Uraemic sarcopenia: aetiology and implications

Abstract

The term uraemic myopathy has been used loosely to describe the skeletal muscle abnormalities in uraemic patients. However, it does not fully explain the observed abnormalities as recent research has documented a normal skeletal muscle physiology in the presence of reduced muscle force, selective structural changes and significant muscle wasting. Ageing is associated with sarcopenia (muscle wasting) and an increase in the prevalence of chronic kidney disease (CKD), which accelerates the normal physiological muscle wasting. Similar to sarcopenia, muscle wasting in uraemic patients appears to be the hallmark of the disease and its aetiology is multifactorial with hormonal, immunologic and myocellular changes, metabolic acidosis, reduced protein intake and physical inactivity. Uraemic sarcopenia presents a high probability for morbidity and mortality and consequently a high priority for muscle wasting prevention and treatment in these patients. Perhaps, the use of the term 'uraemic sarcopenia' would provide recognition by the renal community for this devastating problem. The purpose of this review is to relate the findings of the recent publications that describe abnormalities in uraemic skeletal muscle to the possible pathogenesis of muscle wasting and its consequences in patients with CKD.

Comparative Associations of Muscle Mass and Muscle Strength with Mortality in Dialysis Patients

“…This prevalence is in line with a previous report in CKD stage$3 (16) and prevalent hemodialysis patients (17). It has been proposed that advanced CKD is a condition associated with a process of "accelerated aging" (11,12) and that the effect of various prevalent CKD-associated catabolic alterations may explain why sarcopenia is such a prominent typical feature in CKD (14). Although a lack of control group in our study does not allow us to make solid conclusions, the observed prevalence is within the range reported in geriatric populations (8)(9)(10).…”

“…CKD is considered a risk factor for accelerated aging (11), and prospective studies in older adults with CKD have quantified the risk for physical disability and cognitive decline as being approximately double that of the age-matched general population (12). Although the term sarcopenia is often used in the literature to describe muscle derangements in patients with CKD (13)(14)(15), there are only two studies that have formally assessed its prevalence and clinical correlates. Sarcopenia was more prevalent in individuals with CKD stage$3 than in individuals with normal renal function (16), whereas it affected one third of prevalent hemodialysis patients (17).…”

Sarcopenia in chronic kidney disease on conservative therapy: prevalence and association with mortality

“…Although originally known as a condition related to aging, various international societies currently recognize the important role of catabolic diseases, such as chronic kidney disease (CKD), in the etiology of sarcopenia [1][2][3][4]. In fact, metabolic derangements inherent to CKD lead to increased protein catabolism, resulting in diminished muscle mass and function, independently of age [14,15]. Therefore, it can be hypothesized that CKD patients are prone to develop sarcopenia.…”

Benefits of Physical Exercise in Patients with Chronic Kidney Disease and Hemodialysis: A Mini Review

“…Chronic kidney disease is a catabolic state that activates different intracellular signaling pathways that decrease protein synthesis and increase protein degradation [23]. Some of the pathological mechanisms described in the literature that favor this catabolic state involve metabolic acidosis, increase angiotensin II, systemic inflammation and a sedentary lifestyle [24,25].…”