scholarly journals Bed-side measures for diagnosis of low muscle mass, sarcopenia, obesity, and sarcopenic obesity in patients with chronic kidney disease under non-dialysis-dependent, dialysis dependent and kidney transplant therapy

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242671
Author(s):  
Natália Tomborelli Bellafronte ◽  
Gabriel Ruiz Sizoto ◽  
Lorena Vega-Piris ◽  
Paula Garcia Chiarello ◽  
Guillermina Barril Cuadrado
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Area Under The Curve ◽  
Bioelectrical Impedance ◽  
Fat Free Mass ◽  
Sarcopenic Obesity ◽  
Anthropometric Parameters ◽  
Hand Grip ◽  
European Working

Muscle depletion and sarcopenic obesity are related to a higher morbimortality risk in chronic kidney disease (CKD). We evaluated bed-side measures/indexes associated with low muscle mass, sarcopenia, obesity, and sarcopenic obesity in CKD and proposed cutoffs for each parameter. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People revised consensus applying dual energy X-ray absorptiometry (DXA) and hand grip strength (HGS), and obesity according to the International Society for Clinical Densitometry. Anthropometric parameters including calf (CC) and waist (WC) circumferences and WC/height (WC/H); bioelectrical impedance data including appendicular fat free mass (AFFM) and fat mass index (FMI) were assessed. ROC analysis and area under the curve (AUC) were applied for performance analyses. AFFM and CC presented the best performances for low muscle mass diagnosis–AFFM AUC for women was 0.96 and for men, 0.94, and CC AUC for women was 0.89 and for men, 0.85. FMI and WC/H were the best parameters for obesity diagnosis–FMI AUC for women was 0.99 and for men, 0.96, and WC/H AUC for women was 0.94 and for men, 0.95. The cutoffs (sensibility and specificity, respectively) for women were AFFM≤15.87 (90%; 96%), CC≤35.5 (76%; 94%), FMI>12.58 (100%; 93%), and WC/H>0.66 (91%; 84%); and for men, AFFM≤21.43 (98%; 84%), CC≤37 (88%; 69%), FMI>8.82 (93%; 88%), and WC/H>0.60 (95%; 80%). Sensibility and specificity for sarcopenia diagnosis were for AFFM+HGS in women 85% and 99% and in men, 100% and 99%; for CC+HGS in women 85% and 99% and in men, 100% and 100%; and for sarcopenic obesity were for FMI+AFFM in women 75% and 97% and in men, 75% and 95%. The tested bed-side measures/indexes presented excellent performance.

scholarly journals Performance of Bioelectrical Impedance and Anthropometric Predictive Equations for Estimation of Muscle Mass in Chronic Kidney Disease Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Natália Tomborelli Bellafronte ◽  
Lorena Vega-Piris ◽  
Guillermina Barril Cuadrado ◽  
Paula Garcia Chiarello
Keyword(s):  
Chronic Kidney Disease ◽  
Body Composition ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Linear Regression Analysis ◽  
Bioelectrical Impedance ◽  
Fat Free Mass ◽  
Predictive Equation ◽  
Predictive Equations

Background: Patients with chronic kidney disease (CKD) are vulnerable to loss of muscle mass due to several metabolic alterations derived from the uremic syndrome. Reference methods for body composition evaluation are usually unfeasible in clinical settings.Aims: To evaluate the accuracy of predictive equations based on bioelectrical impedance analyses (BIA) and anthropometry parameters for estimating fat free mass (FFM) and appendicular FFM (AFFM), compared to dual energy X-ray absorptiometry (DXA), in CKD patients.Methods: We performed a longitudinal study with patients in non-dialysis-dependent, hemodialysis, peritoneal dialysis and kidney transplant treatment. FFM and AFFM were evaluated by DXA, BIA (Sergi, Kyle, Janssen and MacDonald equations) and anthropometry (Hume, Lee, Tian, and Noori equations). Low muscle mass was diagnosed by DXA analysis. Intra-class correlation coefficient (ICC), Bland-Altman graphic and multiple regression analysis were used to evaluate equation accuracy, linear regression analysis to evaluate bias, and ROC curve analysis and kappa for reproducibility.Results: In total sample and in each CKD group, the predictive equation with the best accuracy was AFFMSergi (men, n = 137: ICC = 0.91, 95% CI = 0.79–0.96, bias = 1.11 kg; women, n = 129: ICC = 0.94, 95% CI = 0.92–0.96, bias = −0.28 kg). AFFMSergi also presented the best performance for low muscle mass diagnosis (men, kappa = 0.68, AUC = 0.83; women, kappa = 0.65, AUC = 0.85). Bias between AFFMSergi and AFFMDXA was mainly affected by total body water and fat mass. None of the predictive equations was able to accurately predict changes in AFFM and FFM, with all ICC lower than 0.5.Conclusion: The predictive equation with the best performance to asses muscle mass in CKD patients was AFFMSergi, including evaluation of low muscle mass diagnosis. However, assessment of changes in body composition was biased, mainly due to variations in fluid status together with adiposity, limiting its applicability for longitudinal evaluations.

scholarly journals Effect of Low Skeletal Muscle Mass and Sarcopenic Obesity on Chronic Kidney Disease in Patients with Type 2 Diabetes

2021 ◽  
Author(s):  
Da Hea Seo ◽  
Young Ju Suh ◽  
Yongin Cho ◽  
Seong Hee Ahn ◽  
Seongha Seo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Skeletal Muscle ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Bioelectrical Impedance ◽  
Sarcopenic Obesity ◽  
Increased Risk

Abstract The causal relationship between low muscle mass and development of chronic kidney disease (CKD) is uncertain in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the association between low muscle mass or sarcopenic obesity and the risk of incident CKD in patients with T2DM. A total of 3,123 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 an estimated glomerular filtration rate < 60 mL/min/1.73m2. Sarcopenic obesity was defined as the coexistence of sarcopenia and abdominal obesity. During 8.9 years of follow-up, 530 (17.0%) patients developed incident CKD. When subjects 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% confidence interval 1.24-2.51; p=0.001) compared to the other groups. Sarcopenic obesity, but not low muscle mass alone, may increase the risk of CKD in patients with T2DM.

Sarcopenia is an actual problem in chronic kidney disease of the 5d stage

2020 ◽  
Vol 24 (1) ◽  
pp. 60-66
Author(s):  
I. V. Lavrishcheva ◽  
A. Sh. Rumyantsev ◽  
M. V. Zakharov ◽  
N. N. Kulaeva ◽  
V. M. Somova
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Chronic Kidney Disease Stage ◽  
Age Groups ◽  
Disease Stage ◽  
Actual Problem ◽  
European Working ◽  
Low Performance ◽  
6 Minute Walk Test

BACKGROUND. The lack of data on the epidemiology of presarcopenia/sarcopenia leads to an underestimation of the role of this condition in the structure of morbidity and mortality of haemodialysis patients in theRussian Federation. THE AIM: to study the epidemiological aspects of presarcopenia /sarcopenia in patients with chronic kidney disease stage 5d. PATIENTS AND METHODS. This study comprised 317 patients receiving programmed bicarbonate haemodialysis for 8.2 ± 5.1 years, among them 171 women and 146 men, the average age was 57.1 ± 11.3 years. The assessment of the presence of sarcopenia was performed using the method recommended by the European Working Group on Sarcopenia in Older People. RESULTS. The prevalence of presarcopenia was 0.7 % and sarcopenia 29.6 %. The incidence of skeletal muscle mass deficiency according to muscle mass index (IMM) was 30.3 %, 48.7 % showed a decrease in muscle strength according to dynamometry, and low performance of skeletal muscles according to 6 minute walk test was determined in 42.8 %. Sarcopenia patients were significantly characterized by lower body mass index, as well as higher body fat mass values. The duration of haemodialysis (χ2 = 22.376, p = 0.0001) and the patient's age (χ2 = 10.545 p = 0.014) were an independent risk factors for the development of sarcopenia. CONCLUSION. Sarcopenia is recorded more frequently in hemodialysis patients than presarcopenia. Its prevalence increases among patients of older age groups and with a hemodialysis duration of more than 5 years. The age and experience of dialysis make their independent contribution to the development of this syndrome.

scholarly journals Relationships of Fat and Muscle Mass with Chronic Kidney Disease in Older Adults: A Cross-Sectional Pilot Study

2020 ◽  
Vol 17 (23) ◽  
pp. 9124
Author(s):  
Bokun Kim ◽  
Hyuntae Park ◽  
Gwonmin Kim ◽  
Tomonori Isobe ◽  
Takeji Sakae ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Estimated Glomerular Filtration Rate ◽  
Fat Free Mass ◽  
Creatinine Concentration ◽  
Cross Sectional ◽  
Assess Body Composition

This cross-sectional pilot study aimed to assess the relationships of fat and muscle mass with chronic kidney disease (CKD) in older adults. Serum creatinine concentration was used to measure estimated glomerular filtration rate (mL/min/1.73 m2) in the 236 subjects, who were allocated to three groups: a normal (≥60.0), a mild CKD (45.0–59.9), and a moderate to severe CKD (<45.0) group. The Jonckheere-Terpstra test and multivariate logistic regression were employed to assess body composition trends and the relationships of % fat mass (FM) or % muscle mass index (MMI) with moderate-to-severe CKD. Body weight, fat-free mass, MMI, and %MMI tended to decrease with an increase in the severity of CKD, but the opposite trend was identified for %FM. No relationship with BMI was identified. The participants in the middle-high and highest quartile for %FM were 6.55 and 14.31 times more likely to have moderate to severe CKD. Conversely, the participants in the highest quartile for %MMI were 0.07 times less likely to have moderate to severe CKD. Thus, high fat and low muscle mass may be more strongly associated with CKD than obesity per se.

scholarly journals P0921ROLE OF UREMIC TOXIN, INDOXYL SULFATE IN SARCOPENIA OF NONDIALYSIS DEPENDENT-CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jun Chul Kim ◽  
Seok Hui Kang ◽  
Miyeun Han ◽  
Su-Hyun Kim ◽  
Ran-Hui Cha ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Indoxyl Sulfate ◽  
High Rate ◽  
Uremic Toxin ◽  
Inverse Association

Abstract Background and Aims Sarcopenia in patients with chronic kidney disease (CKD) is highly prevalent and leads to high rate of morbidity and mortality. The role of indoxyl sulfate (IS) to develop muscle wasting has been researched and proved in several animal model studies. However, there is no human data showing this relationship in CKD population. The aim of the present study was to evaluate the association between serum IS levels and each component of sarcopenia in nondialysis dependent-CKD (NDD-CKD) patients. Method We enrolled 150 NDD-CKD adult patients from 6 medical centers and collected data of demographics, blood chemistry such as indoxyl sulfate, interleukin (IL)-6, and estimated glomerular filtration rate using MDRD equation (eGFR), and body mass index (BMI, kg/m2). We also measured hand-grip strength (HGS, kg), walking speed (WS, m/s), skeletal muscle mass (SMM, kg) by bioelectrical impedance analysis (BIA). Results The numbers of male sex was 97 (64.7%). Mean age was 63.7±10.8 years old. The numbers of patients with diabetes mellitus was 77 (52.0%). Charlson comorbidity index (CCI) score was 3.9 ± 1.9. The stage of CKD ranged from 3 to 5 (eGFR=33.7±12.0 ml/min/1.73m2, mean±SD). Correlation coefficients with indoxyl sulfate levels were 0.211 for serum IL-6 level (P = 0.010), -0.212 for HGS (P = 0.009), -0.188 for WS (P = 0.021), -0.237 for SMM (P = 0.004), and -0.168 for BMI (P = 0.041), respectively. Correlation analysis showed that indoxyl sulfate levels had inverse association significantly with HGS, WS, SMM, and BMI and were positively associated with serum IL-6 levels. Conclusion Our study shows that higher serum indoxyl sulfate level was significantly associated with lower levels of muscle mass, strength, and physical performance function and higher inflammation status in non-dialysis dependent CKD patients. We suggest that the role of AST120 in prevention or treatment of sarcopenia be studied in this CKD population.

scholarly journals Prevalence of sarcopenia in community-dwelling older adults using the updated EWGSOP2 definition according to kidney function and albuminuria

2020 ◽  
Vol 20 (S1) ◽  
Author(s):  
Rafael Moreno-Gonzalez ◽  
◽  
Xavier Corbella ◽  
Francesco Mattace-Raso ◽  
Lisanne Tap ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Handgrip Strength ◽  
Bioelectrical Impedance ◽  
Community Dwelling ◽  
Cross Sectional ◽  
European Working ◽  
Community Dwelling Older Adults

Abstract Background Loss of muscle mass and function may be more pronounced in older adults with chronic kidney disease (CKD) and with albuminuria. Thus, we investigated the prevalence of sarcopenia among community-dwelling older adults according to kidney function and grade of albuminuria. We also explored differences in the prevalence of sarcopenia according to three different equations for the estimation of glomerular filtration rate (eGFR). Methods A cross-sectional analysis of 1420 community-dwelling older adults (≥75 years old) included in the SCOPE study, a multicenter prospective cohort study, was conducted. Comprehensive geriatric assessment including short physical performance battery (SPPB), handgrip strength test and bioelectrical impedance analysis (BIA) was performed. Sarcopenia was defined using the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). eGFR was calculated using Berlin Initiative Study (BIS), Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) and Full Age Spectrum (FAS) equations, and urinary albumin-to-creatinine ratio (ACR) was collected to categorize CKD according to Kidney Disease Improving Global Outcomes guidelines. Results Median age was 79.5 years (77.0–83.0), 804 (56.6%) were women. Using EWGSOP2 definition, 150 (10.6%) participants met diagnostic criteria for sarcopenia. Moreover, 85 (6%) participants had severe sarcopenia. Sarcopenia was more prevalent in participants with more advanced stages of CKD according to BIS eq. (9.6% in stages 1 and 2 and 13.9% in stages 3a, 3b and 4, p = 0.042), and also according to CKD-EPI (9.8% vs. 14.2%, p = 0.042) and FAS although not reaching statistical signification (9.8% vs. 12.7%, p = 0.119). Thus, differences in prevalence are observed among CKD categories as estimated by different equations. Prevalence of sarcopenia was also higher with increasing albuminuria categories: 9.3% in normoalbuminuric, 13.2% in microalbuminuric and 16.8% in macroalbuminuric participants, (p = 0.019). Conclusions Sarcopenia is common among community-dwelling older adults, especially among those with more advanced CKD categories, with prevalence estimates differing slightly depending on the equation used for the estimation of eGFR; as well as among those with higher albuminuria categories.

scholarly journals Effects of Low Muscle Mass on Albuminuria and Chronic Kidney Disease in Patients With Type 2 Diabetes: The Korean Sarcopenic Obesity Study (KSOS)

2017 ◽  
Vol 73 (3) ◽  
pp. 386-392 ◽  
Author(s):  
Hye Soo Chung ◽  
Soon Young Hwang ◽  
Ju Hee Choi ◽  
Hyun Jung Lee ◽  
Hye Jin Yoo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Muscle Mass ◽  
Sarcopenic Obesity

scholarly journals Sarcopenic Obesity in Chronic Kidney Disease: Challenges in Diagnosis using Different Diagnostic Criteria

2021 ◽  
Author(s):  
Natália Tomborelli Bellafronte ◽  
Amanda de Queirós Mattoso Ono ◽  
Paula Garcia Chiarello
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diagnostic Criteria ◽  
Muscle Mass ◽  
Fat Mass ◽  
Handgrip Strength ◽  
Sarcopenic Obesity ◽  
Obesity Prevalence ◽  
Transplant Patients ◽  
Muscle Impairment

Obesity and muscle impairment (low muscle mass or strength) are present in chronic kidney disease (CKD) and associated to worse prognosis. However, the various existing definitions for these conditions make the diagnosis variable. The aim of the study was to evaluate the agreement between diagnostic criteria for sarcopenic obesity and its components in CKD. Two hundred and sixty seven patients with CKD were included in the study. We assessed body composition by dual energy X-ray absorptiometry (DXA) and muscle function by handgrip strength (HGS); adiposity by BMI, waist circumference (WC), fat mass index (FMI), and percentage of fat mass (%FM). Diagnosis of muscle impairment was made by HGS, appendicular lean mass (ALM) and index (ALMI); obesity by BMI, WC, FMI and %FM, and sarcopenic obesity was diagnosed by concomitant presence of muscle impairment and obesity. Prevalence of muscle impairment varied from 11 to 50%, higher when low muscle mass criteria was used. Prevalence of obesity varied from 26 to 62%, higher when WC and %FM criteria was used. Prevalence of sarcopenic obesity varied from 2 to 23%. Women were more affected by sarcopenic obesity. Muscle impairment and sarcopenic obesity were more prevalent among patients on hemodialysis and obesity among non-dialysis-dependent and kidney transplant patients. The agreement was poor between muscle mass and strength criteria; substantial between FMI, BMI, and %FM and only fair between WC and the others measures; for sarcopenic obesity, varied from poor to almost perfect. Significant differences were found among the various diagnostic criteria that are used in the diagnosis of sarcopenic obesity.

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