Prevalence of sarcopenia and associated factors in patients in hemodialysis
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Published:
Dec 23, 2021
Keywords:
chronic renal insufficiency, hemodialyses, sarcopenia
Main Article Content
Abstract
Objective: To assess the prevalence of sarcopenia and associated factors in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). Methods: This cross-sectional study evaluated patients with CKD undergoing HD from January to October 2016 in two dialysis centers located in Recife, Pernambuco. For the diagnosis of sarcopenia, the criteria proposed by the 2019 European Consensus on Sarcopenia, which advocates low muscle strength as the main criterion, were considered. Demographic, clinical, anthropometric, and behavioral covariates were evaluated. Results: 108 patients were included, with a mean age of 51.4 ± 17.0 years and homogeneous distribution between the sexes.Sarcopenia was present in 38.9% of the population, of which 69% had severe sarcopenia. A higher prevalence of sarcopenia was observed among men (60% vs. 17%; p < 0.001), in those without a partner (48.1% vs. 30.4%; p < 0.045), in smokers (50% vs. 30%; p < 0.034), with low weight (underweight 73.3%, eutrophic 33.9%, overweight 32.4%; p = 0.001) and those with normal albumin levels (47.5% vs. 28.6%; p = 0.045). Conclusion: Approximately one in three nephropathic patients on hemodialysis presented sarcopenia and, among these, most had the severe form of this condition.Uremic sarcopenia was more prevalent in males, in individuals without partners, underweight, in smokers, and among those with normal albumin levels.
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Nunes CF, Carvalho TR de, Duarte R da S, Barboza YACO, Lemos MCC de, Pinho CPS. Prevalence of sarcopenia and associated factors in patients in hemodialysis. Health Sci J [Internet]. 2021Dec.23 [cited 2024May6];11(4):61-9. Available from: https://portalrcs.hcitajuba.org.br/index.php/rcsfmit_zero/article/view/1153
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32. Dorosty A, Arero G, Chamar M, Tavakoli S. Prevalence of sarcopenia and its association with socioeconomic status among the elderly in Tehran. Ethiop J Health Sci. 2016;26(4):389-96. https://doi.org/10.4314/ejhs.v26i4.11 PMid:27587937 PMCid:PMC4992779
33. Confortin SC, Ono LM, Barbosa AR, d'Orsi E. Sarcopenia e sua associação com mudanças nos fatores socioeconômicos, comportamentais e de saúde: o EpiFloripa Elderly Study. Cad Saúde Pública. 2018;34(12):e00164917. https://doi.org/10.1590/0102-311x00164917 PMid:30517315
34. Szulc P, Duboeuf F, Marchand F, Delmas PD. Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr. 2004;80(2):496-503. https://doi.org/10.1093/ajcn/80.2.496 PMid:15277176
35. Castillo EM, Goodman-Gruen D, Kritz-Silverstein D, Morton DJ, Wingard DL, Barrett-Connor E. Sarcopenia in elderly men and women: the Rancho Bernardo study. Am J Prev Med. 2003;25(3):226-31. https://doi.org/10.1016/S0749-3797(03)00197-1
36. Lee SW, Auyeung TW, Kwok T, Lau EMC, Leung PC, Woo J. Associated factors and health impact of sarcopenia in older Chinese men and women: a cross-sectional study. Gerontology. 2007;53(6):404-10. https://doi.org/10.1159/000107355 PMid:17700027
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38. Kilaru S, Frangos SG, Chen AH, Gortler D, Dhadwal AK, Araim O, et al. Nicotine: a review of its role in atherosclerosis. J Am Coll Surg. 2001;193(5):538-46. https://doi.org/10.1016/S1072-7515(01)01059-6
39. Kok MO, Hoekstra T, Twisk JWR. The longitudinal relation between smoking and muscle strength in healthy adults. Eur Adic Res. 2012;18(2):70-5. https://doi.org/10.1159/000333600 PMid:22178906
40. Isoyama N, Qureshi AR, Avesani CM, Lindholm B, Bàràny P, Heimburg O, et al. Comparative associations of muscle mass and muscle strength with mortality in dialysis patients. Clin J Am Soc Nephr. 2014;9(10):1720-8. https://doi.org/10.2215/CJN.10261013 PMid:25074839 PMCid:PMC4186520
41. Kaysen GA, Rathore V, Shearer GC, Depner TA. Mechanisms of hypoalbuminemia in hemodialysis patients. Kidney Int. 1995;48(2):510-6. https://doi.org/10.1038/ki.1995.321 PMid:7564120
2. Fahal Ibrahim H. Uraemic sarcopenia: aetiology and implications. Nephrol Dial Transplant. 2014;29(9):1655-65. https://doi.org/10.1093/ndt/gft070 PMid:23625972
3. Ren H, Gong D, Jia F, Xu B, Liu Z. Sarcopenia in patients undergoing maintenance hemodialysis: incidence rate, risk factors and its effect on survival risk. Ren Fail. 2016; 38(3):364-71. https://doi.org/10.3109/0886022X.2015.1132173 PMid:26738817
4. Hotta C, Hiraki K, Wakamiya A, Otobe Y, Watanabe S, Izawa KP, et al. Relation of physical function and physical activity to sarcopenia in hemodialysis patients: A preliminary study. Int J Cardiol. 2015;191:198-200. https://doi.org/10.1016/j.ijcard.2015.05.005 PMid:25974194
5. Kim JC, Shapiro BB, Zhang M, Li Y, Porszasz J, Bross R, et al. Daily physical activity and physical function in adult maintenance hemodialysis patients. J Cachexia Sarcopenia Muscle. 2014;5(3):209-20. https://doi.org/10.1007/s13539-014-0131-4 PMid:24777474 PMCid:PMC4159490
6. Sharma D, Hawkins M, Abramowitz MK. Association of sarcopenia with eGFR and misclassification of obesity in adults with CKD in the United States. Clim J Am Soc Nephrol. 2014;9(12):2079-88. https://doi.org/10.2215/CJN.02140214 PMid:25392147 PMCid:PMC4255396
7. Kim JK, Choi SR, Choi MJ, Kim SG, Lee YK, Noh JW, et al. Prevalence of and factors associated with sarcopenia in elderly patients with end-stage renal disease. Clin Nutr. 2014;33(1):64-8. https://doi.org/10.1016/j.clnu.2013.04.002 PMid:23631844
8. Lauretani F, Russo CS, Bandinelli S, Benedeta B, Cavazzini C, Iorio AD, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95(5):1851-60. https://doi.org/10.1152/japplphysiol.00246.2003 PMid:14555665
9. Sergi G, Rui M, Veronese N, Bolzetta F, Berton L, Carraro S, et al. Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living caucasian older adults. Clin Nutrition. 2015;34(4):667-73. https://doi.org/10.1016/j.clnu.2014.07.010 PMid:25103151
10. Kyle UG, Bosaeus I, Lorenzo ADD, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis-part I: review of principles and methods. Clin Nutr. 2004;23(5):1226-43. https://doi.org/10.1016/j.clnu.2004.06.004 PMid:15380917
11. Soares V, Avelar IS, Andrade SRS, Vieira MF, Silva MS. Composição corporal de pacientes renais crônicos em hemodiálise: antropometria e análise vetorial por bioimpedância. Rev Latino-Am Enfermagem. 2013;21(6):1240-7. https://doi.org/10.1590/0104-1169.3060.2360 PMid:24402340
12. Barbosa-Silva TG, Menezes ABP, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: improving sarcopenia screening in the clinical practice. J Am Med Dir Assoc. 2016;17(12):1136-41. https://doi.org/10.1016/j.jamda.2016.08.004 PMid:27650212
13. Van Kan GA, Rolland Y, Andrieu S, Bauer J, Béauchet Ó, Bonnefoy M, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an international academy on nutrition and aging (IANA) task force. J. Nutr Health Aging. 2009;13(10):881-9. https://doi.org/10.1007/s12603-009-0246-z PMid:19924348
14. Olinto MTA, Nácul LC, Dias-da-Costa JS, Gigante DP, Menezes AMB, Macedo S. Níveis de intervenção para obesidade abdominal: prevalência e fatores associados. Cad. Saúde Pública. 2006;22(6):1207-15. https://doi.org/10.1590/S0102-311X2006000600010 PMid:16751960
15. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. WHO: Geneva: 2011 [cited 2021 Nov 15]. Available from: https://bit.ly/3wTamGX
16. Brock F, Bettinelli LA, Dobner T, Stobbe JC, Pomatti G, Telles CT. Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders. Rev Latino-Am Enfermagem. 2016;24:e2736. https://doi.org/10.1590/1518-8345.0260.2736 PMid:27508908 PMCid:PMC4990035
17. Blackburn G, Bistrian BR, Maini BS, Schlamm HT, Smith MF. Nutritional and metabolic assessment of the hospitalized patient. J Parenter Enteral Nutr. 1977;1(1): 11-22. https://doi.org/10.1177/014860717700100101 PMid:98649
18. World Health Organization. Obesity: preventing and managing the global epidemic. WHO technical report series; 894. Geneva: WHO; 1999 [cited 2021 Nov 15]. Available from: https://bit.ly/3FbYrHg
19. Lipschitz DA. Screening for nutritional status in the elderly. Primar Care. 1994;21(1):55-67. https://doi.org/10.1016/S0095-4543(21)00452-8 PMid:8197257.
20. Blackburn GL, Thornton PA. Nutritional assessment of the hospitalized patient. Med Clin North Am. 1979;63(5):1103-15. https://doi.org/10.1016/S0025-7125(16)31663-7
21. American College of Sports Medicine. Guidelines for exercise testing and prescription / American College of Sports Medicine. 4th ed. Philadelphia: Wolters Kluwer; 1991. 314 p.
22. Kidney disease: Improving Global Outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013 [cited 2021 Nov 15];3(1): 1-150. Avaiable from: https://bit.ly/3nfGl0W
23. Bataille S, Serveaux M, Carreno E, Pedinielli N, Darmon P, Robert A., et al. The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients. Clin Nutr. 2017;36(6):1654-60. https://doi.org/10.1016/j.clnu.2016.10.016 PMid:27816311
24. Cotrina BWM, Agurto FSRB, Carbajal DFM. Sarcopenia y fragilidad en sujetos sometidos a hemodiálisis en un centro de diálisis en el Perú. Rev Nutr Clin Metab. 2019;2(1):57-64. https://doi.org/10.35454/rncm.v2n1.060
25. Kim JK, Kim SG, Oh JE, Lee YK, Noh JW, Kim HJ, et al. Impact of sarcopenia on long-term mortality and cardiovascular events in patients undergoing hemodialysis. Korean J Intern Med. 2019;34(3):599-607. https://doi.org/10.3904/kjim.2017.083 PMid:29161801 PMCid:PMC6506738
26. Morishita Y, Kubo K, Miki A, Ishibashi K, Kusano E, Nagata D. Positive association of vigorous and moderate physical activity volumes with skeletal muscle mass but not bone density or metabolism markers in hemodialysis patients. Intern Urol Nephrol. 2014;46(3):633-9. https://doi.org/10.1007/s11255-014-0662-9 PMid:24526334
27. Giglio J, Kamimura MA, Iamarca F, Rodrigues J, Santin F, Avesani CM. Association of sarcopenia with nutritional parameters, quality of life, hospitalization, and mortality rates of elderly patients on hemodialysis. J Renal Nut. 2018;28(3):197-207. https://doi.org/10.1053/j.jrn.2017.12.003 PMid:29673501
28. Janssen I, Baumgartner RN, Ross R, Rosemberg IH, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol. 2004;159(4);413-21. https://doi.org/10.1093/aje/kwh058 PMid:14769646
29. Leite LEA, Resende TL, Nogueira GM, Cruz IBM, Schneider RH, Gottilieb MGV. Envelhecimento, estresse oxidativo e sarcopenia: uma abordagem sistêmica. Rev Bras Geriatr Gerontol. 2012;15(2):365-80. https://doi.org/10.1590/S1809-98232012000200018
30. Wang Zhebin, Pang Y, Liu J, Wang J, Xie Z, Huang T. Association of healthy lifestyle with cognitive function among Chinese older adults. Eur J Clin Nutr. 2021;75(2):325-34. https://doi.org/10.1038/s41430-020-00785-2 PMid:33116235
31. Robards J, Evandrou M, Falkingham J, Vlachatoni A. Marital status, health and mortality. Maturitas. 2012;73(4):295-9. https://doi.org/10.1016/j.maturitas.2012.08.007 PMid:23007006 PMCid:PMC3635122
32. Dorosty A, Arero G, Chamar M, Tavakoli S. Prevalence of sarcopenia and its association with socioeconomic status among the elderly in Tehran. Ethiop J Health Sci. 2016;26(4):389-96. https://doi.org/10.4314/ejhs.v26i4.11 PMid:27587937 PMCid:PMC4992779
33. Confortin SC, Ono LM, Barbosa AR, d'Orsi E. Sarcopenia e sua associação com mudanças nos fatores socioeconômicos, comportamentais e de saúde: o EpiFloripa Elderly Study. Cad Saúde Pública. 2018;34(12):e00164917. https://doi.org/10.1590/0102-311x00164917 PMid:30517315
34. Szulc P, Duboeuf F, Marchand F, Delmas PD. Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr. 2004;80(2):496-503. https://doi.org/10.1093/ajcn/80.2.496 PMid:15277176
35. Castillo EM, Goodman-Gruen D, Kritz-Silverstein D, Morton DJ, Wingard DL, Barrett-Connor E. Sarcopenia in elderly men and women: the Rancho Bernardo study. Am J Prev Med. 2003;25(3):226-31. https://doi.org/10.1016/S0749-3797(03)00197-1
36. Lee SW, Auyeung TW, Kwok T, Lau EMC, Leung PC, Woo J. Associated factors and health impact of sarcopenia in older Chinese men and women: a cross-sectional study. Gerontology. 2007;53(6):404-10. https://doi.org/10.1159/000107355 PMid:17700027
37. Rom O, Kaisari S, Aizenbud D, Reznick AZ. Sarcopenia and smoking: a possible cellular model of cigarette smoke effects on muscle protein breakdown. Ann NY Acad Sci. 2012;1259:47-53. https://doi.org/10.1111/j.1749-6632.2012.06532.x PMid:22758636
38. Kilaru S, Frangos SG, Chen AH, Gortler D, Dhadwal AK, Araim O, et al. Nicotine: a review of its role in atherosclerosis. J Am Coll Surg. 2001;193(5):538-46. https://doi.org/10.1016/S1072-7515(01)01059-6
39. Kok MO, Hoekstra T, Twisk JWR. The longitudinal relation between smoking and muscle strength in healthy adults. Eur Adic Res. 2012;18(2):70-5. https://doi.org/10.1159/000333600 PMid:22178906
40. Isoyama N, Qureshi AR, Avesani CM, Lindholm B, Bàràny P, Heimburg O, et al. Comparative associations of muscle mass and muscle strength with mortality in dialysis patients. Clin J Am Soc Nephr. 2014;9(10):1720-8. https://doi.org/10.2215/CJN.10261013 PMid:25074839 PMCid:PMC4186520
41. Kaysen GA, Rathore V, Shearer GC, Depner TA. Mechanisms of hypoalbuminemia in hemodialysis patients. Kidney Int. 1995;48(2):510-6. https://doi.org/10.1038/ki.1995.321 PMid:7564120