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Qaisar R, Burki A, Karim A, Ustrana S, Ahmad F. The Association of Intestinal Leak with Sarcopenia and Physical Disability in Patients with Various Stages of Chronic Kidney Disease. Calcif Tissue Int 2024; 115:132-141. [PMID: 38829421 DOI: 10.1007/s00223-024-01233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024]
Abstract
Sarcopenia is related to disease severity in chronic kidney disease (CKD) patients; however, its pathophysiology remains poorly known. We investigated the associations of biomarkers of intestinal leak with sarcopenia in various stages of CKD. We recruited 61-76-year-old male controls and patients with various stages of CKD (n = 36-57/group) for measuring plasma lipopolysaccharide-binding protein (LBP) and zonulin (markers of intestinal leak), handgrip strength (HGS), skeletal mass index (SMI), and gait speed (markers of sarcopenia), and short physical performance battery (SPPB; marker of physical capacity). CKD stages 4 and 5 were associated with lower HGS, SMI, gait speed, and cumulative SPPB scores and a higher sarcopenia prevalence than controls and patients with CKD stages 1 and 2 (all p < 0.05). CKD patients (stages 1 and 2) had elevated plasma zonulin and LBP when compared with CKD stages 4 and 5. Plasma zonulin and LBP exhibited significant correlations with renal function, HGS, gait speed, SPPB scores, and oxidative stress markers in CKD stages 4 and 5 (all p < 0.05). However, similar relations were not found in early CKD. Collectively, intestinal leak may be contributing to sarcopenia and physical disability in the advanced stages of CKD.
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Affiliation(s)
- Rizwan Qaisar
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
- Space Medicine Research Group, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
- Cardiovascular Research Group, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
| | - Ayousha Burki
- Department of Nephrology, Divisional Headquarter Hospital, Gomal Medical College, Dera Ismail Khan, Pakistan
| | - Asima Karim
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Iron Biology Research Group, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Shahjahan Ustrana
- Department of Biochemistry, Gomal Medical College, Dera Ismail Khan, Pakistan
| | - Firdos Ahmad
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Space Medicine Research Group, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Cardiovascular Research Group, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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de Resende E Silva DT, Bizuti MR, de Oliveira NR, Lima LZM, Dos Santos Arraes VG, Zietz ACG, Zin C, de Sousa Silva GV, Puhle JG, Haag FB. Physical exercise as a modulator of the purinergic system in the control of sarcopenia in individuals with chronic kidney disease on hemodialysis. Purinergic Signal 2024; 20:213-222. [PMID: 37368148 PMCID: PMC11189381 DOI: 10.1007/s11302-023-09950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
The word sarcopenia derives from the Greek terms "sarx" for meat and "penia" for loss, thus being used to define reductions in muscle mass, muscle strength, and lower physical performance that compromise, mainly, the elderly population. Its high negative impact on patients' quality of life encourages the production and publication of new studies that seek to find methods to prevent and reverse cases of loss of muscle mass and strength. Furthermore, the high prevalence of sarcopenia in patients with chronic kidney disease (CKD) is closely related to its pathophysiology, which consists of a state of increased protein catabolism and decreased muscle tissue synthesis. Also considering the inflammatory nature of CKD and sarcopenia, the purinergic system has been an important target of studies, which seek to relate it to the two previous conditions. This system achieves anti-inflammatory action by inhibiting, through adenosine, pro-inflammatory factors such as interleukin-12 (IL-12), tumor necrosis factor alpha (TNF-α), and nitric oxide (NO), as well as by releasing anti-inflammatory substances such as interleukin-10 (IL-10). Simultaneously, the purinergic system presents pro-inflammatory activity, signaled by adenosine triphosphate (ATP), which occurs through the activation of T cells and the release of pro-inflammatory factors such as those mentioned above. Therefore, the ability of this system to act on inflammatory processes can promote positive and negative changes in the clinical aspect of patients with CKD and/or sarcopenia. Furthermore, it appears that there is a correlation between the practice of repeated physical exercise with the clinical improvement and in the quality of life of these patients, presenting a decrease in the levels of C-reactive protein (CRP), NTPDase, and the pro-inflammatory cytokine IL-6, such as increases in IL-10 resulting from modulation of the purinergic system. In this way, the present article seeks to evaluate the effect of physical exercise as a modulator of the purinergic system in the control of sarcopenia in patients with CKD on hemodialysis, in order to trace a relationship that can bring benefits both for biological markers and for quality of life of these patients.
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Affiliation(s)
- Débora Tavares de Resende E Silva
- Department of Graduate Studies in Biomedical Sciences, Federal University of Fronteira Sul (UFFS), Rodovia SC 484-Km 02, Fronteira Sul, Chapecó, SC, CEP 89815-899, Brazil.
| | - Matheus Ribeiro Bizuti
- Department of Medicine, Federal University of Fronteira Sul (UFFS), Chapecó, Santa Catarina, Brazil
| | | | | | | | | | - Carolina Zin
- Department of Medicine, Federal University of Fronteira Sul (UFFS), Chapecó, Santa Catarina, Brazil
| | | | - Josiano Guilherme Puhle
- Department of Health Sciences, Western Santa Catarina University, Videira, Santa Catarina, Brazil
| | - Fabiana Brum Haag
- Nursing College, Federal University of Fronteira Sul (UFFS), Chapecó, Santa Catarina, Brazil
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Heitman K, Alexander MS, Faul C. Skeletal Muscle Injury in Chronic Kidney Disease-From Histologic Changes to Molecular Mechanisms and to Novel Therapies. Int J Mol Sci 2024; 25:5117. [PMID: 38791164 PMCID: PMC11121428 DOI: 10.3390/ijms25105117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic kidney disease (CKD) is associated with significant reductions in lean body mass and in the mass of various tissues, including skeletal muscle, which causes fatigue and contributes to high mortality rates. In CKD, the cellular protein turnover is imbalanced, with protein degradation outweighing protein synthesis, leading to a loss of protein and cell mass, which impairs tissue function. As CKD itself, skeletal muscle wasting, or sarcopenia, can have various origins and causes, and both CKD and sarcopenia share common risk factors, such as diabetes, obesity, and age. While these pathologies together with reduced physical performance and malnutrition contribute to muscle loss, they cannot explain all features of CKD-associated sarcopenia. Metabolic acidosis, systemic inflammation, insulin resistance and the accumulation of uremic toxins have been identified as additional factors that occur in CKD and that can contribute to sarcopenia. Here, we discuss the elevation of systemic phosphate levels, also called hyperphosphatemia, and the imbalance in the endocrine regulators of phosphate metabolism as another CKD-associated pathology that can directly and indirectly harm skeletal muscle tissue. To identify causes, affected cell types, and the mechanisms of sarcopenia and thereby novel targets for therapeutic interventions, it is important to first characterize the precise pathologic changes on molecular, cellular, and histologic levels, and to do so in CKD patients as well as in animal models of CKD, which we describe here in detail. We also discuss the currently known pathomechanisms and therapeutic approaches of CKD-associated sarcopenia, as well as the effects of hyperphosphatemia and the novel drug targets it could provide to protect skeletal muscle in CKD.
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Affiliation(s)
- Kylie Heitman
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Matthew S. Alexander
- Division of Neurology, Department of Pediatrics, The University of Alabama at Birmingham and Children’s of Alabama, Birmingham, AL 35294, USA
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Department of Genetics, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Civitan International Research Center, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Center for Neurodegeneration and Experimental Therapeutics, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Christian Faul
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
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Moreno-González R, Cruzado JM, Corsonello A, Fabbietti P, Tap L, Mattace-Raso F, Ärnlöv J, Carlsson AC, Guligowska A, Kostka T, Artzi-Medvedik R, Melzer I, Roller-Wirnsberger R, Wirnsberger G, Kob R, Sieber C, Lattanzio F, Formiga F. Kidney function and other associated factors of sarcopenia in community-dwelling older adults: The SCOPE study. Eur J Intern Med 2024; 123:81-93. [PMID: 38103954 DOI: 10.1016/j.ejim.2023.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/08/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
AIM Sarcopenia is associated with several factors and medical conditions among older adults, though previous research has shown limitations and inconsistencies, especially regarding chronic kidney disease (CKD). We investigated the clinical and laboratory variables associated with sarcopenia and severe sarcopenia in older adults, focusing on kidney function measures. METHODS Data from community-dwelling adults aged ≥75 years participating in the SCOPE multicenter prospective cohort study were assessed cross-sectionally. Comprehensive geriatric assessment was conducted; sociodemographic and lifestyle factors, clinical variables and comorbidities, anthropometric and bioelectrical impedance analysis, blood and urine laboratory variables were collected. EWGSOP2 revised criteria were used to define sarcopenia and its severity. Estimated glomerular filtration rate (eGFR) was calculated using creatinine and non-creatinine-based equations, and CKD stages were defined accordingly. RESULTS 1420 participants were included, prevalence of sarcopenia was 10.6 %, and 6 % had severe sarcopenia. Multivariate logistic regression analysis showed that age [OR =1.14; 95 %CI (1.09-1.19)], body mass index (BMI) [0.83 (0.79-0.88)], disability performing instrumental activities of daily living (IADL) [2.61 (1.69-4.06)], Mini Mental State Examination (MMSE) score <24 [2.75 (1.62-4.67)], osteoporosis [2.39 (1.55-3.67)], and stage 4 CKD defined by CKD-EPIBTP-B2M, a non-creatinine-based eGFR equation [2.88 (1.11-7.49)], were independently associated with sarcopenia; as were specifically with severe sarcopenia, with more pronounced associations. CONCLUSIONS In community-dwelling older adults, sarcopenia is a relevant condition and is associated with severe CKD, older age, IADL, cognitive impairments, osteoporosis and low BMI. These factors should be assessed for proper identification and management of older patients with sarcopenia, and even more so with severe sarcopenia.
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Affiliation(s)
- Rafael Moreno-González
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge. Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Corsonello
- Center for Biostatistic and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Ageing (IRCCS INRCA), Ancona and Cosenza, Italy; Unit of Geriatric Medicine, Italian National Research Center on Ageing (IRCCS INRCA), Cosenza, Italy and Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Paolo Fabbietti
- Center for Biostatistic and Applied Geriatric Clinical Epidemiology, Italian National Research Center on Ageing (IRCCS INRCA), Ancona and Cosenza, Italy
| | - Lisanne Tap
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden; Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Axel C Carlsson
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Agnieszka Guligowska
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Poland
| | - Rada Artzi-Medvedik
- Department of Nursing, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel
| | | | | | - Robert Kob
- Department of General Internal Medicine and Geriatrics, Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Regensburg, Germany
| | - Cornel Sieber
- Department of General Internal Medicine and Geriatrics, Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Regensburg, Germany
| | - Fabrizia Lattanzio
- Scientific Direction, Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona. L'Hospitalet de Llobregat, Barcelona, Spain
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Zheng X, Ren X, Jiang M, Han L, Zhong C. Association of sarcopenia with rapid kidney function decline and chronic kidney disease in adults with normal kidney function. Br J Nutr 2024; 131:821-828. [PMID: 37839856 DOI: 10.1017/s0007114523002313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
The association between sarcopenia and kidney function remains poorly investigated. We aimed to evaluate the associations between sarcopenia status and kidney function (rapid kidney function decline and chronic kidney disease (CKD)) in middle-aged and older Chinese population. A total of 9375 participants from the China Health and Retirement Longitudinal Study 2011 were included in the cross-sectional analyses. A total of 5864 participants with eGFRcr-cys ≥ 60 ml/min per 1·73 m2 at baseline were included in the longitudinal analyses and were followed up in 2015. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 criteria. In the cross-sectional analyses, possible sarcopenia and sarcopenia were significantly associated with an increased risk of CKD. During the 4 years of follow-up, 359 (6·12 %) participants experienced rapid decline in kidney function and 126 (2·15 %) participants developed CKD. After multivariable adjustment of baseline eGFRcr-cys level and other risk factors, possible sarcopenia (OR, 1·33; 95 % CI 1·01, 2·12) and sarcopenia (OR, 1·49; 95 % CI 1·05, 2·12) were associated with an increased risk of primary outcome (composite of rapid decline in kidney function (annualised decline in eGFRcr-cys ≥ 5 ml/min per 1·73 m2) and progression to CKD (eGFRcr-cys < 60 ml/min per 1·73 m2). Individuals with low muscle mass or low muscle strength alone also had an increased risk of rapid decline in kidney function and progression to CKD.
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Affiliation(s)
- Xiaowei Zheng
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu214122, People's Republic of China
| | - Xiao Ren
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu214122, People's Republic of China
| | - Minglan Jiang
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu214122, People's Republic of China
| | - Longyang Han
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu214122, People's Republic of China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu215000, People's Republic of China
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Cha RH. Pharmacologic therapeutics in sarcopenia with chronic kidney disease. Kidney Res Clin Pract 2024; 43:143-155. [PMID: 38389147 PMCID: PMC11016676 DOI: 10.23876/j.krcp.23.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/25/2023] [Accepted: 10/24/2023] [Indexed: 02/24/2024] Open
Abstract
Inflammation, metabolic acidosis, renin-angiotensin system activation, insulin resistance, and impaired perfusion to skeletal muscles, among others, are possible causes of uremic sarcopenia. These conditions induce the activation of the nuclear factor-kappa B and mitogen-activated protein kinase pathways, adenosine triphosphate ubiquitin-proteasome system, and reactive oxygen species system, resulting in protein catabolism. Strategies for the prevention and treatment of sarcopenia in chronic kidney disease (CKD) are aerobic and resistance exercises along with nutritional interventions. Anabolic hormones have shown beneficial effects. Megestrol acetate increased weight, protein catabolic rate, and albumin concentration, and it increased intracellular water component and muscle mass. Vitamin D supplementation showed improvement in physical function, muscle strength, and muscle mass. Correction of metabolic acidosis showed an increase in protein intake, serum albumin levels, body weight, and mid-arm circumference. The kidney- gut-muscle axis indicates that dysbiosis and changes in gut-derived uremic toxins and short-chain fatty acids affect muscle mass, composition, strength, and functional capacity. Biotic supplements, AST-120 administration, hemodiafiltration, and preservation of residual renal function are alleged to reduce uremic toxins, including indoxyl sulfate (IS) and p-cresyl sulfate (PCS). Synbiotics reversed the microbiota change in CKD patients and decreased uremic toxins. AST-120 administration changed the overall gut microbiota composition in CKD. AST-120 prevented IS and PCS tissue accumulation, ameliorated muscle atrophy, improved exercise capacity and mitochondrial biogenesis, restored epithelial tight junction proteins, and reduced plasma endotoxin levels and markers of oxidative stress and inflammation. In a human study, the addition of AST-120 to standard treatment had modest beneficial effects on gait speed change and quality of life.
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Affiliation(s)
- Ran-hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
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Wannamethee SG, Atkins JL. Sarcopenic Obesity and Cardiometabolic Health and Mortality in Older Adults: a Growing Health Concern in an Ageing Population. Curr Diab Rep 2023; 23:307-314. [PMID: 37566368 PMCID: PMC10640508 DOI: 10.1007/s11892-023-01522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE OF REVIEW Sarcopenic obesity (SO) is a growing public health problem in older adults. Whether SO confers higher risk of cardiometabolic disease and mortality than obesity or sarcopenia alone is still a matter of debate. We focus on recent findings on SO and cardiometabolic health and mortality in older adults. RECENT FINDINGS SO is associated with increased mortality compared to non-sarcopenic obesity, but similar mortality risk compared to sarcopenia without obesity. SO is associated with a higher risk of cardiovascular disease (CVD), diabetes, and physical disability than obesity or sarcopenia alone. SO, in the presence of diabetes, is associated with the highest risk of CVD and chronic kidney disease. A definition and diagnostic criteria for SO has recently been proposed (ESPEN and EASO). SO is associated with more adverse outcomes overall than sarcopenia or obesity alone. Future research is required to assess the impact of the new SO definition on health outcomes.
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Affiliation(s)
- Sasiwarang Goya Wannamethee
- Department Primary Care and Population Health, University College London, Royal Free Campus, London, NW32PF, UK.
| | - Janice L Atkins
- Epidemiology and Public Health Group, Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, Devon, UK
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Choi JY, Yang YM. Analysis of the association between osteoporosis and muscle strength in Korean adults: a national cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:97. [PMID: 37700322 PMCID: PMC10498644 DOI: 10.1186/s41043-023-00443-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND This study aimed to examine the associations between osteoporosis and hand grip strength (HGS), a surrogate marker of muscular strength, among Korean adults stratified by body mass index (BMI), age, and renal function. METHODS This study was conducted using the data obtained from the Korea National Health and Nutrition Examination Survey 2015-2019, a cross-sectional and nationally representative survey performed by the Korea Centers for Diseases Control and Prevention. RESULTS Of the 26,855 subjects included in this study, those with low muscle strength (LMS) and normal muscle strength were showed in 4,135 (15.4%) and 22,720 (84.6%) subjects, respectively. The osteoporotic subjects had a higher prevalence rate for LMS than those without osteoporosis after adjusting for age [odds ratio (OR), 1.684; 95% confidence interval (CI), 1.500-1.890). The subjects with osteoporosis and BMI < 18.5 kg/m2 also had a higher prevalence rate for LMS after adjusting for age compared to those with non-osteoporosis and BMI < 18.5 kg/m2 (OR, 1.872; 95% CI, 1.043-3.359). Compared to the non-osteoporotic subjects with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2, those with osteoporosis and eGFR ≥ 60 mL/min/1.73 m2 had a higher prevalence rate for LMS after controlling for age and sex (OR, 1.630; 95% CI, 1.427-1.862). CONCLUSIONS The results showed that osteoporosis was likely to contribute to an increased prevalence rate of LMS in terms of HGS. Aging, BMI, and renal function also had significant effects on the association between osteoporosis and LMS. This association is likely to assist in developing better strategies to estimate bone health in clinical or public health practice.
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Affiliation(s)
- Ji-Young Choi
- Department of Food and Nutrition, College of Natural Science and Public Health and Safety, Chosun University, Gwangju, Republic of Korea
| | - Young-Mo Yang
- Department of Pharmacy, College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea.
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Du W, Gao C, Wang X, Ma X, Xie J, Yu H, Yang Z, Chen Z, Chen X. Validity of the SARC-F questionnaire in assessing sarcopenia in patients with chronic kidney disease: a cross-sectional study. Front Med (Lausanne) 2023; 10:1188971. [PMID: 37534318 PMCID: PMC10391647 DOI: 10.3389/fmed.2023.1188971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Objective To examine the validity of the 5-component SARC-F questionnaire for screening sarcopenia among patients with chronic kidney disease (CKD). Methods Eligible participants were enrolled from the Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from March 2019 to November 2019. Evaluations were performed using the self-administered SARC-F questionnaire. Sarcopenia was diagnosed by grip strength, the chair stand test and appendicular skeletal muscle mass. The severity of sarcopenia was evaluated by gait speed. We calculated the sensitivity and specificity of the SARC-F to evaluate construct validity. Moreover, receiver operating characteristic (ROC) curve analysis was performed to identify the cutoff value for nondialysis-dependent (NDD) CKD patients' and maintenance hemodialysis (MHD) patients' scores. Results A total of 105 NDD-CKD patients and 125 MHD patients were included, and the prevalence of sarcopenia was 5.7 and 31.2%, respectively. Among them, there were 21 (16.8%) MHD patients with severe sarcopenia but no NDD-CKD patients with severe sarcopenia. The sensitivity and specificity of the SARC-F were 16.7 and 98.0% for NDD-CKD patients, and 48.7 and 89.5% for MHD patients, respectively. For NDD-CKD patients, the area under the receiver operating characteristic curve (AUROC) of the total SARC-F score was 0.978 (95% confidence interval (CI): 0.929-0.997, p < 0.001), and the cutoff value of 1 reached the highest Youden index of 0.950 and max ROC curve area of 0.974. For MHD patients, the AUROC of the total SARC-F score was 0.730 (95% CI: 0.644-0.806, p < 0.001), and the cutoff value of 4 reached the highest Youden index of 0.383 and max ROC curve area of 0.691. Conclusion CKD patients, especially MHD patients, were at high risk of suffering sarcopenia. The SARC-F had low-to-moderate sensitivity but high specificity for screening sarcopenia among patients with CKD. The best cutoff values of the SARC-F score were different for screening sarcopenia among NDD-CKD and MHD patients.
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Affiliation(s)
- Wen Du
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenni Gao
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuejie Wang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nephrology, RuiJin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaobo Ma
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijin Yu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenhua Yang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijin Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nephrology, Wuxi Branch of Ruijin Hospital, Wuxi, Jiangsu Province, China
| | - Xiaonong Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Enoki Y, Nagai T, Hamamura Y, Osa S, Nakamura H, Taguchi K, Watanabe H, Maruyama T, Matsumoto K. The G protein-coupled receptor ligand apelin-13 ameliorates skeletal muscle atrophy induced by chronic kidney disease. J Cachexia Sarcopenia Muscle 2023; 14:553-564. [PMID: 36562292 PMCID: PMC9891924 DOI: 10.1002/jcsm.13159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Targeting of the apelin-apelin receptor (Apj) system may serve as a useful therapeutic intervention for the management of chronic kidney disease (CKD)-induced skeletal muscle atrophy. We investigated the roles and efficacy of the apelin-Apj system in CKD-induced skeletal muscle atrophy. METHODS The 5/6-nephrectomized mice were used as CKD models. AST-120, a charcoal adsorbent of uraemic toxins (8 w/w% in diet), or apelin (1 μmol/kg) was administered to CKD mice to investigate the mechanism and therapeutic potential of apelin on CKD-induced skeletal muscle atrophy. The effect of indoxyl sulfate, a uraemic toxin, or apelin on skeletal muscle atrophy was evaluated using mouse myoblast cells (C2C12 cells) in vitro. RESULTS Skeletal muscle atrophy developed over time following nephrectomy at 12 weeks, as confirmed by a significant increase of atrogin-1 and myostatin mRNA expression in the gastrocnemius (GA) muscle and a decrease of lower limb skeletal muscle weight (P < 0.05, 0.01 and 0.05, respectively). Apelin expression in GA muscle was significantly decreased (P < 0.05) and elabela, another Apj endogenous ligand, tended to show a non-significant decrease at 12 weeks after nephrectomy. Administration of AST-120 inhibited the decline of muscle weight and increase of atrogin-1 and myostatin expression. Apelin and elabela expression was slightly improved by AST-120 administration but Apj expression was not, suggesting the involvement of uraemic toxins in endogenous Apj ligand expression. The administration of apelin at 1.0 μmol/kg for 4 weeks to CKD mice suppressed the increase of atrogin-1 and myostatin, increased apelin and Apj mRNA expression at 30 min after apelin administration and significantly ameliorated weight loss and a decrease of the cross-sectional area of hindlimb skeletal muscle. CONCLUSIONS This study demonstrated for the first time the association of the Apj endogenous ligand-uraemic toxin axis with skeletal muscle atrophy in CKD and the utility of therapeutic targeting of the apelin-Apj system.
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Affiliation(s)
- Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Tomoya Nagai
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yuna Hamamura
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Sumika Osa
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Hideaki Nakamura
- Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Hiroshi Watanabe
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
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11
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Ulgen C, Ozturk I, Sahin M, Guzel FB, Oguz A, Altunoren O, Gungor O. The amount of skeletal muscle mass is associated with arterial stiffness in hemodialysis patients. Ther Apher Dial 2023; 27:24-30. [PMID: 35426237 DOI: 10.1111/1744-9987.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/11/2022] [Accepted: 04/11/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Sarcopenia was determined to be associated with increased arterial stiffness in the nondialysis patient population, but there is no available data on this subject in dialysis patients. METHODS A total of 79 patients were included in the study. Sarcopenia was diagnosed according to the EWSGOP-2 criteria. Arterial stiffness was measured noninvasively with a mobile-O-Graph device. RESULTS Skeletal muscle mass was observed to be positively correlated with weight, body mass index, creatinine, and uric acid, while negatively correlated with augmentation index. There was a correlation between augmentation index and sodium, phosphorus, systolic blood pressure, diastolic blood pressure, cardiac index, muscle percentage, fat percentage, and skeletal muscle mass. When the determinants of augmentation index in the linear regression analysis were viewed, just the systolic blood pressure and skeletal muscle mass were observed to be the determinant. CONCLUSION Decreased skeletal muscle mass contributes to increased arterial stiffness in hemodialysis patients.
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Affiliation(s)
- Cansu Ulgen
- Internal Medicine Department, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Ilyas Ozturk
- Nephrology Department, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Murat Sahin
- Endocrinology and Metabolism Department, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Fatma Betul Guzel
- Nephrology Department, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Ayten Oguz
- Endocrinology and Metabolism Department, Biruni University Faculty of Medicine, Istanbul, Turkey
| | - Orcun Altunoren
- Nephrology Department, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Ozkan Gungor
- Nephrology Department, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
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12
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Effects of a Combined Intradialytic Exercise Training Program on Functional Capacity and Body Composition in Kidney Transplant Candidates. J Funct Morphol Kinesiol 2023; 8:jfmk8010009. [PMID: 36648901 PMCID: PMC9844356 DOI: 10.3390/jfmk8010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023] Open
Abstract
Chronic kidney disease (CKD) leads to gradual muscle mass loss, which is strongly associated with lower functional capacity, which limits a patient’s daily activities. The aim of the present study is to examine the effects of a 4-month intradialytic exercise program on the functional capacity and body composition of kidney transplant (KT) candidates. Twenty-nine male patients on hemodialysis (HD) waiting for a kidney transplant, with a mean age of 53.86 ± 9.56 years old and BMI 27.11 ± 5.55 kg/m2, were randomly assigned into the following two groups: A (nA = 15 HD patients), who followed a 4-month intradialytic exercise program combining aerobic and resistance training, with a supervised, progressively increasing workload, and B (nB = 14 HD patients), who continued to receive usual care. At baseline and the end of the study, the KT candidates underwent a 6-min walking distance (6-MWD), and a 10-repetition sit-to-stand test (10-STS) to access physical function, a handgrip strength (HGS) test to evaluate the muscle strength of the non-fistula hand. Moreover, the bioelectrical impedance analysis (BIA) was performed to assess body composition indices, such as body fat (BF), body fat mass index (BFMI), fat-free mass index (FFMI), body cell mass (BCM), basal metabolic rate (BMR), extracellular water (ECW), intracellular water (ICW), total body water (TBW) and phase angle (PhA). Following the exercise program, group A showed favorable improvements in HGS (from 26.59 ± 9.23 to 28.61 ± 9.58 kg, p < 0.05) and 6-MWD (from 427.07 ± 7.66 to 468.16 ± 11.39 m, p < 0.05). Intergroup results from 6-MWD showed a statistically significant difference (Δp = 0.04), at the end of the study. Moreover, group A results from BIA revealed a significant increase of BMR by 2.4% (p < 0.05), ECW by 3.6% (p = 0.01), ICW by 3.8% (p = 0.01), TBW by 4.1% (p = 0.01), lean mass by 2.7% (p = 0.01), and PhA by 13.3% (p = 0.04), while a reduction in BF by 5.0% (p = 0.01) and BFMI by 6.6% (p = 0.03) was also noticed. At the end of the study, group A showed statistical differences in BMR (Δp = 0.01), BMR/BW (Δp = 0.01), dry lean (Δp = 0.01), and PhA (Δp = 0.03), compared to the group B. Linear regression analysis in group A after training showed positive correlations between HGS and both PhA (r = 0.52, p = 0.04) and FFMI (r = 0.64, p = 0.01), and a strong negative correlation between 6-MWT and BF (r = −0.61, p = 0.01). In conclusion, a 4-month intradialytic exercise program can enhance body composition and some physical parameters in HD patients awaiting kidney transplantation.
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13
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Chen X, Zhu X, Han P, Zhang Y, He M, Zhang Y, Liu J, Tang J, Zhang Y, Zheng Y, Zhang Z, Li M, Guo Q. Sarcopenia is associated with mild-to-moderate chronic kidney disease in Chinese community-dwelling older men but not in women. J Int Med Res 2022; 50:3000605221136683. [PMID: 36446755 PMCID: PMC9716608 DOI: 10.1177/03000605221136683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine whether a relationship exists between sarcopenia, including its individual components (muscle mass, muscle strength and gait speed), and mild-to-moderate chronic kidney disease (CKD) in Chinese older adults. METHODS This cross-sectional study comprised participants aged ≥60 years from Tianjin and Shanghai, China, who joined a national free physical examination program between 2014 and 2019, and consented to study inclusion. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (2019 version). Mild-to-moderate CKD was defined as estimated glomerular filtration rate (eGFR) between 45 ml/min/1.73 m2 and 60 ml/min/1.73 m2. RESULTS A total of 1627 participants were included (mean age, 69.32 ± 6.17 years; 43.8% male). Sarcopenia was significantly associated with mild-to-moderate CKD in men but not women. Among three physical performance components, slow gait speed (odds ratio 1.89, 95% confidence interval 1.38, 2.58) was associated with mild-to-moderate CKD in both men and women after adjusting for all other variables. CONCLUSIONS Sarcopenia was closely associated with mild-to-moderate CKD in older men, and slow gait speed was related to mild-to-moderate CKD in men and women. These findings may help guide better diagnosis and management of CKD in the context of slow gait speed, and facilitate earlier CKD detection and appropriate intervention in older adults.
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Affiliation(s)
- Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiaoyan Zhu
- Department of Rehabilitation Medicine, Shanghai Herson Rehabilitation Hospital, Shanghai, China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuanyuan Zhang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Mian He
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuhui Zhang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jinghuan Liu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jiawei Tang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yisong Zhang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yaqing Zheng
- Department of Rehabilitation Medicine, Fujian Provincial Hospital, Fujian, China
| | - Ziwei Zhang
- Department of Rehabilitation Medicine, Fujian Provincial Hospital, Fujian, China
| | - Ming Li
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China,Qi Guo, Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 1500 Zhouyuan Road, Pudong New District, Shanghai, 201318, China.
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14
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Ogi M, Seto T, Wakabayashi Y. A comparison of the utility of the urine dipstick and urine protein-to-creatinine ratio for predicting microalbuminuria in patients with non-diabetic lifestyle-related diseases -a comparison with diabetes. BMC Nephrol 2022; 23:377. [PMID: 36434544 PMCID: PMC9700904 DOI: 10.1186/s12882-022-02974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The utility of dipstick proteinuria for predicting microalbuminuria in non-diabetic lifestyle-related diseases compared with the urine protein-to-creatinine ratio (uPCR) and the effect of dipstick proteinuria on the cut-off value (CO) and accuracy of uPCR are unclear. METHODS The subjects included Japanese patients ≥ 18 years old with lifestyle-related diseases who had an estimated glomerular filtration rate of ≥ 15 ml/min/1.73 m2 and uPCR of < 0.5 g/gCr at initiation. Urine dipstick, uPCR and urine albumin-to-creatinine ratio (uACR) were measured three times per case. Microalbuminuria was defined as uACR of 30-299 mg/gCr for at least 2 of 3 measurements. Youden's Index was used as the optimal CO. Factors associated with microalbuminuria were analyzed using a logistic regression model. RESULTS In 313 non-diabetic cases (median 70.8 years old), 3 dipstick proteinuria measurements were independently useful for detecting microalbuminuria, and the CO was set when a trace finding was obtained at least 1 of 3 times (sensitivity 0.56, specificity 0.80, positive predictive value [PPV] 0.73, negative predictive value [NPV] 0.65). A single uPCR measurement was more useful than 3 dipstick measurements, and was useful for detecting microalbuminuria even in cases with three consecutive negative proteinuria findings, indicating that the CO of the second uPCR with G1-3a (n = 136) was 0.06 g/gCr (sensitivity 0.76, specificity 0.84. PPV 0.68, NPV 0.89), while that with G3-b4 (n = 59) was 0.10 g/gCr (sensitivity 0.56, specificity 0.91. PPV 0.83, NPV 0.71). The sum of 3 uPCRs was useful for detecting microalbuminuria in cases with G1-3a (sensitivity 0.67, specificity 0.94, PPV 0.82, NPV 0.86) and G3b-4 (sensitivity 0.78, specificity 0.94, PPV 0.91 NPV 0.83), with both COs being 0.23 g/gCr. These COs of microalbuminuria did not change when trace or more proteinuria was included, although the sensitivity increased. A high uPCR and low urine specific gravity or creatinine level were independent factors for uACR ≥ 30 mg/gCr in cases with negative proteinuria, although the uPCR was a major predictive factor of a uACR ≥ 30 mg/gCr. CONCLUSIONS The uPCR (preferably determined using early-morning urine), including in dipstick-negative proteinuria cases with non-diabetic lifestyle-related diseases, can aid in the early detection of microalbuminuria. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Makoto Ogi
- Department of Internal Medicine, Yuurinkouseikai Fuji Hospital, 1784 Niihashi, Gotemba, Shizuoka 412-0043 Japan
| | - Takuya Seto
- Department of Internal Medicine, Yuurinkouseikai Fuji Hospital, 1784 Niihashi, Gotemba, Shizuoka 412-0043 Japan
| | - Yoshinori Wakabayashi
- Department of Internal Medicine, Yuurinkouseikai Fuji Hospital, 1784 Niihashi, Gotemba, Shizuoka 412-0043 Japan
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15
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Yang YM, Choi EJ. Association of renal function with muscle strength in Korean adults: A population-based study using the Korea National Health and Nutrition Examination Surveys (KNHANES) from 2014 to 2018. Medicine (Baltimore) 2022; 101:e31014. [PMID: 36254011 PMCID: PMC9575765 DOI: 10.1097/md.0000000000031014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Hand grip strength (HGS), a simple measure of upper limb muscle function, can be used to assess overall muscular strength, and reduced HGS in patients with poor renal functions has been observed. This study examined the associations between renal function and HGS, a surrogate marker of muscular strength, among a stratified sample of Korean adults. This study obtained data from the Korea National Health and Nutrition Examination Survey from 2014 to 2018, a cross-sectional and nationally representative survey conducted by the Korea Centers for Diseases Control and Prevention. In men, low muscle strength (LMS) and normal muscle strength (NMS) were defined as HGS < 28.9 kg and HGS ≥ 28.9 kg, respectively. In women, LMS and NMS were considered as HGS < 16.8 kg and HGS ≥ 16.8 kg, respectively. Of the 25,746 subjects in this study, there were 3603 (14.0%) and 22,143 (86.0%) subjects who displayed LMS and NMS, respectively. Subjects with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 had a higher risk of developing LMS than those with eGFR ≥ 60 mL/min/1.73 m2 after adjusting for age (odds ratio, 1.772; 95% CI, 1.498-2.096); the significant differences remained after adjusting for other factors including age. Similar tendencies were shown in men and women when analyzed according to gender; however, the risk of developing LMS was higher in men than in women. Results showed that decreased renal function was likely to contribute to an increased prevalence of LMS based on HGS. This association may assist in developing better strategies to estimate renal function in clinical or public health practice.
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Affiliation(s)
- Young-Mo Yang
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea
| | - Eun Joo Choi
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea
- *Correspondence: Eun Joo Choi, Department of Pharmacy, College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, South Korea (e-mail: )
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16
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Seo DH, Suh YJ, Cho Y, Ahn SH, Seo S, Hong S, Lee YH, Choi YJ, Lee E, Kim SH. Effect of low skeletal muscle mass and sarcopenic obesity on chronic kidney disease in patients with type 2 diabetes. Obesity (Silver Spring) 2022; 30:2034-2043. [PMID: 36062861 DOI: 10.1002/oby.23512] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between low muscle mass or sarcopenic obesity and the risk of incident chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM). METHODS A total of 3123 patients with T2DM with preserved renal function were followed up for incident CKD. Skeletal muscle mass was estimated from bioelectrical impedance analysis. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 . Sarcopenic obesity was defined as the coexistence of sarcopenia and abdominal obesity. RESULTS During 8.9 years of follow-up, 530 (17.0%) patients developed incident CKD. When patients were divided into three groups based on sex-specific tertiles, lower muscle mass was not associated with an increased risk of incident CKD after adjustment for risk factors. However, when patients were divided into four groups according to the presence of sarcopenia and obesity, sarcopenic obesity was associated with an increased risk of incident CKD (adjusted hazard ratio 1.77; 95% CI: 1.24-2.51; p = 0.001) compared with the other groups. CONCLUSIONS Sarcopenic obesity, but not low muscle mass alone, may increase the risk of CKD in patients with T2DM.
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Affiliation(s)
- Da Hea Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yongin Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seong Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seongha Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Eunjig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Hun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
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17
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Changes in body composition in relation to estimated glomerular filtration rate and physical activity in predialysis chronic kidney disease. Chronic Dis Transl Med 2022; 8:305-313. [DOI: 10.1002/cdt3.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/24/2022] [Accepted: 08/16/2022] [Indexed: 11/07/2022] Open
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18
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Song P, Xu X, Zhao Y, Gu M, Chen X, Zhang H, Wu X, Yu C, Niu J, Ding W, Zhang S, Guo Q. Different stages of chronic kidney disease are associated with physical performance in adults over 60 years. Front Public Health 2022; 10:963913. [PMID: 36159314 PMCID: PMC9501662 DOI: 10.3389/fpubh.2022.963913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/10/2022] [Indexed: 01/24/2023] Open
Abstract
Objective The purpose of this study was to determine the association between different stages of chronic kidney disease (CKD) and sarcopenia and its components in the Chinese older population. Methods The study comprised of 2,213 participants aged ≥ 60 years (1,025 men; mean age: 70.7 years) recruited from Shanghai who were invited to participate in a comprehensive geriatric assessment. Sarcopenia was defined according to the AWGS 2019 consensus update on sarcopenia diagnosis criteria. The glomerular filtration rate (GFR) was estimated using the equation that originated from the CKD-EPI equation, the stages of CKD are classified according to the Kidney Disease-Improving Global Outcomes (KDIGO). Results The overall prevalence of sarcopenia was 19.0%, which increased with the severity of CKD. The prevalence of sarcopenia in patients with CKD 3-4 and kidney failure was significantly higher than that in normal and CKD 1-2 (p < 0.05). In logistic regression analysis model, compared with normal and CKD 1 patients, kidney failure was significantly associated with the increased risk of sarcopenia and low grip strength (p < 0.05); CKD 2, CKD 3-4 and kidney failure groups were significantly associated with an increased risk of low walking speed (p < 0.05), respectively; while the association between CKD and muscle mass was not shown. Conclusions In our study, only decreased physical performance, as represented by walking speed, was significantly associated with increased CKD severity. This may improve the evidence for the prevention and intervention of sarcopenia in patients with CKD.
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Affiliation(s)
- Peiyu Song
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Xinghong Xu
- Shanghai Yongci Rehabilitation Hospital, Shanghai, China
| | - Yinjiao Zhao
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Minghong Gu
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hui Zhang
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Xinze Wu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jianying Niu
- Department of Nephrology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wei Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suhua Zhang
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China,Suhua Zhang
| | - Qi Guo
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China,Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China,*Correspondence: Qi Guo
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Choi Y, Cho J, Kim J, Bae JH, Cho EJ, Chang E, Joa KL, Kim J, Park DH, Kang JH, Kwak HB. Dynapenic-abdominal obesity as an independent risk factor for chronic kidney disease in postmenopausal women: a population-based cohort study. Menopause 2022; 29:1040-1046. [PMID: 36040432 PMCID: PMC9422766 DOI: 10.1097/gme.0000000000002032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/22/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Low muscle strength and obesity lead to a higher risk of chronic kidney disease (CKD). Perimenopause is associated with a natural decline in muscle strength and an increase in visceral adiposity. Dynapenic obesity, which is the coexistence of low muscle strength and obesity, is expected to synergistically increase the prevalence of CKD in postmenopausal women. The aim of this study was to determine combined associations of dynapenia and obesity with CKD in postmenopausal women. METHODS This study used data from the Korean National Health and Nutrition Examination Survey, 2016 to 2019. The study included 4,525 postmenopausal women aged 42 to 80 years that were classified into four groups based on waist circumference (≥85 cm) and hand grip strength (<18 kg): normal, dynapenic, obese, or dynapenic-obese. According to the Kidney Disease: Improving Global Outcomes, we defined CKD as an estimated glomerular filtration rate <60 mL/min per 1.73 m2. Complex sample logistic regression models were conducted to determine the relationships among coexistence of dynapenia, abdominal obesity, and the risk of CKD. RESULTS Dynapenic-abdominal obese group displayed lower estimated glomerular filtration rate levels than other groups (P < 0.05 for all data). The prevalence rates of CKD were 15.5%, 7.8%, 6.2%, and 2.4% in the dynapenic-abdominal obese, dynapenic, abdominal obese, and normal groups, respectively (P < 0.001). Complex sample logistic regression analyses, after adjusting for age, height, health behaviors, and comorbidities, showed that the odds ratio for CKD with respect to dynapenic-abdominal obesity was 1.82 (95% confidence interval, 1.19-2.79) and to abdominal obesity was 1.54 (95% confidence interval, 1.07-2.22) than in the normal group. CONCLUSIONS This study demonstrated that dynapenic-abdominal obesity, as determined by low handgrip strength and high waist circumference values, was associated with increased risk of CKD in postmenopausal women.
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Affiliation(s)
- Youngju Choi
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
| | - Jinkyung Cho
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Korea Institute of Sports Science, Seoul
| | - Jiyeon Kim
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
| | - Jun Hyun Bae
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
| | - Eun-Jeong Cho
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University
| | - Eunwook Chang
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Kinesiology, College of Arts & Sports, Inha University
| | - Kyung-Lim Joa
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Physical & Rehabilitation Medicine, College of Medicine, Inha University
| | - Junghoon Kim
- Sports and Exercise Medicine Laboratory, Korea Maritime and Ocean University, Busan
| | - Dong-Ho Park
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University
- Department of Kinesiology, College of Arts & Sports, Inha University
| | - Ju-Hee Kang
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University
- Department of Pharmacology, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hyo-Bum Kwak
- From the Institute of Sports and Arts Convergence (ISAC), Inha University, Incheon
- Department of Biomedical Science, Program in Biomedical Science and Engineering, Inha University
- Department of Kinesiology, College of Arts & Sports, Inha University
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20
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Influence of protein intake on the changes in skeletal muscle mass after kidney transplantation. Clin Nutr 2022; 41:1881-1888. [DOI: 10.1016/j.clnu.2022.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 12/18/2022]
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21
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Shin SP, Koh DH. Clinical Impact of Sarcopenia on Cholangiocarcinoma. Life (Basel) 2022; 12:life12060815. [PMID: 35743846 PMCID: PMC9224765 DOI: 10.3390/life12060815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Sarcopenia is considered an important factor affecting the prognosis of cancer patients. Only complete surgical resection confers the chance of curing cholangiocarcinoma with sarcopenia. However, the prognosis is poor, even for patients who undergo surgical resection. Data from 13 trials of patients with sarcopenia and intrahepatic cholangiocarcinoma (ICC) or perihilar cholangiocarcinoma (PHC) were collected and reviewed. During all trials, sarcopenia was assessed using the psoas muscle or total skeletal muscle at the L3 level on cross-sectional images. The data showed heterogeneity among the subjects and treatment options and discrepancies in methods of measuring muscle mass and setting the cut-off level. Despite conflicting results regarding morbidity, mortality, and recurrence, sarcopenia may be associated with poor overall survival and recurrence-free survival (RFS) for ICC patients. The impact of sarcopenia on the morbidity of ICC patients remains unclear. The impact of PHC on morbidity, mortality, and RFS is also unclear. Further well-designed studies are needed to elucidate the effects of sarcopenia on ICC and PHC.
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Affiliation(s)
- Suk-Pyo Shin
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77, Sakju-ro, Chuncheon-si 24253, Gangwon-do, Korea;
| | - Dong-Hee Koh
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea
- Correspondence: ; Tel.: +82-31-8086-2450
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22
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Association between Three Waist Circumference-Related Obesity Metrics and Estimated Glomerular Filtration Rates. J Clin Med 2022; 11:jcm11102876. [PMID: 35629005 PMCID: PMC9147861 DOI: 10.3390/jcm11102876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
Studies that have assessed the associations between obesity and the estimated glomerular filtration rate (eGFR) have reported inconsistent results. This cross-sectional study was performed to investigate the associations between three waist circumference (WC)-related obesity metrics (waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and waist-to-height0.5 ratio (WHt.5R)) and eGFRs. This study included 2133 men and 3443 women who were older than 40 years with eGFRs ≥ 60 mL/min/1.73 m² from the Korean Multi-Rural Communities Cohort. We calculated the residual body mass index (BMI) to reduce multicollinearity among the obesity metrics and performed multiple linear regression. For both sexes, among the adjusted models, most of the general obesity metrics were significantly associated with eGFRs. Particularly for women, the WC-related and general obesity metrics had a stronger effect on eGFRs in the quartile models that included the BMI and the residual BMI, respectively. When WC-related obesity metrics had a stronger effect than the general obesity metric, for both sexes, WHtR showed a significant impact than WHt.5R and WHR on eGFRs. Reducing multicollinearity had an important role in assessing the obesity metrics’ association with eGFRs. Overall, applying the residual method in further studies might help with evaluating the obesity paradox on renal function.
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23
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Nguyen M, Mukaneza Y, Tremblay M, Huard G, Tang A, Rose CF, Bémeur C. Renal dysfunction independently predicts muscle mass loss in patients following liver transplantation. CANADIAN LIVER JOURNAL 2022; 5:411-423. [DOI: 10.3138/canlivj-2021-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Liver transplantation (LT) is the only curative treatment for cirrhosis. However, the presence of complications can impact outcomes following LT. Sarcopenia, or muscle mass loss, is highly prevalent in patients with cirrhosis and is associated with longer hospitalization stays and a higher infection rate post-surgery. We aimed to identify patients at higher risk of early sarcopenia post-LT. METHODS: This retrospective study included 79 cirrhotic patients who underwent LT. Muscle mass was evaluated using the third lumbar spine vertebra skeletal muscle mass index (SMI) and sarcopenia was defined using established cut-off values. Computerized tomography (CT) scans performed within six-month peri-operative period (three months pre- and post-LT) were included in the study. Complications and comorbidities were collected and correlated to SMI post-LT and predictive models for SMI post-LT were constructed. RESULTS: The overall prevalence of sarcopenia was 46% and 62% before and after LT, respectively. Newly developed sarcopenia was found in 42% of patients. Post-LT sarcopenia was associated with longer hospital stays (54±37 vs 29±10 days, p = 0.002), higher number of infection (3±1 vs 1±2, p = 0.027), and greater number of complications (5±2 vs 3±2, p <0.001) compared to absence of sarcopenia. Multivariate analyses showed that the SMI post-LT was independently associated with pre-LT renal function markers, the glomerular filtration rate (GFR) and creatinine (Model 1, GFR: β = 0.33; 95% CI = 0.04–0.17; p = 0.003; Model 2, Creatinine: β = –0.29; 95% CI = –0.10 to –0.02; p = 0.009). CONCLUSIONS: The present study highlights the potential role of renal dysfunction in the development and persistence of sarcopenia after LT.
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Affiliation(s)
- Mimosa Nguyen
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Yvette Mukaneza
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Mélanie Tremblay
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Geneviève Huard
- Centre hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - An Tang
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Centre hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Christopher F Rose
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Chantal Bémeur
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Department of Nutrition, Université de Montréal, Montréal, Québec, Canada
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24
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de Amorim GJ, Calado CKM, Souza de Oliveira BC, Araujo RPO, Filgueira TO, de Sousa Fernandes MS, Castoldi A, Vajgel G, Valente LM, de Lima-Filho JL, Carvalho PRC, Souto FO. Sarcopenia in Non-Dialysis Chronic Kidney Disease Patients: Prevalence and Associated Factors. Front Med (Lausanne) 2022; 9:854410. [PMID: 35463026 PMCID: PMC9021613 DOI: 10.3389/fmed.2022.854410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/22/2022] [Indexed: 12/14/2022] Open
Abstract
Background Sarcopenia is related to morbidity and mortality in non-dialysis Chronic Kidney Disease (ND-CKD) patients; however, the pathophysiology of sarcopenia remains unclear. The study aimed to assess the prevalence and factors associated with sarcopenia in ND-CKD individuals. Methods We cross-sectionally evaluated 139 prevalent ND-CKD patients attending our outpatient clinic at Hospital das Clínicas of the Federal University of Pernambuco, between April and October 2019. Patients older than 18 years old and at G3-G5 CKD stages were included. Hand grip strength, Muscle Mass appendicular Index, and Gait Speed (GS) were defined by the standards of the European Working Group on Sarcopenia in Older People 2 guideline. Results Sarcopenia prevalence was 20.9% and severe sarcopenia 2.9%. Sarcopenic were mostly found in elderly ones (64.8 ± 13.5 years vs. 54.9 ± 12.8 years, p < 0.001), revealing lower body mass index [26.1 (6.8) vs. 28.6 (6.2), p = 0.023], lower phase angle (PhA) [4.50 (1.10) vs. 5.60 (1.20), p < 0.001] and lower GS [1.00 (0.50) vs. 1.40 (0.4), p < 0.001]. They also presented lower serum creatinine levels [2.40 (1.50) vs. 3.0 (1.8), p = 0.032], lower Albumin-to-Creatinine Ratio [72.60 (1008.30) vs. 342.30 (1172.1), p = 0.039] and Hemoglobin levels [11.45 (1.8) vs. 12.60 (2.40), p = 0.003], and higher levels of C-reactive protein [0.2 (0.80) vs. 0.03 (0.3), p = 0.045] compared to non-sarcopenic. Under Poisson Multivariate Model, PhA [Relative precision (RP): 0.364, Confidence Interval (CI) (95%):0.259–0.511, p < 0.001], Interleukin six (IL-6) [RP: 1.006, CI (95%):1.001–1.01, p = 0.02] and serum creatinine levels [RP: 0.788, CI (95%): 0.641–0.969, p = 0.024] were associated with sarcopenia. Conclusions Sarcopenia predominance was identified in our ND-CKD population, and was associated with lower PhA values, higher IL-6 levels, and lower serum creatinine levels.
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Affiliation(s)
- Geraldo José de Amorim
- Nephrology Service, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil.,Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
| | | | | | | | - Tayrine Ordonio Filgueira
- Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
| | | | - Angela Castoldi
- Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
| | - Gisele Vajgel
- Nephrology Service, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
| | - Lucila Maria Valente
- Nephrology Service, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
| | - José Luiz de Lima-Filho
- Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
| | | | - Fabricio Oliveira Souto
- Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
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25
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Lo LWT, Xu Y, Howe TS, Koh JSB, Lo NN, Yang YO. End stage renal disease patients undergoing hip fracture surgery have increased length of stay, acute hospital bill size, and reduced survivorship-implications on a bundled care program. Arch Osteoporos 2022; 17:59. [PMID: 35385992 DOI: 10.1007/s11657-022-01103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/26/2022] [Indexed: 02/03/2023]
Abstract
UNLABELLED End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rates. As these patients significantly skew healthcare financing in a bundled care payment (BCP) program, a risk stratified approach to BCPs could be done to take into account the difference in resources required. INTRODUCTION End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rate. Hip fracture patients with ESRD may significantly skew healthcare financing in a bundled care payment (BCP) program. MATERIALS AND METHODS ESRD patients undergoing hip fracture surgery from June 2007 to June 2012 within a tertiary hospital in Singapore were identified and matched to two other controls without ESRD based on secondary features of sex, age, fracture type, and surgery performed. Data was collected for American Society of Anesthesiologist (ASA) score, duration of surgery (DOS), length of stay (LOS), 30-day and 1-year mortality, and the presence of 10 other comorbidities: diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), ischemic heart disease (IHD), arrhythmia (ARR), cerebrovascular disease (CVA), dementia (DEM), asthma (ASTH), peripheral vascular disease (PVD), and anemia (ANE) from electronic medical records. Costs were retrieved from the gross acute hospitalization bill. RESULTS Forty-one ESRD patients were successfully matched with 82 controls. Patients with ESRD had higher ASA scores (3 vs 2, p = 0.0001), had 75% higher LOS (21 vs 12 days, p < 0.0001), were associated with 67% higher healthcare expenditure (median $20542 vs $12236, p < 0.0001), and 1-year mortality (OR: 19.6, p < 0.0001). ESRD patients had an average of 4.1 comorbidities per patient compared to 1.84 in the control group. CONCLUSION ESRD is an outsized factor on the outcome of hip fracture patients who have markedly higher and more variable healthcare utilization.
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Affiliation(s)
- Louise Woon Theng Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Yanling Xu
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.,Monash School of Medicine, Clayton, Australia
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Joyce Suang Bee Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Youheng Ou Yang
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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26
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Arazi H, Mohabbat M, Saidie P, Falahati A, Suzuki K. Effects of Different Types of Exercise on Kidney Diseases. Sports (Basel) 2022; 10:sports10030042. [PMID: 35324651 PMCID: PMC8952011 DOI: 10.3390/sports10030042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
The effects of exercise on kidney function have been studied for more than three decades. One of the most common health issues among patients with chronic kidney disease (CKD) is a lack of physical activity, which leads to a low exercise capacity in these patients. The majority of maintenance hemodialysis (MHD) patients do not exercise at all. At each stage of dialysis, patients lose 10–12 g of their amino acids through blood sampling. Dialysis also leads to increased cortisol and circadian rhythm sleep disorders in hemodialysis (HD) patients. Studies have also reported higher C-reactive protein levels in HD patients, which causes arterial stiffness. Exercise has a variety of health benefits in these patients, including improved blood pressure control, better sleep, higher physical function, and reduced anxiety and depression. On the other hand, it should be noted that intense exercise has the potential to progress KD, especially when conducted in hot weather with dehydration. This review aimed to investigate the effects of different types of exercise on kidney disease and provide exercise guidelines. In conclusion, moderate-intensity and long-term exercise (for at least a 6-month period), with consideration of the principles of exercise (individualization, intensity, time, etc.), can be used as an adjunctive treatment strategy in patients undergoing dialysis or kidney transplantation.
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Affiliation(s)
- Hamid Arazi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
- Correspondence: (H.A.); (K.S.); Tel.: +98-911-139-9207 (H.A.)
| | - Majid Mohabbat
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Payam Saidie
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Akram Falahati
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: (H.A.); (K.S.); Tel.: +98-911-139-9207 (H.A.)
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27
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Cha RH, Kang SH, Han MY, An WS, Kim SH, Kim JC. Effects of AST-120 on muscle health and quality of life in chronic kidney disease patients: results of RECOVERY study. J Cachexia Sarcopenia Muscle 2022; 13:397-408. [PMID: 34862753 PMCID: PMC8818653 DOI: 10.1002/jcsm.12874] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The prevalence of sarcopenia is increased with declining renal function. Elevated serum indoxyl sulfate levels are associated with poor skeletal muscle conditions. We aimed to determine the effects of AST-120, the oral adsorbent of indoxyl sulfate, on sarcopenia and sarcopenia-associated factors in chronic kidney disease patients. METHODS This was a 48 week, randomized controlled, parallel group, open-label, multicentre trial (n = 150). The participants were randomly assigned in a 1:1 ratio to the control (CON) and AST-120 (Renamezin®, REN) groups. Outcome measurements were performed at baseline and every 24 weeks for 48 weeks. The primary outcome was gait speed difference ≥0.1 m/s between the two groups, and secondary outcomes included hand grip strength, muscle mass, and health-related quality of life. RESULTS A difference of gait speed ≥0.1 m/s was not observed during the study period. The mean dynamic-start gait speed in the REN group increased from baseline to 48 weeks (1.04 ± 0.31 to 1.08 ± 0.32 m/s, P = 0.019). The static-start gait speed changed by -0.024 and 0.04 m/s (P = 0.049) in the CON and REN groups over 48 weeks, respectively. Hand grip strength decreased during the first 24 weeks and did not significantly change over the next 24 weeks in either group. The proportion of low muscle mass or sarcopenia at baseline was larger in the REN group than in the CON group, but the difference attenuated over the study period [low muscle mass and sarcopenia in the CON and REN groups at baseline, 4.0% vs. 18.9% (P = 0.004) and 2.7% vs. 13.5% (P = 0.017); at 24 weeks, 2.9% vs. 13.6% (P = 0.021) and 1.4% vs. 10.5% (P = 0.029); and at 48 weeks, 7.6% vs. 12.9% (P = 0.319) and 4.5% vs. 8.1% (P = 0.482), respectively]. Bodily pain, vitality, symptoms/problems, and cognitive function in the REN group improved, while the quality of social interactions and the kidney disease effects in the CON group aggravated from baseline to 48 weeks. Interaction between time and group was evident only in symptoms/problems, cognitive function, and kidney disease effects. CONCLUSIONS The addition of AST-120 to standard treatment in chronic kidney disease patients did not make a significant difference in gait speed, although AST-120 modestly had beneficial effects on gait speed change and quality of life and showed the potential to improve sarcopenia. (clinicaltrials.gov: NCT03788252).
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Affiliation(s)
- Ran-Hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Seok Hui Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Mi Yeun Han
- Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Won Suk An
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Su-Hyun Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jun Chul Kim
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
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28
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Banks NF, Rogers EM, Church DD, Ferrando AA, Jenkins NDM. The contributory role of vascular health in age-related anabolic resistance. J Cachexia Sarcopenia Muscle 2022; 13:114-127. [PMID: 34951146 PMCID: PMC8818606 DOI: 10.1002/jcsm.12898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/18/2021] [Accepted: 11/22/2021] [Indexed: 12/25/2022] Open
Abstract
Sarcopenia, or the age-related loss of skeletal muscle mass and function, is an increasingly prevalent condition that contributes to reduced quality of life, morbidity, and mortality in older adults. Older adults display blunted anabolic responses to otherwise anabolic stimuli-a phenomenon that has been termed anabolic resistance (AR)-which is likely a casual factor in sarcopenia development. AR is multifaceted, but historically much of the mechanistic focus has been on signalling impairments, and less focus has been placed on the role of the vasculature in postprandial protein kinetics. The vascular endothelium plays an indispensable role in regulating vascular tone and blood flow, and age-related impairments in vascular health may impede nutrient-stimulated vasodilation and subsequently the ability to deliver nutrients (e.g. amino acids) to skeletal muscle. Although the majority of data has been obtained studying younger adults, the relatively limited data on the effect of blood flow on protein kinetics in older adults suggest that vasodilatory function, especially of the microvasculature, strongly influences the muscle protein synthetic response to amino acid feedings. In this narrative review, we examine evidence of AR in older adults following amino acid and mixed meal consumption, examine the evidence linking vascular dysfunction and insulin resistance to age-related AR, review the influence of nitric oxide and endothelin-1 on age-related vascular dysfunction as it relates to AR, briefly review the potential causal role of arterial stiffness in promoting skeletal muscle microvascular dysfunction and AR, and provide a brief overview and future considerations for research examining age-related AR.
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Affiliation(s)
- Nile F Banks
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, IA, USA
| | - Emily M Rogers
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, IA, USA
| | - David D Church
- Center for Translational Research in Aging and Longevity, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Arny A Ferrando
- Center for Translational Research in Aging and Longevity, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nathaniel D M Jenkins
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, University of Iowa, Iowa City, IA, USA.,Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, USA
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29
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Cha RH, Lee GS. Steady exercise improves hand grip and leg muscle strength in hemodialysis patients. J Exerc Rehabil 2022; 17:435-443. [PMID: 35036393 PMCID: PMC8743601 DOI: 10.12965/jer.2142616.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/21/2021] [Indexed: 11/22/2022] Open
Abstract
Sarcopenia due to chronic inflammation and biochemical disturbances in chronic kidney disease is severer and more prevalent in hemodialysis (HD) patients. We longitudinally evaluated the hand grip strength (HGS) and leg muscle strength (LMS) and evaluated the role of exercise in muscle strength in HD patients. We screened (January, n=127) and followed up (June, n=110 and December 2020, n=104). HGS and LMS at single center by using digital hand and leg dynamometer. HGS (24.2 kg vs. 15.5 kg) and LMS (32.8 kg vs. 22.5 kg) were better in men (P<0.001 and P<0.001, respectively). Older patients (≥60 years) showed decreased LMS than others in women (P=0.01). Patients who performed steady home- or hospital-based exercise showed marginally higher HGS (23.1 kg vs. 19.8 kg, P=0.07) and significantly higher LMS (33.7 kg vs. 25.9 kg, P=0.004). Steady exercise improved LMS throughout the study period (30.3 kg vs. 33.2 kg from Jan to Jun 2020, P=0.004; 30.3 kg vs. 34.2 kg from Jan to Dec 2020, P=0.014). Multiple linear regression analysis proved steady exercise was independently associated with better HGS and LMS. Steady exercise showed greater impact on LMS in male patients with longer HD vintage (≥44 months) and on HGS in younger male patients with shorter HD vintage (<44 months). Steady exercise was an important determinant of muscle strength in HD patients. We need to encourage patients to steadily perform regular home- or group-exercise before sarcopenia develops.
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Affiliation(s)
- Ran-Hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Geum Sil Lee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
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30
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Prevalence and determinants of sarcopenia in Indian patients with chronic kidney disease stage 3 & 4. Osteoporos Sarcopenia 2022; 7:153-158. [PMID: 35005252 PMCID: PMC8714469 DOI: 10.1016/j.afos.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/17/2021] [Accepted: 11/18/2021] [Indexed: 12/31/2022] Open
Abstract
Objectives There is limited literature on the prevalence and determinants of sarcopenia in the Indian predialysis chronic kidney disease (CKD) population. The current study attempts to characterize sarcopenia in CKD stages 3 & 4 using 3-compartment model dual-energy X-ray absorptiometry (DXA). Methods This is secondary data from a randomized trial on bicarbonate supplementation for preserving muscle mass. A 3-compartment DXA was done to assess body composition in 188 subjects aged 18 to 65, with stable kidney function. Sarcopenia was defined by Asian Working Group criteria - appendicular skeletal mass index < 5.4 kg/m2 in women and < 7 kg/m2 in men. Results Sarcopenia was present in 69.1% (n = 130). There was no difference in the prevalence of sarcopenia in CKD stage 3 (n = 62; 72.1%) vs CKD stage 4 (n = 68, 66.7%); P = 0.434. A lower body mass index (BMI) (OR 1.69; 95% CI 1.43, 2.01) and lower bicarbonate levels (OR 1.22; 95% CI 1.02, 1.47), and age (OR 0.95; 95% CI 0.91, 0.98) was independently associated with the muscle mass. A BMI cut-off of 18 failed to identify sarcopenia in 78.4% (n = 102) subjects (Kappa statistic 0.396). The receiver operating characteristic curve for mid-arm muscle circumference for identifying sarcopenia was 0.651 (95% CI 0.561, 0.740). Conclusions Sarcopenia is highly prevalent in CKD 3 and 4. Sarcopenic individuals are older, with a low BMI and lower bicarbonate levels. The anthropometric parameters and biochemical parameters did not help identify sarcopenia in the predialysis population.
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Sasaki S, Nakamura K, Ukawa S, Okada E, Amagasa S, Inoue S, Kimura T, Yoshimura A, Tanaka A, Nakagawa T, Imae A, Tamakoshi A. Association of accelerometer-measured physical activity with kidney function in a Japanese population: the DOSANCO Health Study. BMC Nephrol 2022; 23:7. [PMID: 34979979 PMCID: PMC8722077 DOI: 10.1186/s12882-021-02635-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/09/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sedentary behavior and decreased physical activity are associated with reduced kidney function, yet most evidence is based on self-reported physical activity. This study investigated the association between accelerometer-based physical activity level and kidney function in a general Japanese population. METHODS A cross-sectional study was conducted in 440 community-dwelling Japanese participants, aged 35-79 years. Time (min/d) was assessed for the following types of physical activity: sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Kidney function was assessed using estimated glomerular filtration rate (eGFR). A linear regression model was employed to calculate the β coefficient of eGFR for a 60-min/d increase in sedentary behavior and LPA and a 10-min/d increase in MVPA. A logistic regression model was used to calculate the odds ratio for low eGFR (< 60 versus ≥60 mL/min/1.73m2) for a 60-min/d or 10-min/d increase in each physical activity type. RESULTS MVPA time and eGFR were positively associated in both men and women, after adjusting for age, body mass index, and other clinical characteristics (Men: β, 0.91; P = 0.021; Women: β, 0.70; P = 0.034). In women, sedentary behavior and eGFR were inversely associated after adjusting for the same factors (β, - 1.06; P = 0.048). The odds ratio (95% confidence interval) for low eGFR associated with a 60-min increase in sedentary behavior was 1.65 (1.07-2.55) after adjusting for the same factors in women. CONCLUSION Longer sedentary behavior and shorter MVPA time were associated with lower kidney function in the Japanese population.
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Affiliation(s)
- Sachiko Sasaki
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.,Department of Physical Therapy, Faculty of Human Science, Hokkaido Bunkyo University, 5-196-1 Kogane-chuo, Eniwa, 061-1449, Japan
| | - Koshi Nakamura
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan. .,Department of Public Health and Hygiene, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Shigekazu Ukawa
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.,Research Unit of Advanced Interdisciplinary Care Science, Osaka City University Graduate School of Human Life Science, Sugimoto 3-3-138, Sumiyoshi-ku, Osaka, 558-8585, Japan
| | - Emiko Okada
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.,Department of Nutritional Epidemiology, National Institute of Biomedical Innovation, Health and Nutrition, 1-23-1, Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - Shiho Amagasa
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Aya Yoshimura
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Aya Tanaka
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Takafumi Nakagawa
- The Hokkaido Centre for Family Medicine, 1-18, Kita 41, Higashi 15, Higashi-ku, Sapporo, 007-0841, Japan
| | - Akihiro Imae
- Suttu Municipal Clinic, 72-2, Utoshima-Cho, Suttu-Cho, Suttu-Gun, Hokkaido, 048-0406, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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Chatzipetrou V, Bégin MJ, Hars M, Trombetti A. Sarcopenia in Chronic Kidney Disease: A Scoping Review of Prevalence, Risk Factors, Association with Outcomes, and Treatment. Calcif Tissue Int 2022; 110:1-31. [PMID: 34383112 PMCID: PMC8732833 DOI: 10.1007/s00223-021-00898-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022]
Abstract
Sarcopenia, a condition characterized by loss of skeletal muscle mass and function, has important clinical ramifications. We aimed to map the existing literature about prevalence, risk factors, associated adverse outcomes, and treatment of sarcopenia in individuals with chronic kidney disease (CKD). A scoping review of the literature was conducted to identify relevant articles published from databases' inception to September 2019. Individuals with CKD, regardless of their disease stage and their comorbidities, were included. Only studies with sarcopenia diagnosed using both muscle mass and function, based on published consensus definitions, were included. For studies on treatment, only randomized controlled trials with at least one sarcopenia parameter as an outcome were included. Our search yielded 1318 articles, of which 60 from were eligible for this review. The prevalence of sarcopenia ranged from 4 to 42% according to the definition used, population studied, and the disease stage. Several risk factors for sarcopenia were identified including age, male gender, low BMI, malnutrition, and high inflammatory status. Sarcopenia was found to be associated with several adverse outcomes, including disabilities, hospitalizations, and mortality. In CKD subjects, several therapeutic interventions have been assessed in randomized controlled trial with a muscle mass, strength, or function endpoint, however, studies focusing on sarcopenic CKD individuals are lacking. The key interventions in the prevention and treatment of sarcopenia in CKD seem to be aerobic and resistance exercises along with nutritional interventions. Whether these interventions are effective to treat sarcopenia and prevent clinical consequences in this population remains to be fully determined.
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Affiliation(s)
- Varvara Chatzipetrou
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Marie-Josée Bégin
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Mélany Hars
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Division of Geriatrics, Department of Readaptation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
- Division of Geriatrics, Department of Readaptation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland.
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Otobe Y, Rhee CM, Nguyen M, Kalantar-Zadeh K, Kopple JD. Current status of the assessment of sarcopenia, frailty, physical performance and functional status in chronic kidney disease patients. Curr Opin Nephrol Hypertens 2022; 31:109-128. [PMID: 34772840 PMCID: PMC8688315 DOI: 10.1097/mnh.0000000000000763] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Low physical function, frailty, and sarcopenia are common complications of chronic kidney disease (CKD). In this article, we review the epidemiology and pathogenesis of low physical function, as well as its associations with adverse outcomes in CKD patients. Additionally, we present various traditional and novel methods for assessment of physical function in CKD patients. RECENT FINDINGS In nondialysis dependent (NDD) and dialysis-dependent CKD patients, the prevalence of low physical function, frailty, and sarcopenia are substantially higher than in the general population. The potential mechanisms of low physical function, frailty, and sarcopenia in CKD patients are due to various factors including underlying kidney disease, co-existing comorbidities, and certain therapeutic interventions utilized in CKD. Increasing evidence has also uncovered the ill effects of impaired physical function on clinical outcomes in CKD patients. SUMMARY Routine assessment of physical function is an under-utilized yet important component in the management of CKD patients. Future studies are needed to determine how prescription of exercise and increased daily physical activity can be tailored to optimize the health and well-being of NDD and dialysis-dependent CKD patients in pursuit of successful aging.
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Affiliation(s)
- Yuhei Otobe
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Matthew Nguyen
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, CA
- UCLA Fielding School of Public Health, Los Angeles, CA
| | - Joel D. Kopple
- UCLA Fielding School of Public Health, Los Angeles, CA
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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Yu MY, Park JH, Kim YC, Park JY, Cha RH. Comparison of intradialytic neuromuscular electrical stimulation and oral nutritional supplements in hemodialysis patients: study protocol for a multicenter, parallel-group, randomized controlled trial in Korea. Trials 2021; 22:942. [PMID: 34930408 PMCID: PMC8686339 DOI: 10.1186/s13063-021-05918-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background The prevalence of sarcopenia increases as renal function decreases, and a considerable number of hemodialysis (HD) patients have sarcopenia. Exercise and nutritional support are established interventions to prevent and treat sarcopenia. Recently, many studies evaluating intradialytic neuromuscular electrical stimulation (NMES) showed improvement of muscular strength and mass, functional capacity, and quality of life (QOL). However, there has been no research about the effect of simultaneous nutritional support and NMES in HD patients. Methods This is a 12-week, randomized controlled, parallel-group, multicenter trial of intradialytic NMES and protein supplementation for HD patients. Seventy-two patients receiving HD will be randomly assigned in a 1:1:1:1 ratio to control, intradialytic NMES only, protein supplementation only, and intradialytic NMES combined with protein supplementation groups. NMES will be delivered to a total of four areas of the bilateral vastus medialis and vastus lateralis using a 4-channel NMES instrument. A total of 25 g of protein supplements will be provided at the beginning of every dialysis session or after the NMES. The primary endpoint is the difference of hand grip and leg muscle strength at 12 weeks among 4 treatment groups. Secondary endpoints include muscle mass, physical performances, and questionnaires about QOL and physical activity. Discussion In this study, we will evaluate the differential effectiveness of nutritional support and NMES during HD on muscle strength, muscle mass, physical function, and QOL. We expect that this study can provide guidelines for a new therapeutic option for HD patients who are unable or hesitant to exercise. Furthermore, this option can offer an opportunity to improve the physical function, QOL, and prognosis of HD patients. Trial registration Clinical Research Information Service (CRIS), Korea, KCT0005573. Retrospectively registered on 03 November 2020
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Affiliation(s)
- Mi-Yeon Yu
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Republic of Korea
| | - Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Ilsan, Gyeonggi-do, Republic of Korea
| | - Ran-Hui Cha
- Department of Internal Medicine, National Medical Center, 245, Eulji-ro, Jung-gu, Seoul, 04564, Republic of Korea.
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35
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Kim B, Kim G, Kim E, Park J, Isobe T, Sakae T, Oh S. The A Body Shape Index Might Be a Stronger Predictor of Chronic Kidney Disease Than BMI in a Senior Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412874. [PMID: 34948483 PMCID: PMC8701813 DOI: 10.3390/ijerph182412874] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/23/2021] [Accepted: 12/05/2021] [Indexed: 12/20/2022]
Abstract
The A Body Shape Index (ABSI) was recently introduced to quantify abdominal adiposity relative to the body mass index (BMI) and height. This cross-sectional study was performed to explore whether the ABSI is linked to chronic kidney disease (CKD) in older adults and compare the predictive capacity of the ABSI versus BMI for CKD. In total, 7053 people aged ≥ 60 years were divided into normal, mild, and moderate-to-severe CKD groups based on their estimated glomerular filtration rate (eGFR). The correlation of the ABSI with the eGFR and the differences and trends in the ABSI and BMI among the groups were analyzed, and the cutoff points for moderate-to-severe CKD were calculated. The association between the ABSI and CKD was stronger than that between the BMI and CKD. The ABSI had a better capacity to discriminate the CKD stage than did the BMI. The capacity of the ABSI to predict moderate-to-severe CKD was higher than that of the BMI and was more substantial in women than men. The ABSI cutoff points for CKD were ≥0.0822 and 0.0795 in men and women, respectively. In conclusion, the ABSI serves as a better index than the BMI for screening and detecting high-risk individuals with CKD.
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Affiliation(s)
- Bokun Kim
- Department of Kinesiology, Silla University, Busan 46958, Korea;
| | - Gwonmin Kim
- Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (G.K.); (J.P.)
| | - Eonho Kim
- Department of Physical Education, Dongguk University, Seoul 04620, Korea;
| | - Jonghwan Park
- Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (G.K.); (J.P.)
| | - Tomonori Isobe
- Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan; (T.I.); (T.S.)
| | - Takeji Sakae
- Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan; (T.I.); (T.S.)
| | - Sechang Oh
- Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan; (T.I.); (T.S.)
- Correspondence: ; Tel.: +81-29-853-3291
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Kato H, Watanabe H, Imafuku T, Arimura N, Fujita I, Noguchi I, Tanaka S, Nakano T, Tokumaru K, Enoki Y, Maeda H, Hino S, Tanaka M, Matsushita K, Fukagawa M, Maruyama T. Advanced oxidation protein products contribute to chronic kidney disease-induced muscle atrophy by inducing oxidative stress via CD36/NADPH oxidase pathway. J Cachexia Sarcopenia Muscle 2021; 12:1832-1847. [PMID: 34599649 PMCID: PMC8718075 DOI: 10.1002/jcsm.12786] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/10/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sarcopenia with chronic kidney disease (CKD) progression is associated with life prognosis. Oxidative stress has attracted interest as a trigger for causing CKD-related muscular atrophy. Advanced oxidation protein products (AOPPs), a uraemic toxin, are known to increase oxidative stress. However, the role of AOPPs on CKD-induced muscle atrophy remains unclear. METHODS In a retrospective case-control clinical study, we evaluated the relationship between serum AOPPs levels and muscle strength in haemodialysis patients with sarcopenia (n = 26, mean age ± SEM: 78.5 ± 1.4 years for male patients; n = 22, mean age ± SEM: 79.1 ± 1.5 for female patients), pre-sarcopenia (n = 12, mean age ± SEM: 73.8 ± 2.0 years for male patients; n = 4, mean age ± SEM: 74.3 ± 4.1 for female patients) or without sarcopenia (n = 12, mean age ± SEM: 71.3 ± 1.6 years for male patients; n = 7, mean age ± SEM: 77.7 ± 1.6 for female ). The molecular mechanism responsible for the AOPPs-induced muscle atrophy was investigated by using 5/6-nephrectomized CKD mice, AOPPs-overloaded mice, and C2C12 mouse myoblast cells. RESULTS The haemodialysis patients with sarcopenia showed higher serum AOPPs levels as compared with the patients without sarcopenia. The serum AOPPs levels showed a negative correlation with grip strength (P < 0.01 for male patients, P < 0.01 for female patients) and skeletal muscle index (P < 0.01 for male patients). Serum AOPPs levels showed a positive correlation with cysteinylated albumin (Cys-albumin), a marker of oxidative stress (r2 = 0.398, P < 0.01). In the gastrocnemius of CKD mice, muscle AOPPs levels were also increased, and it showed a positive correlation with atrogin-1 (r2 = 0.538, P < 0.01) and myostatin expression (r2 = 0.421, P < 0.05), but a negative correlation with PGC-1α expression (r2 = 0.405, P < 0.05). Using C2C12 cells, AOPPs increased atrogin-1 and myostatin expression through the production of reactive oxygen species via CD36/NADPH oxidase pathway, and decreased myotube formation. AOPPs also induced mitochondrial dysfunction. In the AOPPs-overloaded mice showed that decreasing running time and hanging time accompanied by increasing AOPPs levels and decreasing cross-sectional area in gastrocnemius. CONCLUSIONS Advanced oxidation protein products contribute to CKD-induced sarcopenia, suggesting that AOPPs or its downstream signalling pathway could be a therapeutic target for the treatment of CKD-induced sarcopenia. Serum AOPPs or Cys-albumin levels could be a new diagnostic marker for sarcopenia in CKD.
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Affiliation(s)
- Hiromasa Kato
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Hiroshi Watanabe
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Tadashi Imafuku
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Nanaka Arimura
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Issei Fujita
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Isamu Noguchi
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Shoma Tanaka
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Takehiro Nakano
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Kai Tokumaru
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Yuki Enoki
- Division of PharmacodynamicsKeio University Faculty of PharmacyTokyoJapan
| | - Hitoshi Maeda
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
| | - Shinjiro Hino
- Department of Medical Cell Biology, Institute of Molecular Embryology and GeneticsKumamoto UniversityKumamotoJapan
| | | | | | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of MedicineTokai UniversityIseharaJapan
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical SciencesKumamoto UniversityKumamotoJapan
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Creatinine generation rate can detect sarcopenia in patients with hemodialysis. Clin Exp Nephrol 2021; 26:272-277. [PMID: 34591238 DOI: 10.1007/s10157-021-02142-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sarcopenia is strongly associated with long-term mortality in patients undergoing hemodialysis. The diagnostic modalities used to assess muscle mass, such as bioimpedance analysis and dual-energy X-ray absorption measurement, have limitations for application in patients on hemodialysis. Therefore, there is a need to establish a simple index for assessing muscle mass that can be universally performed in patients on hemodialysis. METHODS Patients on maintenance hemodialysis were included in this study. Laboratory tests, skeletal muscle mass measured by bioimpedance analysis, and clinical records were obtained retrospectively. The creatinine generation rate (CGR) was calculated from the pre- and postdialysis blood tests using a kinetic model as the index for whole-body muscle mass. Correlations between the CGR and skeletal muscle mass were investigated, and the cut-off value for muscle wasting was determined. Kaplan-Meier survival analysis was performed to investigate the feasibility of the CGR for predicting long-term survival. RESULTS Among the 130 patients included, eight were diagnosed with sarcopenia by bioimpedance analysis. The CGR was positively correlated with skeletal muscle mass (r = 0.454, p < 0.001). Multiple linear regression analysis revealed that age and sex independently influenced the CGR. The patients were classified into two groups according to age- and sex-adjusted CGRs. During a median follow-up period of 32 months, the Kaplan-Meier survival analysis showed that patients with low CGR showed significantly poor long-term prognosis (p = 0.002). CONCLUSION The CGR is a simple index for muscle mass and can predict long-term mortality in patients on hemodialysis.
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Lorenz EC, Kennedy CC, Rule AD, LeBrasseur NK, Kirkland JL, Hickson LJ. Frailty in CKD and Transplantation. Kidney Int Rep 2021; 6:2270-2280. [PMID: 34514190 PMCID: PMC8418946 DOI: 10.1016/j.ekir.2021.05.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
The population is aging. Although older adults have higher rates of comorbidities and adverse health events, they represent a heterogeneous group with different health trajectories. Frailty, a clinical syndrome of decreased physiological reserve and increased susceptibility to illness and death, has emerged as a potential risk stratification tool in older patients with chronic kidney disease (CKD). Frailty is commonly observed in patients with CKD and associated with numerous adverse outcomes, including falls, decreased quality of life, hospitalizations, and death. Multiple pathologic factors contribute to the development of frailty in patients with CKD, including biological mechanisms of aging and physiological dysregulation. Current interventions to reduce frailty are promising, but additional investigations are needed to determine whether optimizing frailty measures improves renal and overall health outcomes. This review of frailty in CKD examines frailty definitions, the impact of frailty on health outcomes across the CKD spectrum, mechanisms of frailty, and antifrailty interventions (e.g., exercise or senescent cell clearance) tested in CKD patients. In addition, existing knowledge gaps, limitations of current frailty definitions in CKD, and challenges surrounding effective antifrailty strategies in CKD are considered.
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Affiliation(s)
- Elizabeth C Lorenz
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Cassie C Kennedy
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
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Lin MH, Chang CY, Wu DM, Lu CH, Kuo CC, Chu NF. Relationship of Multimorbidity, Obesity Status, and Grip Strength among Older Adults in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147540. [PMID: 34299990 PMCID: PMC8307394 DOI: 10.3390/ijerph18147540] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023]
Abstract
Background: The combination of multiple disease statuses, muscle weakness, and sarcopenia among older adults is an important public health concern, and a health burden worldwide. This study evaluates the association between chronic disease statuses, obesity, and grip strength (GS) among older adults in Taiwan. Methods: A community-based survey was conducted every 3 years among older adults over age 65, living in Chiayi County, Taiwan. Demographic data and several diseases statuses, such as diabetes mellitus, hypertension, cerebrovascular disease, cardiovascular disease, and certain cancers, were collected using a questionnaire. Anthropometric characteristics were measured using standard methods. Grip strength was measured using a digital dynamometer (TKK5101) method. Results: A total of 3739 older individuals were recruited (1600 males and 2139 females) with the mean age of 72.9 years. The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females. GS significantly decreased most in males with cerebrovascular disease (from 33.0—29.5 kg, p < 0.001) and in females with diabetes mellitus (from 21.8—21.0 kg, p < 0.01). GS was highest in older adults with obesity (body mass index ≥ 27 kg/m2); however, there was no significant change of GS as the disease number increased. Conclusion: Older adults who have two, rather than one or greater than three chronic diseases, have significantly lower GSs than those who are healthy. Stroke and CKD for males, and hypertension and diabetes for females, are important chronic diseases that are significantly associated with GS. Furthermore, being overweight may be a protective factor for GS in older adults of both sexes.
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Affiliation(s)
- Ming-Hsun Lin
- National Defense Medical Center, Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, Taipei 114, Taiwan; (M.-H.L.); (C.-Y.C.); (C.-H.L.)
| | - Chun-Yung Chang
- National Defense Medical Center, Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, Taipei 114, Taiwan; (M.-H.L.); (C.-Y.C.); (C.-H.L.)
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City 802, Taiwan
| | - Der-Min Wu
- National Defense Medical Center, School of Public Health, Taipei 114, Taiwan;
| | - Chieh-Hua Lu
- National Defense Medical Center, Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, Taipei 114, Taiwan; (M.-H.L.); (C.-Y.C.); (C.-H.L.)
| | - Che-Chun Kuo
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan City 325, Taiwan;
| | - Nain-Feng Chu
- National Defense Medical Center, School of Public Health, Taipei 114, Taiwan;
- Department of Internal Medicine, Tri-Service General Hospital, Taipei 114, Taiwan
- Correspondence: or ; Tel.: +886-2-8791-0506; Fax: +886-2-8792-0590
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Suzuki S, Kanaji S, Urakawa N, Takiguchi G, Hasegawa H, Yamashita K, Matsuda T, Oshikiri T, Nakamura T, Kakeji Y. Impact of chronic kidney disease stage on morbidity after gastrectomy for gastric cancer. Ann Gastroenterol Surg 2021; 5:519-527. [PMID: 34337301 PMCID: PMC8316737 DOI: 10.1002/ags3.12441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
AIM The outcomes of gastrectomy for gastric cancer in patients at each severity of chronic kidney disease (CKD) remain unknown. METHODS We retrospectively analyzed the outcomes of 560 patients who underwent distal or total gastrectomy for gastric cancer between 2009 and 2018. We classified the patients into four groups based on estimated glomerular filtration rate: stage 1/2 (normal to mild, n = 375), stage 3a (mild to moderate, n = 122), stage 3b (moderate to severe, n = 43), and stage 4/5 (severe to end-stage, n = 20) CKD. The relationship between CKD stage and the incidence of postoperative morbidity was analyzed. RESULTS CKD was a predictor of overall morbidity independent of age, gender, American Society of Anesthesiologists Performance Status, pulmonary comorbidity, extent of lymphadenectomy, and operation time in a multivariate analysis. The incidences of overall and severe morbidity were significantly increased with CKD progression (both P < .001). Compared to stage 1/2 CKD, the odds of overall morbidity were significantly elevated in stage 3a (odds ratio [OR] 1.87, P = .007), stage 3b (OR 3.86, P < .001), and stage 4/5 (OR 8.60, P < .001). The risk of procedure-related morbidity was strikingly increased in stage 3b (OR 2.93, P = .004). The risk of procedure-unrelated morbidity elevated markedly in stage 3a (OR 2.77, P = .001). A significant graded association between CKD progression and overall morbidity was also revealed in elderly patients (P = .001). CONCLUSIONS The severity of CKD predicts the likelihood and type of morbidity after gastrectomy and can guide surgical decision-making for patients with gastric cancer.
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Affiliation(s)
- Satoshi Suzuki
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Shingo Kanaji
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Naoki Urakawa
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Gosuke Takiguchi
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Hiroshi Hasegawa
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Kimihiro Yamashita
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Takeru Matsuda
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Taro Oshikiri
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Tetsu Nakamura
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Yoshihiro Kakeji
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
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β2-adrenergic receptor agonist counteracts skeletal muscle atrophy and oxidative stress in uremic mice. Sci Rep 2021; 11:9130. [PMID: 33911115 PMCID: PMC8080640 DOI: 10.1038/s41598-021-88438-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
In patients with chronic kidney disease, skeletal muscle dysfunction is associated with mortality. Uremic sarcopenia is caused by ageing, malnutrition, and chronic inflammation, but the molecular mechanism and potential therapeutics have not been fully elucidated yet. We hypothesize that accumulated uremic toxins might exert a direct deteriorative effect on skeletal muscle and explore the pharmacological treatment in experimental animal and culture cell models. The mice intraperitoneally injected with indoxyl sulfate (IS) after unilateral nephrectomy displayed an elevation of IS concentration in skeletal muscle and a reduction of instantaneous muscle strength, along with the predominant loss of fast-twitch myofibers and intramuscular reactive oxygen species (ROS) generation. The addition of IS in the culture media decreased the size of fully differentiated mouse C2C12 myotubes as well. ROS accumulation and mitochondrial dysfunction were also noted. Next, the effect of the β2-adrenergic receptor (β2-AR) agonist, clenbuterol, was evaluated as a potential treatment for uremic sarcopenia. In mice injected with IS, clenbuterol treatment increased the muscle mass and restored the tissue ROS level but failed to improve muscle weakness. In C2C12 myotubes stimulated with IS, although β2-AR activation also attenuated myotube size reduction and ROS accumulation as did other anti-oxidant reagents, it failed to augment the mitochondrial membrane potential. In conclusion, IS provokes muscular strength loss (uremic dynapenia), ROS generation, and mitochondrial impairment. Although the β2-AR agonist can increase the muscular mass with ROS reduction, development of therapeutic interventions for restoring skeletal muscle function is still awaited.
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Watanabe D, Yoshida T, Nakagata T, Sawada N, Yamada Y, Kurotani K, Tanaka K, Okabayashi M, Shimada H, Takimoto H, Nishi N, Abe K, Miyachi M. Factors associated with sarcopenia screened by finger-circle test among middle-aged and older adults: a population-based multisite cross-sectional survey in Japan. BMC Public Health 2021; 21:798. [PMID: 33902521 PMCID: PMC8074487 DOI: 10.1186/s12889-021-10844-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/13/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Previous epidemiological studies have demonstrated the prevalence and relationship of various factors associated with sarcopenia in older adults; however, few have examined the status of sarcopenia in middle-aged adults. In this study, we aimed to, 1) evaluate the validity of the finger-circle test, which is potentially a useful screening tool for sarcopenia, and 2) determine the prevalence and factors associated with sarcopenia in middle-aged and older adults. METHODS We conducted face-to-face surveys of 525 adults, who were aged 40-91 years and resided in Settsu City, Osaka Prefecture, Japan to evaluate the validity of finger-circle test. The finger-circle test evaluated calf circumference by referring to an illustration printed on the survey form. The area under the receiver operating characteristic curves (AUROC) was plotted to evaluate the validity of the finger-circle test for screening sarcopenia and compared to that evaluated by skeletal muscle mass index (SMI) measured using bioimpedance. We also conducted multisite population-based cross-sectional anonymous mail surveys of 9337 adults, who were aged 40-97 years and resided in Settsu and Hannan Cities, Osaka Prefecture, Japan. Participants were selected through stratified random sampling by sex and age in the elementary school zones of their respective cities. We performed multiple logistic regression analysis to explore associations between characteristics and prevalence of sarcopenia. RESULTS Sarcopenia, defined by SMI, was moderately predicted by a finger-circle test response showing that the subject's calf was smaller than their finger-circle (AUROC: 0.729, < 65 years; 0.653, ≥65 years); such subjects were considered to have sarcopenia. In mail surveys, prevalence of sarcopenia screened by finger-circle test was higher in older subjects (approximately 16%) than in middle-aged subjects (approximately 8-9%). In a multiple regression model, the factors associated with sarcopenia were age, body mass index, smoking status, self-reported health, and number of meals in all the participants. CONCLUSIONS Sarcopenia, screened by the finger-circle test, was present not only among older adults but also among middle-aged adults. These results may provide useful indications for developing public health programs, not only for the prevention, but especially for the management of sarcopenia. TRIAL REGISTRATION UMIN000036880, registered prospectively May 29, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042027.
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Affiliation(s)
- Daiki Watanabe
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Institute for Active Health, Kyoto University of Advanced Science, 1-1 Nanjo Otani, Sogabe-cho, Kameoka-city, Kyoto, 621-8555 Japan
| | - Tsukasa Yoshida
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Institute for Active Health, Kyoto University of Advanced Science, 1-1 Nanjo Otani, Sogabe-cho, Kameoka-city, Kyoto, 621-8555 Japan
| | - Takashi Nakagata
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Institute for Active Health, Kyoto University of Advanced Science, 1-1 Nanjo Otani, Sogabe-cho, Kameoka-city, Kyoto, 621-8555 Japan
| | - Naomi Sawada
- Department of Health and Welfare, Settsu City Local Government, 1-1-1 Mishima, Settsu-city, Osaka, 566-8555 Japan
- Present Address: Department of Developing Next Generation, Settsu City Local Government, 1-1-1 Mishima, Settsu-city, Osaka, 566-8555 Japan
| | - Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Institute for Active Health, Kyoto University of Advanced Science, 1-1 Nanjo Otani, Sogabe-cho, Kameoka-city, Kyoto, 621-8555 Japan
| | - Kayo Kurotani
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- Faculty of Life and Environmental Sciences, Showa Women’s University, 1-7-57 Taishido, Setagaya-ku, Tokyo, 154-8533 Japan
| | - Kenji Tanaka
- Department of Health, Hannan City Local Government, 35-1 Ozaki-cho, Hannan-city, Osaka, 599-0201 Japan
| | - Megumi Okabayashi
- Department of Public Health and Medical Affairs, Osaka Prefectural Government, 2-1-22 Otemae, Chuo-ku, Osaka-city, Osaka, 540-8570 Japan
| | - Hidekazu Shimada
- Department of Public Health and Medical Affairs, Osaka Prefectural Government, 2-1-22 Otemae, Chuo-ku, Osaka-city, Osaka, 540-8570 Japan
| | - Hidemi Takimoto
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
| | - Nobuo Nishi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
| | - Keiichi Abe
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
- National Institutes of Biomedical Innovation, Health and Nutrition, 7-6-8 Saito-Asagi, Ibaraki-city, Osaka, 567-0085 Japan
| | - Motohiko Miyachi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636 Japan
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Optimal Protein Intake in Pre-Dialysis Chronic Kidney Disease Patients with Sarcopenia: An Overview. Nutrients 2021; 13:nu13041205. [PMID: 33917381 PMCID: PMC8067427 DOI: 10.3390/nu13041205] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 12/23/2022] Open
Abstract
Multi-factors, such as anorexia, activation of renin-angiotensin system, inflammation, and metabolic acidosis, contribute to malnutrition in chronic kidney disease (CKD) patients. Most of these factors, contributing to the progression of malnutrition, worsen as CKD progresses. Protein restriction, used as a treatment for CKD, can reduce the risk of CKD progression, but may worsen the sarcopenia, a syndrome characterized by a progressive and systemic loss of muscle mass and strength. The concomitant rate of sarcopenia is higher in CKD patients than in the general population. Sarcopenia is also associated with mortality risk in CKD patients. Thus, it is important to determine whether protein restriction should be continued or loosened in CKD patients with sarcopenia. We may prioritize protein restriction in CKD patients with a high risk of end-stage kidney disease (ESKD), classified to stage G4 to G5, but may loosen protein restriction in ESKD-low risk CKD stage G3 patients with proteinuria <0.5 g/day, and rate of eGFR decline <3.0 mL/min/1.73 m2/year. However, the effect of increasing protein intake alone without exercise therapy may be limited in CKD patients with sarcopenia. The combination of exercise therapy and increased protein intake is effective in improving muscle mass and strength in CKD patients with sarcopenia. In the case of loosening protein restriction, it is safe to avoid protein intake of more than 1.5 g/kgBW/day. In CKD patients with high risk in ESKD, 0.8 g/kgBW/day may be a critical point of protein intake.
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Cha RH, Lee GS, Yoo JY, Rhee OB, Jeon YD. Hand Grip and Leg Muscle Strength in Hemodialysis Patients and Its Determinants. J Korean Med Sci 2021; 36:e76. [PMID: 33754509 PMCID: PMC7985287 DOI: 10.3346/jkms.2021.36.e76] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Chronic kidney disease is associated with chronic inflammation and progressive loss of peripheral muscle strength and the ability to exercise, and these changes are highly pronounced in patients receiving hemodialysis (HD). We evaluated hand grip strength (HGS) and leg muscle strength (LMS) in patients receiving HD and attempted to identify factors associated with muscle strength. METHODS We screened HGS (opposite the fistula side) and LMS (both sides) in HD patients at a single center (n = 112) by using digital hand and leg dynamometers (T.K.K. 5401 and 5710e/5715, Takei Scientific Instruments Co. Ltd., Niigata, Japan). RESULTS The mean age of patients was 62.6 years, and 73.2% of the patients were male. Diabetes was the cause of kidney failure in 50% of the patients, and the median HD vintage was 34 months. A total of 77.7% of patients reported that they participated in regular home-based exercise, and 29.5% of patients regularly participated in hospital-based resistance exercise. HGS and LMS showed good correlation (r = 0.715, P < 0.001). HGS (25.1 vs. 17.0 kg) and LMS (30.1 vs. 20.4 kg) were greater in males (P < 0.001 and P < 0.001, respectively) than in females. Older patients (≥ 60 years) showed less LMS than younger patients in both males and females (P = 0.012 and P = 0.037, respectively), but HGS did not differ according to age. Patients performing regular home- or hospital-based exercise showed higher HGS than those who did not exercise (24.2 vs. 18.6 kg, P = 0.011), but LMS was not significantly different (29.3 vs. 23.6 kg, P = 0.185). Multiple linear regression analysis proved that male sex, younger age, and any type of exercise were factors associated with improved HGS and LMS. Groups of older age (≥ 60 years), male sex, and shorter duration of HD (< median) benefitted more from exercise. CONCLUSION Sex, age, and exercise were the most important determinants of muscle strength in HD patients. We need to encourage patients to engage in regular home or group exercise from the beginning of dialysis and introduce new feasible forms of exercise for HD patients.
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Affiliation(s)
- Ran Hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Korea.
| | - Geum Sil Lee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Ju Yeon Yoo
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Oe Bog Rhee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yong Duk Jeon
- Department of Internal Medicine, National Medical Center, Seoul, Korea
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Wu WT, Lee TM, Han DS, Chang KV. The Prevalence of Sarcopenia and Its Impact on Clinical Outcomes in Lumbar Degenerative Spine Disease-A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10040773. [PMID: 33671958 PMCID: PMC7919040 DOI: 10.3390/jcm10040773] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023] Open
Abstract
The association of sarcopenia with poor clinical outcomes has been identified in various medical conditions, although there is a lack of quantitative analysis to validate the influence of sarcopenia on patients with lumbar degenerative spine disease (LDSD) from the available literature. Therefore, this systematic review and meta-analysis aimed to summarize the prevalence of sarcopenia in patients with LDSD and examine its impact on clinical outcomes. The electronic databases (PubMed and Embase) were systematically searched from inception through December 2020 for clinical studies investigating the association of sarcopenia with clinical outcomes in patients with LDSD. A random-effects model meta-analysis was carried out for data synthesis. This meta-analysis included 14 studies, comprising 1953 participants. The overall prevalence of sarcopenia among patients with LDSD was 24.8% (95% confidence interval [CI], 17.3%–34.3%). The relative risk of sarcopenia was not significantly increased in patients with LDSD compared with controls (risk ratio, 1.605; 95% CI, 0.321–8.022). The patients with sarcopenia did not experience an increase in low back and leg pain. However, lower quality of life (SMD, −0.627; 95% CI, −0.844–−0.410) were identified postoperatively. Sarcopenia did not lead to an elevated rate of complications after lumbar surgeries. Sarcopenia accounts for approximately one-quarter of the population with LDSD. The clinical manifestations are less influenced by sarcopenia, whereas sarcopenia is associated with poorer quality of life after lumbar surgeries. The current evidence is still insufficient to support sarcopenia as a predictor of postoperative complications.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 108, Taiwan; (W.-T.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 100, Taiwan;
| | - Tsung-Min Lee
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 100, Taiwan;
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 108, Taiwan; (W.-T.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 100, Taiwan;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 108, Taiwan; (W.-T.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 100, Taiwan;
- Correspondence: ; Tel.: +886-223717101-5309
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Jiang S, Oh DS, Dorotea D, Son E, Kim DS, Ha H. Dojuksan ameliorates tubulointerstitial fibrosis through irisin-mediated muscle-kidney crosstalk. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 80:153393. [PMID: 33120292 DOI: 10.1016/j.phymed.2020.153393] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Sarcopenia progresses in chronic kidney disease (CKD) and is positively correlated with mortality in end-stage kidney disease patients. Circulating irisin, an exercise-induced myokine, gradually decreases during CKD stage progression. Irisin inhibits the progression of kidney fibrosis, which is the final common outcome of CKD. Our preliminary study with C2C12 cells showed that Dojuksan, a herbal decoction, increases the expression of PGC1α (a regulator of irisin) and FNDC5 (a precursor of irisin). HYPOTHESIS Dojuksan may increase circulating irisin and prevent the progression of kidney fibrosis. STUDY DESIGN AND METHODS Unilateral ureteral obstruction (UUO) was performed on seven-week-old male C57BL/6 mice to induce kidney tubulointerstitial fibrosis. Dojuksan (50, 100, or 200 mg/kg/day) or losartan (1.5 mg/kg/day), a standard clinical treatment for CKD, was administered orally one day prior to surgery and continued for seven days thereafter. To determine the role of irisin released from muscles, TGFβ-stimulated murine proximal tubular epithelial cells (mProx24 cells) were treated with conditioned media (CM) from Dojuksan-treated C2C12 muscle cells transfected with FNDC5 siRNA. RESULTS UUO mice exhibited muscle wasting along with progressive kidney injury. Similar to losartan, Dojuksan ameliorated kidney inflammation and fibrosis in UUO mice. Dojuksan, but not losartan, increased plasma irisin concentration in UUO mice. Dojuksan significantly increased basal FNDC5 expression and inhibited TNFα-induced and indoxyl sulfate-induced FNDC5 down-regulation in C2C12 cells. The TGFβ-induced collagen I (COL1) up-regulation in mProx24 cells was effectively inhibited by CM from C2C12 cells after Dojuksan treatment. Moreover, irisin inhibited TGFβ-induced COL1 in mProx24 cells, which was not affected by CM from C2C12 cells transfected with FNDC5 siRNA. CONCLUSION Dojuksan ameliorates kidney fibrosis through irisin-mediated muscle-kidney crosstalk, suggesting that Dojuksan may be used as an alternative therapeutic agent against CKD.
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Affiliation(s)
- Songling Jiang
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Dal-Seok Oh
- The Herbal Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Debra Dorotea
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Eunjung Son
- The Herbal Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Dong-Seon Kim
- The Herbal Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hunjoo Ha
- Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea.
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Association of skeletal muscle mass, kidney disease and mortality in older men and women: the cardiovascular health study. Aging (Albany NY) 2020; 12:21023-21036. [PMID: 33139582 PMCID: PMC7695366 DOI: 10.18632/aging.202135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022]
Abstract
Low muscle mass (sarcopenia) is a prevalent and major concern in the aging population as well as in patients with chronic kidney disease (CKD). We hypothesized that sarcopenia is an independent predictor of incident and progressive CKD and increased mortality in older men and women (≥65 years) from the Cardiovascular Health Study. Sarcopenia was defined by bioimpedance-estimated skeletal muscle mass index (SMI) as a continuous variable and categorically (normal, class I, and class II). Cox regression hazard ratios (HRs) estimated the risk of incident and prevalent CKD and mortality in individuals with and without CKD. Low SMI was associated with increased prevalence of CKD in men (p<0.001), but lower prevalence of CKD in women (p=0.03). Low muscle mass was not associated with incident CKD or rapid CKD progression (>3 ml/minute/1.73m2/year decline in eGFR) in men, but was associated with lower risk of incident CKD in women ([adjusted RR=0.69, 95% (0.51,0.94)]. Low muscle mass (class II) was independently associated with higher mortality only in men [(adjusted HR=1.26, 95% (1.05,1.50)]. Neither definition of sarcopenia was associated with mortality in men or women with CKD. Further studies are needed to understand the mechanisms by which sarcopenia contributes to higher mortality in aging men.
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Kabasawa K, Nakamura K, Ito Y, Tanaka J, Narita I. Association Between Estimated Glomerular Filtration Rate Based on Cystatin C and Grip Strength in Community-Dwelling Japanese Older Adults. J Gerontol A Biol Sci Med Sci 2020; 76:1653-1660. [PMID: 32971533 DOI: 10.1093/gerona/glaa240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Kidney dysfunction is associated with sarcopenia. Estimated glomerular filtration rate based on cystatin C (eGFRcys), an alternative to creatinine-based measures of kidney function eGFR, is not affected by muscle mass. Given that the association of eGFRcys with muscle weakness would be limited, we examined the association in older adults with normal or compromised kidney function. METHODS This cross-sectional study involved 594 community-dwelling Japanese adults aged ≥40 years living in Yuzawa, Japan. Serum creatinine, cystatin C, and handgrip strength were concurrently measured at a health-check examination in 2015. eGFR was calculated according to the equation developed for the Japanese population using creatinine and cystatin C. Associations of eGFRcys and eGFRcreat with low grip strength (men, <26 kg and women, <18 kg) were analyzed using logistic regression models adjusted to control for potential confounders. RESULTS Participants (mean age, 74.9 years) included 319 women and 109 individuals with low grip strength. Mean eGFRcys was 75.2 (SD 18.6) mL/min/1.73 m2. Pearson's correlation coefficients of handgrip strength for eGFRcys and eGFRcreat were 0.19 (p < .001) and -0.04 (p = .281), respectively. Multivariate logistic regression analysis showed the adjusted odds ratio (OR) of low grip strength for the highest versus lowest quartile of eGFRcys value was 2.46 (95% confidence interval, 1.03-5.86; p-trend = .026); whereas the comparative adjusted OR for eGFRcreat was 0.67 (95% confidence interval, 0.34-1.32). CONCLUSIONS Low kidney function as assessed by eGFRcys was associated with muscle weakness in community-dwelling Japanese older adults.
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Affiliation(s)
- Keiko Kabasawa
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Kazutoshi Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Yumi Ito
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Junta Tanaka
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Ichiei Narita
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan.,Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Pechmann LM, Jonasson TH, Canossa VS, Trierweiler H, Kisielewicz G, Petterle RR, Moreira CA, Borba VZC. Sarcopenia in Type 2 Diabetes Mellitus: A Cross-Sectional Observational Study. Int J Endocrinol 2020; 2020:7841390. [PMID: 33178269 PMCID: PMC7644336 DOI: 10.1155/2020/7841390] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the prevalence of low muscle mass and sarcopenia in patients with type 2 diabetes mellitus (T2DM) versus paired controls (control group, CG) and the association between sarcopenia and chronic diabetes complications. METHODS Men and women ≥50 years with T2DM (T2DM group, T2DMG) were recruited during routine outpatient visits. Total body densitometry and handgrip strength (HGS) were evaluated in the T2DMG and CG, while the T2DMG was also evaluated for the physical performance using the gait speed (GS) test. Sarcopenia was diagnosed according to the criteria of the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). RESULTS The study included 177 individuals in the T2DMG and 146 in the CG. The mean HGS value was lower in the T2DMG (24.4 ± 10.3 kg) compared with the CG (30.9 ± 9.15 kg), p < 0.001, with low HGS in 46 (25.9%) and 10 (9%) in the T2DMG and CG, respectively (p < 0.001). The prevalence of sarcopenia defined according to the FNIH criteria was higher in the T2DMG 23 (12.9%) compared with the CG 8 (5.4%), p < 0.03. The presence of albuminuria increased the odds of sarcopenia (odds ratio (OR) 2.84, 95% confidence interval (CI) 1.07-7.68, p=0.04) and osteoporosis (OR 3.38, 95% CI 1.12-9.89, p=0.03), even in patients with mild to moderate nephropathy. The body composition analysis showed increased odds of sarcopenia with increased percentage of total fat (%TF) in women (OR 1.18, 95% CI, 1.03-1.43, p=0.03) and men (OR 1.31, 95% CI, 1.10-1.75, p=0.01). CONCLUSION Patients with T2DM presenting with albuminuria, osteoporosis, and increased %TF were more likely to have sarcopenia. This finding emphasizes the need for patients with T2DM to be evaluated for sarcopenia to allow for early implementation of measures to prevent or treat this disorder.
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Affiliation(s)
- L. M. Pechmann
- Internal Medicine and Endocrine Division (SEMPR), Universidade Federal do Paraná, Centro de Diabetes Curitiba, Curitiba, PR, Brazil
| | - T. H. Jonasson
- Endocrine Division, Hospital de Clínicas da Universidade Federal Do Paraná (SEMPR), Avenida Agostinho Leão Júnior, 285, Alto da Glória, Curitiba, PR 80030-110, Brazil
| | - V. S. Canossa
- Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | - R. R. Petterle
- Department of Integrative Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - C. A. Moreira
- Endocrine Division, Hospital de Clínicas da Universidade Federal Do Paraná (SEMPR), Avenida Agostinho Leão Júnior, 285, Alto da Glória, Curitiba, PR 80030-110, Brazil
| | - V. Z. C. Borba
- Endocrine Division, Hospital de Clínicas da Universidade Federal Do Paraná (SEMPR), Avenida Agostinho Leão Júnior, 285, Alto da Glória, Curitiba, PR 80030-110, Brazil
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Bakaloudi DR, Siargkas A, Poulia KA, Dounousi E, Chourdakis M. The Effect of Exercise on Nutritional Status and Body Composition in Hemodialysis: A Systematic Review. Nutrients 2020; 12:E3071. [PMID: 33050111 PMCID: PMC7601723 DOI: 10.3390/nu12103071] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/27/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) is associated with aggravating factors which can affect both body composition and nutritional status. The purpose of the present systematic review was to investigate the potential effects of any physical activity on body composition or nutritional status among patients with stage 5 CKD undergoing hemodialysis (HD). A literature search on PubMed, Scopus, Web of Science, Google Scholar, and Cochrane was conducted and 14 randomized clinical trials were included. Skeletal muscle index and mid-arm muscular circumference increased after resistance exercise, and the results on body mass index, % body fat, and lean body mass varied. Serum albumin and C-reactive protein, in most cases, showed a slight increase and decrease, respectively. An improvement was also observed in body strength and overall performance status. The results suggest that physical activity can be beneficial for both the body composition and nutritional status of patients undergoing HD and can help in the prevention of sarcopenia. However, further research is needed mainly in the field of nutritional status.
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Affiliation(s)
- Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.R.B.); (A.S.)
| | - Antonios Siargkas
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.R.B.); (A.S.)
| | - Kalliopi Anna Poulia
- Department of Nutrition and Dietetics, Laiko General Hospital, 11527 Athens, Greece;
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.R.B.); (A.S.)
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