Evaluation of the impact of an intradialytic exercise programme on sarcopaenia in very elderly haemodialysis patients

Definition and evolution of the concept of sarcopenia

Sarcopenia and dynapenia are two terms associated with ageing that respectively define the loss of muscle mass and strength. In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP) introduced the EWGSOP2 diagnostic algorithm for sarcopenia, which integrates both concepts. It consists of 4 sequential steps: screening for sarcopenia, examination of muscle strength, assessment of muscle mass and physical performance; depending on these last 3 aspects sarcopenia is categorised as probable, confirmed, and severe respectively. In the absence of validation of the EWGSOP2 algorithm in various clinical contexts, its use in haemodialysis poses several limitations: (a) low sensitivity of the screening, (b) the techniques that assess muscle mass are not very accessible, reliable, or safe in routine clinical care, (c) the sequential use of the magnitudes that assess dynapenia and muscle mass do not seem to adequately reflect the muscular pathology of the elderly person on dialysis. We reflect on the definition of sarcopenia and the use of more precise terms such as "myopenia" (replacing the classic concept of sarcopenia to designate loss of muscle mass), dynapenia and kratopenia. Prospective evaluation of EWGSOP2 and its comparison with alternatives (i.e. assessment of kratopenia and dynapenia only; steps 2 and 4) is proposed in terms of its applicability in clinical routine, resource consumption, identification of at-risk individuals and impact on events.

Prevalence of sarcopenia in patients with chronic kidney disease: a global systematic review and meta-analysis

Sarcopenia is a risk factor for adverse clinical outcomes in chronic kidney disease (CKD) patients, including mortality. Diagnosis depends on adopted consensus definition and cutoff values; thus, prevalence rates are generally heterogeneous. We conducted a systematic review and meta-analysis to investigate the global prevalence of sarcopenia and its traits across the wide spectrum of CKD. A systematic search was conducted using databases, including MEDLINE and EMBASE, for observational studies reporting the prevalence of sarcopenia. We considered sarcopenia according to the consensus definition of the European Working Group on Sarcopenia in Older People (EWGSOP), the Asian Working Group for Sarcopenia, the Foundation for the National Institutes of Health Sarcopenia Project, and the International Working Group on Sarcopenia (IWGS). Subgroup analyses by CKD stages, consensus, and gender were performed. Pooled prevalence was obtained from random-effect models. A total of 140 studies (42 041 patients) across 25 countries were included in this systematic review and meta-analyses. Global prevalence of sarcopenia was 24.5% [95% confidence interval (CI): 20.9-28.3) and did not differ among stages (P = 0.33). Prevalence varied according to the consensus definition from 11% to 30%, with no significant difference (P = 0.42). Prevalence of severe sarcopenia was 21.0% (95% CI: 11.7-32.0), with higher rates for patients on dialysis (26.2%, 95% CI: 16.6-37.1) compared to non-dialysis (3.0%, 95% CI: 0-11.1; P < 0.01). Sarcopenic obesity was observed in 10.8% (95% CI: 3.5-21.2). Regarding sarcopenia traits, low muscle strength was found in 43.4% (95%CI: 35.0-51.9), low muscle mass in 29.1% (95% CI: 23.9-34.5), and low physical performance in 38.6 (95% CI: 30.9-46.6) for overall CKD. Prevalence was only higher in patients on dialysis (50.0%, 95% CI: 41.7-57.4) compared to non-dialysis (19.6%, 95% CI: 12.8-27.3; P < 0.01) for low muscle strength. We found a high global prevalence of sarcopenia in the wide spectrum of CKD. Low muscle strength, the primary sarcopenia trait, was found in almost half of the overall population with CKD. Patients on dialysis were more prevalent to low muscle strength and severe sarcopenia. Nephrology professionals should be aware of regularly assessing sarcopenia and its traits in patients with CKD, especially those on dialysis.

The impact of aerobic exercise on health-related quality of life among patients undergoing maintenance hemodialysis

To investigate the effect of exercise on cardiopulmonary function and the life quality of maintenance hemodialysis patients. Eighty-four patients who underwent maintenance hemodialysis treatment for more than 3 months were randomly divided into experimental group and control group. The general data and nutritional indexes, including hemoglobin and plasma albumin, before and after the experiment. The differences in lung function, cardiac ultrasound, cardiopulmonary function, exercise endurance between the 2 groups before and after intervention were compared. The short form 36-item health survey (SF-36) and self-rating depression scale (SDS) were assessed. In our study, the experimental group had better Force vital capacity (FVC) and peak expiratory flow (PEF) after the intervention compared to the control group (P < .05). Anaerobic threshold and 6-minute walk test (6MWT) improved significantly in the experimental group (P < .05), and SF-36 showed better physical functioning, social functioning, general health, and vitality scores in the experimental group compared to the control group (P < .05). In addition, following 24 weeks of exercise, the Depression score of the exercise group showed a statistically significant improvement when compared to the control group (P < .05). After the intervention, hemoglobin improved significantly in the experimental group (P < .05). Intradialytic exercise can improve hemoglobin, Alb, pulmonary function, aerobic capacity, and exercise endurance in maintenance hemodialysis patients, so as to improve the quality of life, which is worthy of further promotion.

Interventions to increase physical activity level in patients with whole spectrum chronic kidney disease: a systematic review and meta-analysis

Background: Little is known about effective interventions to increase physical activity levels in this population. This systematic review and meta-analysis evaluated the effectiveness of different interventions for physical activity levels in whole-spectrum CKD patients.Methods: In this systematic review and meta-analysis, PubMed, Embase, and Web of Science were searched from inception to December 2022, with an update in March 2023. Studies of clinical interventions based on assessing physical activity outcomes (e.g., daily steps, time spent doing physical activity) in patients with whole-spectrum CKD were included. The pooled effect size was calculated using a restricted maximum likelihood method and reported as a standardized mean difference (SMD) with 95% confidence interval (95% CI).Results: The systematic review included 2,156 participants (59.9 ± 8.7 years) from 35 studies. Interventions aimed at modifying physical activity were associated with significantly higher physical activity levels in patients with CKD (SMD = 0.22; 95% CI: 0.08 to 0.36; I2 = 55%). Exercise-based interventions and real-time step feedback increased physical activity by 0.26 (95% CI: 0.07 to 0.45; I2 = 59%) and 0.36 (95% CI: 0.12 to 0.60; I2 = 0%) standard deviations, respectively. Effect sizes did not vary by disease stage or study duration; however, there was evidence of small study or publication bias for the primary analysis.Conclusion: In this systematic review and meta-analysis, intervention strategies aimed at modifying physical activity were associated with significantly increased physical activity levels in patients with whole-spectrum CKD.

A Sarcopenia Index Derived from Malnutrition Parameters in Elderly Haemodialysis Patients

(1) Background: Persons with chronic kidney disease may have sarcopenia characterized by the loss of muscle mass and loss of muscle strength. However, EWGSOP2 criteria to diagnose sarcopenia are technically challenging, especially in elderly persons on hemodialysis. Sarcopenia may be associated with malnutrition. We aimed at defining a sarcopenia index derived from malnutrition parameters for use in elderly haemodialysis patients. (2) Methods: A retrospective study of 60 patients aged 75 to 95 years treated with chronic hemodialysis was conducted. Anthropometric and analytical variables, EWGSOP2 sarcopenia criteria and other nutrition-related variables were collected. Binomial logistic regressions were used to define the combination of anthropometric and nutritional parameters that best predict moderate or severe sarcopenia according to EWGSOP2, and performance for moderate and severe sarcopenia was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. (3) Results: The combination of loss of strength, loss of muscle mass and low physical performance correlated with malnutrition. We developed regression-equation-related nutrition criteria that predicted moderate sarcopenia (elderly hemodialysis sarcopenia index-moderate, EHSI-M) and severe sarcopenia (EHSI-S) diagnosed according to EWGSOP2 with an AUC of 0.80 and 0.866, respectively. (4) Conclusions: There is a close relationship between nutrition and sarcopenia. The EHSI may identify EWGSOP2-diagnosed sarcopenia from easily accessible anthropometric and nutritional parameters.

Clasificación funcional del paciente anciano en hemodiálisis y su influencia en la individualización del tratamiento

Introducción: La edad de los pacientes en hemodiálisis está aumentando, presentando mayor deterioro. Objetivos: Conocer la situación del paciente ancia­no en hemodiálisis categorizando nuestra población. Ana­lizar la relación entre las escalas de funcio­nalidad, desnutrición y comorbilidad. Material y Método: Estudio descriptivo transversal, pacien­tes 75-95 años. Se midieron: a) Comorbilidad-CHARLSON: alta (>6 puntos). b) Nutrición-MISS: extremadamente des­nutrido (<10 puntos.); desnutrición muy severa (>7-10 puntos); moderada-severa (>5-7 puntos); leve-moderada (>2-5 puntos); normonutrido (<2 puntos); c) Dependencia-BAR­THEL, independiente (100 puntos); dependencia leve (91-99 puntos); moderada (61-90 puntos.); severa (21-60 puntos.); total (<20 puntos). d) Fragilidad-FRAIL, no fragilidad (0 puntos); prefrágil (1-2 puntos); frágil (>3 puntos). Resultados: 60 pacientes, 68%(41) hom­bres, edad media 81,85±5,58 años y tiempo HD 49,88±40,29 meses. Etiología más prevalente, diabe­tes mellitus (28%). MIS: 6,01±3,80 puntos. clasificándose 8(13%) normonu­tridos, 24(40%) desnutrición leve-moderada, 10(17%) desnutrición moderada-severa, 13(22%) desnutrición muy severa y 5(8%) extremadamente desnutridos. BARTHEL: 88,16±18,59 puntos, clasificó 32(53%) independientes, 6(10%) dependencia leve, 17(28%) dependencia modera­da, 4(7%) dependencia severa, 1(2%) dependencia total. FRAIL: 1,98±1,32 puntos, clasificó 10(17%) no frágiles, 31(51%) prefrágiles y 19(32%) frágiles. CHARLSON: 10,01±2,20 puntos. Presentando 60(100%) alta comorbilidad. CHARLSON presentó diferencias entre sexo, mayor en hombres (p=0,002). Se encontró alta correlación entre Barthel y Frail (r=0,647,p<0,001), moderada entre MIS y Barthel (r=0,556, p<0,001) y MIS y Frail (r=0,455,p<0,001). Charlson obtuvo peor correlación. Conclusiones: Se evidenció gran deterioro ge­neral del paciente añoso en diálisis, alertando sobre la nece­sidad de realizar tratamientos individualizados enfocados en su recuperación, incluida la propia diálisis.