Uremic myopathy: is oxidative stress implicated in muscle dysfunction in uremia?

Καλτσάτου, Αντωνία; Sakkas, Giorgos K.; Poulianiti, Konstantina; Koutedakis, Yiannis; Tepetes, Konstantinos; Christodoulidis, Grigorios; Stefanidis, Ioannis; Karatzaferi, Christina

doi:10.3389/fphys.2015.00102

Cited by 38 publications

(49 citation statements)

References 57 publications

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“…44 However, demonstration of weakness in proximal pelvic muscles is a strong indicator of myopathy. Muscle biopsy studies have shown atrophy of type II fibres and fibre splitting, 44,45 but biopsy is rarely undertaken due to the invasive nature of the procedure. No specific treatment exists for uraemic myopathy however management of the potential contributing factors such as hyperparathyroidism, vitamin D and anaemia may be beneficial.…”

Section: Physical Disabilitymentioning

confidence: 99%

Neurological complications in chronic kidney disease

Arnold

Issar

Krishnan

et al. 2016

JRSM Cardiovascular Disease

162

129

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Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

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Section: Physical Disabilitymentioning

confidence: 99%

Neurological complications in chronic kidney disease

Arnold

Issar

Krishnan

et al. 2016

JRSM Cardiovascular Disease

162

129

View full text Add to dashboard Cite

show abstract

“…Instead, these functional differences may result, at least in part, from the greater degree of pre-existent muscle and nerve dysfunction caused by sequelae of renal failure itself. 19 , 23 , 24 …”

Section: Discussionmentioning

confidence: 99%

The Spectrum of Hand Dysfunction After Hemodialysis Fistula Placement

Rehfuss

Berceli

Barbey

et al. 2017

Kidney International Reports

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IntroductionContemporary dogma has classically attributed hand dysfunction following hemodialysis arteriovenous fistula (AVF) placement to regional ischemia. We hypothesize that hemodynamic perturbations alone do not entirely explain the postoperative changes in hand function and, furthermore, that various elements of hand function are differentially affected following surgery.MethodsBilateral wrist and digital pressures and upper extremity nerve conduction tests were recorded preoperatively and at 6 weeks and 6 months following upper extremity AVF construction in 46 patients. Concurrently, biomechanical tests were administered to evaluate multiple limb functional domains, including grip strength, dexterity, sensation, and perception of hand function.ResultsMean participant age was 59 ± 14 years (75% male), and 48% were on hemodialysis at the time of access placement. Of the participants, 69% had a brachial-based AVF, and the remainder had radial-based accesses. Six weeks following AVF placement, a significant decrease in access-side digital pressures was observed, with only partial recovery at 6 months (P < 0.0001). Grip strength was significantly worse in the access-side limb (P = 0.0003), and the Disability of Arm, Shoulder and Hand (DASH) questionnaire score substantially worsened postoperatively (P = 0.06). Digital sensation and limb dexterity did not differ between limb sides (P > 0.1) or change significantly over time (P > 0.1). Principal component analyses demonstrated that nerve conduction parameters tended to track the biomechanical parameters, yet both were relatively independent of the hemodynamic parameters.DiscussionOur findings suggest that ischemia alone does not completely explain access-related hand dysfunction and that future study is needed to elucidate alternative mechanisms.

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“…Yet this is confounded by the fact that as patients’ CKD progresses, they may also accumulate multiple comorbidities that limit the ability to be active, and that uremia itself is strongly associated with increasing fatigue, impaired muscle function, and reduced exercise tolerance. 24 , 25 The emphasis may also be to encourage greater physical activity in the early stages of CKD, to improve or maintain cardiac function, which may help to prevent associated kidney decline (e.g., cardiorenal syndrome). The threshold for when an exercise intervention is needed, and the type of intervention required to improve physical activity level and kidney health, requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

The Association of Daily Activity Levels and Estimated Kidney Function in Men and Women With Predialysis Chronic Kidney Disease

West

Chaudhry

et al. 2017

Kidney International Reports

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IntroductionChronic kidney disease (CKD) is often accompanied by complications including poor physical activity level. However, only a few studies have objectively characterized physical activity levels in predialysis CKD. Our study sought to measure daily activity levels by accelerometry in individuals with CKD (stages III−V) and to determine the association between daily activity and kidney function.MethodsWe determined kidney function by means of the estimated glomerular filtration rate (eGFR) using the Modification of Diet and Renal Disease (MDRD) equation. Participants wore an accelerometer for 7 consecutive days, and we measured multiple physical activity outcomes including total daily activity, sedentary, light, and moderate−vigorous activity. Average durations and intensity of activity were determined according to stage of CKD. The association between kidney function and activity level was determined by regression analysis.ResultsWe analyzed data from 110 individuals (60% men and 40% women) with stages III to V CKD. The mean age of our participants was 64 years, mean body mass index was 27.5 kg/m2, and mean eGFR was 23.7 ± 1.2 ml/min/1.73 m2. Our participants were primarily sedentary (mean duration of inactivity = 1152 ± 100 minutes per day; 79% of day). Light activity was performed 280 ± 99 minutes per day, and individuals participated in only 6 ± 9 minutes per day of moderate−vigorous activity. The eGFR did not predict physical activity level (P > 0.05 for all).DiscussionIndividuals with stages III to V CKD are sedentary, and do not meet the national recommendations of 150 minutes of moderate−vigorous activity per week. Further study is required to determine whether interventions to increase activity levels in patients with CKD are associated with improved health outcomes.

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Uremic myopathy: is oxidative stress implicated in muscle dysfunction in uremia?

Cited by 38 publications

References 57 publications

Neurological complications in chronic kidney disease

Neurological complications in chronic kidney disease

The Spectrum of Hand Dysfunction After Hemodialysis Fistula Placement

The Association of Daily Activity Levels and Estimated Kidney Function in Men and Women With Predialysis Chronic Kidney Disease

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