome (PEW). Systemic inflammation was assessed by dosing: CRP, IL6, TNFα, MCP1, IL10, IL17, fetuin, IL12. Results: 24% of patients were sarcopenic. Sarcopenic individuals had lower creatinine clearance (18 ± 11 vs. 23 ± 19 mL/min; p = 0.0087) as well as lower BMI (24.8 ± 3.0 vs. 28.4 ± 5.5 Kg/m2; p < 0.0001) and a lower FTI (11.6 ± 3.9 vs. 14.4 ± 5.1 kg/m2, p = 0.023). Sarcopenic persons had higher prevalence of PEW (52 vs. 20%, p < 0.0001) and a tendency to have higher MIS (6.6 ± 6.5 vs. 4.5 ± 4.0, p = 0.09); however, they did not show any difference in systemic inflammation compared to non-sarcopenic individuals. Conclusions: CKD sarcopenic patients were more malnourished than non-sarcopenic ones, but the two groups did not show any difference in systemic inflammation.

Development of Taiwan Risk Score for Sarcopenia (TRSS) for Sarcopenia Screening among Community-Dwelling Older Adults

“…This result was similar to those reported in a previous study, in which the sarcopenia index (SI), defined as serum creatinine/serum cystatin C × 100, was an applicable predictor of muscle mass [38]. Moreover, sarcopenic individuals had lower creatinine clearance, which is related to regeneration of muscle tissue [39,40]. Therefore, we supposed that creatinine level might be a better predictor of sarcopenia than eGFR.…”

Malnutrition as a Strong Predictor of the Onset of Sarcopenia

“…In our study, the ESPEN criteria seemed to be slightly more related to the incidence of sarcopenia than the new GLIM criteria. The links between malnutrition and sarcopenia have already been explored in several cross-sectional studies: In older patients with advanced chronic disease (Stages 3b-5) by using the malnutrition inflammation score (MIS) for the diagnosis of malnutrition and the EWGSOP2 for the diagnosis of sarcopenia [37], in older patients with chronic pulmonary disease by using the ESPEN [38] and the EWGSOP2 [38] criteria, and in older people discharged from post-acute care by using the ESPEN and the EWGSOP criteria [39]. However, the cross-sectional study design did not allow the authors to establish cause-effect relationships.…”

Frailty phenotype and multi-domain impairments in older patients with chronic kidney disease

“…We evaluated 112 patients attending our outpatient clinic for advanced CKD between 9/2016 and 3/2018 (belonging to the population included in the PROVE study that has already been described elsewhere [14]). We asked to participate to the study to all eligible patients that attended the clinic during the enrollment period, when they came for a control visit.…”

“…We measured: body weight, height, body mass index (BMI, calculated according to Quetelet Index (kg/m 2 )) and mid-arm muscle circumference (MAMC) of the dominant arm [14].…”

“…Physical Activity Scale (PAS) is designed to assess the degree of physical activity of CKD patients aged ≥65 years and a score < 7 corresponds to reduced overall physical activity [14]. PAS < 7 was used to define the reduction of physical activity in the assessment of FP score.…”