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De Smet S, Leunis S, Van Criekinge H, Vandecruys M, Vrancken L, Renier M, Fieuws S, Goetschalckx K, Luyten J, Raes J, Bogaerts S, De Geest S, Van Craenenbroeck AH, Cornelissen V, Monbaliu D. Home-based exercise and PHysical activity maintenance interventiOn after livEr traNsplantation: Impact of eXercise intensity (PHOENIX-Liver). BMJ Open Sport Exerc Med 2025; 11:e002436. [PMID: 40098918 PMCID: PMC11911812 DOI: 10.1136/bmjsem-2024-002436] [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: 12/23/2024] [Accepted: 01/21/2025] [Indexed: 03/19/2025] Open
Abstract
Liver transplant recipients experience comorbidities, including impaired physical fitness, which could be managed by exercise and physical activity interventions. This study aims to evaluate the feasibility, clinical effectiveness and cost-effectiveness of a 6-month exercise intervention, followed by a 15-month tailored physical activity maintenance intervention, in de novo liver transplant recipients. This single-centre, randomised, controlled, single-blinded trial will recruit 147 adult liver transplant recipients at 3-5 months post-transplant. Participants will be randomised into (1) 6 months of enhanced usual care, not followed by a physical activity intervention (control (CON) group, n=49), (2) 6 months of moderate-intensity exercise training, followed by a physical activity intervention (moderate-intensity training (MIT) group; n=49) or (3) consecutively 3 months of moderate-intensity exercise training, 3 months of high-intensity interval training and a physical activity intervention (moderate and high-intensity training (MHIT) group; n=49). Exercise training will consist of home-based stationary bicycling and muscle-strengthening exercises, partially supervised by participants' local physiotherapists. The physical activity intervention includes an array of behaviour change techniques. Primary hypothesis: after the exercise intervention, peak oxygen uptake (V̇O2peak) will be higher in MHIT versus CON (α-level 0.05). Secondary hypotheses: after the exercise intervention, V̇O2peak will be higher in MIT versus CON and MHIT versus MIT (α-level 0.025). Secondary outcomes, assessed up to 2 years post-transplant, include physical fitness, cardiovascular and graft health, quality of life, physical activity and implementation outcomes. Trial registration number NCT06302205.
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Affiliation(s)
- Stefan De Smet
- Exercise physiology research group, Department of movement sciences, KU Leuven, Leuven, Belgium
| | - Sofie Leunis
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Hanne Van Criekinge
- Department of Microbiology, Immunology and Transplantation, Abdominal Transplantation, KU Leuven, Leuven, Belgium
| | - Marieke Vandecruys
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | | | - Marie Renier
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Flanders, Belgium
| | - Steffen Fieuws
- Department public health and primary care, I-BioStat, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Flanders, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular Diseases, UZ Leuven, Leuven, Flanders, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Flanders, Belgium
| | - Jeroen Luyten
- Department of Public Health and Primary Care, Unit for Health Technology Assessment Research, KU Leuven, Leuven, Flanders, Belgium
| | - Jeroen Raes
- Department of Microbiology and Immunology, Katholieke Universiteit Leuven Rega Institute for Medical Research, Leuven, Flanders, Belgium
- VIB Department of Molecular Microbiology KULeuven, Heverlee, Flanders, Belgium
| | - Stijn Bogaerts
- Department of Development and Regeneration, Locomotor and Neurological Disorders, KU Leuven University Hospitals Leuven, Leuven, Belgium
- Department of Physical and Rehabilitation Medicine, UZ Leuven, Leuven, Flanders, Belgium
| | - Sabina De Geest
- Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, BS, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology, UZ Leuven, Leuven, Flanders, Belgium
| | - Véronique Cornelissen
- Group Rehabilitation in Internal Disorders, Katholieke Universiteit Leuven Department of Rehabilitation Sciences, Leuven, Vlaanderen, Belgium
| | - Diethard Monbaliu
- Department of Microbiology, Immunology and Transplantation, Abdominal Transplantation, KU Leuven, Leuven, Belgium
- Transplantoux Foundation, Leuven, Belgium
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Tomizawa M, Hori S, Yoneda T, Maesaka F, Onishi S, Shimizu T, Onishi K, Morizawa Y, Gotoh D, Nakai Y, Miyake M, Torimoto K, Tanaka N, Fujimoto K. Immunosuppressant-Induced Alteration of Gut Microbiota Causes Loss of Skeletal Muscle Mass: Evidence from Animal Experiments Using Mice and Observational Study on Humans. J Clin Med 2025; 14:1628. [PMID: 40095615 PMCID: PMC11900293 DOI: 10.3390/jcm14051628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 01/16/2025] [Accepted: 02/26/2025] [Indexed: 03/19/2025] Open
Abstract
Background/Objectives: The number of older adults requiring a kidney transplant (KT) is increasing; hence, postoperative sarcopenia prevention is necessary. KT recipients require permanent oral immunosuppressants (ISs), and the gut microbiota (GM) plays a role in various systemic diseases. However, few studies have evaluated post-kidney transplantation frailty and the associations among ISs, GM, and muscle mass alterations. Therefore, we investigated the effects of ISs on GM and skeletal muscle mass in mice and human KT recipients. Methods: Mice were treated with six different ISs, and their skeletal muscle mass, GM diversity, and colonic mucosal function were assessed. Human KT recipients and donors were monitored before and after surgery for 1 year, and GM diversity was evaluated before and 1 month after surgery. Results: The abundance of Akkermansia, crypt depth, and mucin 2 expression were lower in tacrolimus- and prednisolone-treated mice. The psoas muscle volume changes at 1 month and 1 year after surgery were lower in KT recipients than in donors. Furthermore, the beta diversity was significantly different between the operative groups (p = 0.001), and the KT group showed the lowest Shannon index. Conclusions: The findings of this study indicate potential links among ISs, GM, and muscle mass decline. Further investigation is required to improve therapeutic strategies and patient outcomes.
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Affiliation(s)
- Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Fumisato Maesaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Sayuri Onishi
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Kenta Onishi
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
- Department of Prostate Brachytherapy, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Nara, Japan; (M.T.); (S.H.); (T.Y.); (F.M.); (S.O.); (T.S.); (K.O.); (Y.M.); (D.G.); (Y.N.); (M.M.); (K.T.); (N.T.)
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Kim HJ, Seong EY, Jung HJ, Song SH. The phase angle before transplantation can predict the status of low muscle mass after kidney transplantation. Clin Exp Nephrol 2024; 28:1319-1326. [PMID: 39168881 DOI: 10.1007/s10157-024-02543-1] [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: 04/05/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND This study aimed to evaluate the association between phase angle, muscle strength, and muscle mass in patients undergoing kidney transplantation. METHODS Patients whose pre- and follow-up phase angles were measured after kidney transplantation were enrolled. Phase angle and body composition were measured using a multi-frequency bioimpedance analysis device before and at 7 and 14 days and 3, 6, and 12 months after transplantation. Muscle strength was evaluated using handgrip strength (HGS). Low HGS was defined as < 28 kg in males and < 18 kg in females. Low muscle mass was defined as an appendicular lean mass index of < 7.0 kg/m2 in males and < 5.7 kg/m2 in females. RESULTS Eighty-eight patients (mean age 52.3 ± 10.1 years) were analyzed. The mean phase angle of pre-transplantation was 5.0 ± 1.0°. Body fat percentage was significantly higher at 6 and 12 months after transplantation than pre-transplantation (P < 0.0001). Twelve months after kidney transplantation, the prevalence of low HGS decreased (pre-transplantation vs. 12 months post-transplantation: 28.4% vs. 17.0%), and the prevalence of low muscle mass (pre-transplantation vs. 12 months post-transplantation: 21.6% vs. 28.4%) increased. The pre-transplantation phase angle was significantly associated with low muscle mass at 12 months after kidney transplantation (odds ratio [OR]: 0.34; 95% confidence interval [CI]: 0.16-0.72; P = 0.005). The pre-transplantation phase angle was not significantly associated with low HGS (OR: 0.37; 95% CI 0.12-1.17; P = 0.090) 12 months after kidney transplantation. CONCLUSIONS Pre-transplantation phase angle can predict muscle mass status 12 months after kidney transplantation.
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Affiliation(s)
- Hyo Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea
| | - Hyuk Jae Jung
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea
- Department of Surgery, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea.
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea.
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Fukuhara H, Nishida H, Takai S, Nawano T, Takehara T, Takai Y, Narisawa T, Kanno H, Yagi M, Yamagishi A, Naito S, Tsuchiya N. Dialysis Duration, Time Interaction, and Visceral Fat Accumulation: A 6-Year Posttransplantation Study. Clin Exp Nephrol 2024; 28:943-952. [PMID: 38658443 DOI: 10.1007/s10157-024-02492-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Kidney transplantation (KT) leads to body composition change, particularly increasing the fat mass. However, limited researches have focused on the long-term follow-up of these changes and factors influencing body composition after KT. METHODS This study evaluated body composition in 31 adult KT recipients, measuring body mass index (BMI), the psoas muscle mass index (PMI) representing muscle mass, visceral and subcutaneous adipose tissue (VAT and SAT) representing fat mass, and skeletal muscle radiodensity (SMR) representing muscle quality before KT and at 2, 4, and 6 years posttransplantation using computed tomography. Linear mixed models (LMM) analyzed temporal changes and contributing factors, while growth curve models assessed influence of these factors on body composition changes posttransplantation. RESULTS Following KT, BMI, and PMI remained stable, while SAT increased significantly, revealing a 1.30-fold increase from baseline 2 years after transplantation. Similarly, a substantial increase in VAT was observed, with a 1.47-fold increase from baseline 2 years after transplantation with a further 1.75-fold increase 6 years after transplantation. In contrast, SMR decreased with a 0.86-fold decrease from baseline after 2 years. VAT increase was significantly influenced by the interaction between posttransplantation and dialysis duration. Growth curve models confirmed this interaction effect persistently influenced VAT increase posttransplantation. CONCLUSIONS The study revealed that KT promoted significant alterations in body composition characterized by increase in the VAT and SAT and a decline in SMR. Notably, dialysis duration and its interaction with posttransplantation duration emerged as significant factors influencing VAT increase.
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Affiliation(s)
- Hiroki Fukuhara
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Hayato Nishida
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Satoshi Takai
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takaaki Nawano
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tomohiro Takehara
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yuki Takai
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takafui Narisawa
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hidenori Kanno
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Mayu Yagi
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Atsushi Yamagishi
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Sei Naito
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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Seet C, Clementoni L, Akhtar MR, Chandak P, Saoud M, Elsaadany A, Yaqoob MM, Mohamed IH, Khurram MA. Assessing Patients beyond the Simple Optics of BMI: The Concomitant Role of Sarcopenia and BMI in Predicting Kidney Transplant Outcomes. Life (Basel) 2024; 14:1036. [PMID: 39202778 PMCID: PMC11355760 DOI: 10.3390/life14081036] [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: 07/04/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Body composition is associated with prognosis in many clinical settings, and patients undergoing kidney transplantation are often high risk with multiple comorbidities. We aimed to assess the effect of sarcopenia and body composition on transplant outcomes. METHODS We performed a retrospective analysis of 274 kidney transplants with CT scans within 3 years of transplantation. The skeletal muscle index (SMI) at the L3 vertebrae was used to evaluate sarcopenia (SMI < 40.31 cm2/m2 in males, <30.88 cm2/m2 in females). Sarcopenia, body mass index (BMI), and the visceral-to-subcutaneous-fat ratio (VSR) were assessed separately. We also used a composite BMI/sarcopenia measurement in four patient groups: BMI < 25/Non-Sarcopenic, BMI < 25/Sarcopenic, BMI > 25/Non-Sarcopenic, and BMI > 25/Sarcopenic. The outcomes measured were eGFR (1 and 3 months; and 1, 3, and 5 years), delayed graft function (DGF), rejection, major adverse cardiovascular events (MACE), and post-operative complications. RESULTS Sarcopenia was associated with an increased 1-year risk of MACE (OR 3.41, p = 0.036). BMI alone had no effect on function, DGF, MACE, or on other complications. High VSR was associated with a lower risk of DGF (OR 0.473, p = 0.016). When sarcopenia and BMI were assessed together, the BMI > 25/sarcopenic patients had the poorest outcomes, with increased risk of MACE (OR 26.06, p = 0.001); poorer eGFR at 1, 3, 12, and 36 months; (p < 0.05 at all timepoints), and poorer graft survival (p = 0.002). CONCLUSIONS Sarcopenia alone is associated with an increased risk of MACE. Overweight sarcopenic patients are additionally at increased risk of graft loss and have poorer graft function for up to three years.
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Affiliation(s)
- Christopher Seet
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart’s Health NHS Trust, London E1 1FR, UK
| | - Laura Clementoni
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart’s Health NHS Trust, London E1 1FR, UK
| | - Mohammed Rashid Akhtar
- Department of Radiology, The Royal London Hospital, Bart’s Health NHS Trust, London E1 1FR, UK
| | - Pankaj Chandak
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart’s Health NHS Trust, London E1 1FR, UK
| | - Mohammed Saoud
- Department of Radiology, The Royal London Hospital, Bart’s Health NHS Trust, London E1 1FR, UK
| | - Amr Elsaadany
- Department of Radiology, The Royal London Hospital, Bart’s Health NHS Trust, London E1 1FR, UK
| | - Muhammad Magdi Yaqoob
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart’s Health NHS Trust, London E1 1FR, UK
- William Harvey Research Institute, Queen Mary University London, London E1 4NS, UK
| | - Ismail Heyder Mohamed
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart’s Health NHS Trust, London E1 1FR, UK
- William Harvey Research Institute, Queen Mary University London, London E1 4NS, UK
| | - Muhammad Arslan Khurram
- Department of Nephrology and Transplantation, The Royal London Hospital, Bart’s Health NHS Trust, London E1 1FR, UK
- William Harvey Research Institute, Queen Mary University London, London E1 4NS, UK
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Guo Y, Zhang M, Ye T, Wang Z, Yao Y. Application of Bioelectrical Impedance Analysis in Nutritional Management of Patients with Chronic Kidney Disease. Nutrients 2023; 15:3941. [PMID: 37764725 PMCID: PMC10537787 DOI: 10.3390/nu15183941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Body composition measurement plays an important role in the nutritional diagnosis and treatment of diseases. In the past 30 years, the detection of body composition based on bioelectrical impedance analysis (BIA) has been widely used and explored in a variety of diseases. With the development of technology, bioelectrical impedance analysis has gradually developed from single-frequency BIA (SF-BIA) to multi-frequency BIA (multi-frequency BIA, MF-BIA) and over a range of frequencies (bioimpedance spectroscopy, BIS). As the clinical significance of nutrition management in chronic kidney disease has gradually become prominent, body composition measurement by BIA has been favored by nephrologists and nutritionists. In the past 20 years, there have been many studies on the application of BIA in patients with CKD. This review describes and summarizes the latest research results of BIA in nutritional management of patients with CKD including pre-dialysis, hemodialysis, peritoneal dialysis and kidney transplantation, in order to provide reference for the application and research of BIA in nutritional management of chronic kidney disease in the future.
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Affiliation(s)
- Yanchao Guo
- Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.G.); (T.Y.)
| | - Meng Zhang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.)
| | - Ting Ye
- Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.G.); (T.Y.)
| | - Zhixiang Wang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.)
| | - Ying Yao
- Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.G.); (T.Y.)
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.)
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Fujimoto T, Hyodo Y, Ishimura T, Tashiro Y, Endo T, Nisioka S, Yokoyama N, Yamamoto K, Yano I, Fujisawa M. Association of Alpha-Actinin-3 Polymorphism With Sarcopenia in Kidney Transplant Recipients. Transplant Proc 2023:S0041-1345(23)00150-1. [PMID: 37037724 DOI: 10.1016/j.transproceed.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/13/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Sarcopenia is defined as the loss of skeletal muscle mass and function and is associated with increased mortality. Certain genetic polymorphisms represent risk factors used to assess the incidence of sarcopenia; however, few studies have evaluated the association between genetic polymorphisms and sarcopenia after kidney transplantation (KTx). We examined single-nucleotide polymorphisms (SNPs) in the genes involved in sarcopenia after KTx. METHODS Sixty-five patients who underwent KTx were enrolled in this study. We used the psoas mass index (PMI; the cross-sectional area of the bilateral psoas muscle/height) as a surrogate marker for assessing the extent of sarcopenia. We determined the PMI before KTx and 1 year after KTx, and we identified 5 SNPs in 5 genes associated with sarcopenia in the general population. Finally, the link between the changes in PMI 1 year after KTx and each SNP was examined. RESULTS The median PMI before KTx and 1 year after KTx was 7.4 (4.6-13.2) and 7.0 (3.6-13.6), respectively. The PMI decreased in 43 patients (66.2%). The alpha-actinin-3 rs1815739 genotype was associated with changes in PMI; the distribution of CT+TT genotypes in the PMI decrease group was significantly higher than that of the CC genotype (odds ratio, 4.23; 95% CI 0.05-0.97; P = 0.025). Moreover, the T allele frequency was significantly higher in the PMI decrease group than in the PMI increase group (odds ratio, 2.34; 95% CI 0.18-0.950; P = 0.025). CONCLUSION The alpha-actinin-3 rs1815739 genotype may represent a genetic risk factor for sarcopenia after KTx.
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Affiliation(s)
- Takuya Fujimoto
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoji Hyodo
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuki Tashiro
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahito Endo
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shun Nisioka
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Yokoyama
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Ikuko Yano
- Department of Pharmacy, Kobe University Hospital, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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8
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Karakizlis H, Trudel N, Brose A, Reinisch A, Reichert M, Hecker A, Bender F, Askevold I, Rainer L, Weimer R, Krombach GA, Padberg W, Liese J. Sarcopenia of kidney transplant recipients as a predictive marker for reduced graft function and graft survival after kidney transplantation. Langenbecks Arch Surg 2023; 408:103. [PMID: 36826595 PMCID: PMC9958183 DOI: 10.1007/s00423-023-02836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE The association between sarcopenia of kidney transplant recipients and outcome after kidney transplantation (KT) has not yet been fully understood and is still considered controversial. The aim of our study was to analyze the impact of pre-transplant sarcopenia on graft function, postoperative complication rates, and survival of the patients after renal transplantation. METHODS In this retrospective single-center study, all patients who underwent KT (01/2013-12/2017) were included. Demographic data, rejection rates, delayed graft function, and graft and patient survival rates were analyzed. Sarcopenia was measured in computed tomography images by the sex-adjusted Hounsfield unit average calculation (HUAC). RESULTS During the study period, 111 single KTs (38 women and 73 men) were performed. Living donor kidney transplants were performed in 48.6%. In total, 32.4% patients had sarcopenia. Sarcopenic patients were significantly older (59.6 years vs. 49.8 years; p < 0.001), had a higher body mass index (BMI = 27.6 kg/m2 vs. 25.0 kg/m2; p = 0.002), and were more likely to receive deceased donor kidneys (72.2% vs. 41.3%; p = 0.002). Interestingly, 3 years after KT, the creatinine serum levels were significantly higher (2.0 mg/dl vs. 1.5 mg/dl; p = 0.001), whereas eGFR (39.9 ml/min vs. 53.4 ml/min; p = 0.001) and graft survival were significantly lower (p = 0.004) in sarcopenic transplant recipients. Sarcopenic patients stayed in hospital significantly longer postoperatively than those who were non-sarcopenic. CONCLUSIONS At the time of kidney transplantation, sarcopenia was found to predict reduced long-term graft function and diminished graft survival after KT. The early identification of sarcopenic patients can not only enable an optimized selection of recipients, but also the initiation of pre-habilitation programs during the waiting period.
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Affiliation(s)
- H Karakizlis
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - N Trudel
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
- Department of Diagnostic and Interventional Radiology, Marienhospital Stuttgart, Stuttgart, Germany
| | - A Brose
- Department of Radiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - A Reinisch
- Department of General, Visceral and Oncologic Surgery, Hospital and Clinics Wetzlar, Teaching Hospital of the Justus-Liebig-University Giessen, Wetzlar, Germany
| | - M Reichert
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - A Hecker
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - F Bender
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - I Askevold
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - L Rainer
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - R Weimer
- Department of Internal Medicine II, Division of Nephrology and Renal Transplantation, Justus-Liebig-University of Giessen, Giessen, Germany
| | - G A Krombach
- Department of Radiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany
| | - J Liese
- Department of General, Visceral and Thoracic Surgery, Justus-Liebig-University of Giessen, Rudolf-Buchheim-Str. 7, Giessen, Germany.
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9
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Zhang JZ, Shi W, Zou M, Zeng QS, Feng Y, Luo ZY, Gan HT. Diagnosis, prevalence, and outcomes of sarcopenia in kidney transplantation recipients: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:17-29. [PMID: 36403578 PMCID: PMC9891953 DOI: 10.1002/jcsm.13130] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/14/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
The prevalence of sarcopenia and its clinical predictors and clinical impact vary among kidney transplant recipients (KTRs), in part because of different diagnostic criteria. This study aimed to assess the reported diagnosis criteria of sarcopenia and compare them in terms of prevalence, clinical predictors, and impact of sarcopenia. The Medline, Embase, and Cochrane Library were searched for the full-length reports published until 28 January 2022. The subgroup analysis, meta-regression, and sensitivity analysis were performed and heterogeneity was assessed using the I2 . A total of 681 studies were retrieved, among which only 23 studies (including 2535 subjects, 59.7% men, mean age 49.8 years) were eventually included in the final analysis. The pooled prevalence in these included studies was 26% [95% confidence interval (95% CI): 20-34%, I2 = 93.45%], including 22% (95% CI: 14-32%, I2 = 88.76%) in men and 27% (95% CI: 14-41%, I2 = 90.56%) in women (P = 0.554 between subgroups). The prevalence of sarcopenia diagnosed using low muscle mass was 34% (95% CI: 21-48%, I2 = 95.28%), and the prevalence of using low muscle mass in combination with low muscle strength and/or low physical performance was 21% (95% CI: 15-28%, I2 = 90.37%) (P = 0.08 between subgroups). In meta-regression analyses, the mean age (regression coefficient: 1.001, 95% CI: 0.991-1.011) and percentage male (regression coefficient: 0.846, 95% CI: 0.367-1.950) could not predict the effect size. Lower body mass index (odds ratio (OR): 0.57, 95% CI: 0.39-0.84, I2 = 61.5%), female sex (OR: 0.31, 95% CI: 0.16-0.61, I2 = 0.0%), and higher age (OR: 1.08, 95% CI: 1.05-1.10, I2 = 10.1%) were significantly associated with a higher risk for sarcopenia in KTRs, but phase angle (OR: 0.81, 95% CI: 0.16-4.26, I2 = 84.5%) was not associated with sarcopenia in KTRs. Sarcopenia was not associated with rejections (risk ratio (RR): 0.67, 95% CI: 0.23-1.92, I2 = 12.1%), infections (RR: 1.03, 95% CI: 0.34-3.12, I2 = 87.4%), delayed graft functions (RR: 0.81, 95% CI: 0.46-1.43, I2 = 0.0%), and death (RR: 0.95, 95% CI: 0.32-2.82, I2 = 0.0%) in KRTs. Sarcopenia was found to be very common in KRTs. However, we have not found that sarcopenia had a negative impact on clinical health after kidney transplantation. Large study cohorts and multicentre longitudinal studies in the future are urgently needed to explore the prevalence and prognosis of sarcopenia in kidney transplant patients.
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Affiliation(s)
- Jin-Zhi Zhang
- Department of Infectious Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Shi
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Zou
- Lab of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi-Shan Zeng
- Lab of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Feng
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Yi Luo
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua-Tian Gan
- Lab of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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10
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Bellafronte NT, Govêia TR, Chiarello PG. Sarcopenia in chronic kidney disease: prevalence by different definitions and relationship with adiposity. Appl Physiol Nutr Metab 2022; 47:915-925. [PMID: 35658617 DOI: 10.1139/apnm-2021-0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This was a cross-sectional study with Chronic Kidney Disease (CKD) patients under non-dialysis-dependent (NDD), hemodialysis (HD) and kidney transplant (KTx) treatment aimed to evaluate the prevalence of sarcopenia using the European Working Group on Sarcopenia in Older People (EWGSOP2) and the Foundation of the National Institutes of Health (FNIH) guidelines; also analyze the relationship between sarcopenia and its components with body adiposity. Body composition was assessed by dual energy X-ray absorptiometry (DXA) and anthropometry. Bioelectrical impedance provided data of phase angle and body water. The prevalence of sarcopenia in total sample (n=243; 53% men, 48±10 y) was 7% by FNIH and 5% by EWGSOP2 criteria; and was low in each CKD group independently of the criteria applied (max 11% prevalence). Low muscle mass was present in 39% (FNIH) and 36% (EWGSOP2) and dynapenia in 10% of patients. Sarcopenic patients by EWGSOP2 criteria presented low body adiposity. Conversely, sarcopenic patients by FNIH presented high adiposity. This study suggests that in CKD (i) sarcopenia and low muscle mass prevalence varies according to the diagnostic criteria, (ii) are common conditions, (iii) association with body adiposity depends on the criteria used to define low muscle mass, (iv) FNIH criteria detected high adiposity in individuals with sarcopenia. Novelty bullets: Prevalence of sarcopenia and low muscle mass in CKD varied according to the diagnostic criteria; association of excess adiposity with sarcopenia and low muscle mass depends on muscle mass index applied; FNIH criteria detected higher adiposity in individuals with sarcopenia. NOVELTY BULLETS Prevalence of sarcopenia and low muscle mass in CKD varied according to the diagnostic criteria; Association of excess adiposity with sarcopenia and low muscle mass depends on muscle mass index applied; FNIH criteria detected higher adiposity in individuals with sarcopenia and low muscle mass.
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Affiliation(s)
| | - Thaísa Ribeiro Govêia
- University of São Paulo, Nutrition and Metabolism Undergraduate Course, Ribeirão Preto City, São Paulo State, Brazil;
| | - Paula Garcia Chiarello
- University of São Paulo, Department of Health Sciences, Ribeirão Preto City, São Paulo State, Brazil;
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11
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Fukuhara H, Nishida H, Nawano T, Takai S, Narisawa T, Kanno H, Yagi M, Yamagishi A, Sakurai T, Naito S, Kato T, Tsuchiya N. Changes in Visceral and Subcutaneous Adipose Tissue and Body Composition in Kidney Transplant Recipients at 1, 3, and 5 Years After Kidney Transplant. Transplant Proc 2022; 54:351-354. [PMID: 35039158 DOI: 10.1016/j.transproceed.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Body composition changes 1 year after kidney transplant (KT) have been studied extensively. However, the number of reports on midterm body composition changes has been limited. METHODS The medical records and computed tomography scans of 10 living kidney recipients (6 men, 4 women) before KT and at 1, 3, and 5 years post KT were analyzed. Each patient's body mass index was calculated, and the skeletal muscle mass was evaluated using the skeletal muscle mass index and psoas muscle mass index. Each patient's abdominal adipose tissue mass was also quantified by examining the visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratios. These changes were assessed using repeated-measures analysis of variance. RESULTS The body mass index, skeletal muscle mass index, and psoas muscle mass index values did not differ significantly between the pre-KT and 1-, 3-, and 5-year post KT measurements. Conversely, a significant difference was found in the average VAT, SAT, and VAT/SAT ratio values between the pre-KT and at 1, 3, and 5 years post KT (P < .05). The average VAT measurements before and at 1, 3, and 5 years post KT were 66, 94, 108, and 113 cm2, respectively, indicating an increasing trend over time. CONCLUSIONS We observed an increase in the VAT, SAT, and VAT/SAT ratio in patients at 1, 3, and 5 years post KT.
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Affiliation(s)
- Hiroki Fukuhara
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan.
| | - Hayato Nishida
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takaaki Nawano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Satoshi Takai
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takafui Narisawa
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hidenori Kanno
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mayu Yagi
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Atsushi Yamagishi
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Toshihiko Sakurai
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sei Naito
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomoyuki Kato
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
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12
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Souweine JS, Gouzi F, Badia É, Pomies P, Garrigue V, Morena M, Hayot M, Mercier J, Ayoub B, Quintrec ML, Raynaud F, Cristol JP. Skeletal Muscle Phenotype in Patients Undergoing Long-Term Hemodialysis Awaiting Kidney Transplantation. Clin J Am Soc Nephrol 2021; 16:1676-1685. [PMID: 34750160 PMCID: PMC8729424 DOI: 10.2215/cjn.02390221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Age and comorbidity-related sarcopenia represent a main cause of muscle dysfunction in patients on long-term hemodialysis. However, recent findings suggest muscle abnormalities that are not associated with sarcopenia. The aim of this study was to isolate functional and cellular muscle abnormalities independently of other major confounding factors, including malnutrition, age, comorbidity, or sedentary lifestyle, which are common in patients on maintenance hemodialysis. To overcome these confounding factors, alterations in skeletal muscle were analyzed in highly selected patients on long-term hemodialysis undergoing kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In total, 22 patients on long-term hemodialysis scheduled for kidney transplantation with few comorbidities, but with a long-term uremic milieu exposure, and 22 age, sex, and physical activity level frequency-matched control participants were recruited. We compared biochemical, functional, and molecular characteristics of the skeletal muscle using maximal voluntary force and endurance of the quadriceps, 6-minute walking test, and muscle biopsy of vastus lateralis. For statistical analysis, mean comparison and multiple regression tests were used. RESULTS In patients on long-term hemodialysis, muscle endurance was lower, whereas maximal voluntary force was not significantly different. We observed a transition from type I (oxidative) to type II (glycolytic) muscle fibers, and an alteration of mitochondrial structure (swelling) without changes in DNA content, genome replication (peroxisome proliferator activator receptor γ coactivator-1α and mitochondrial transcription factor A), regulation of fusion (mitofusin and optic atrophy 1), or fission (dynamin-related protein 1). Notably, there were autophagosome structures containing glycogen along with mitochondrial debris, with a higher expression of light chain 3 (LC3) protein, indicating phagophore formation. This was associated with a greater conversion of LC3-I to LC3-II and the expression of Gabaralp1 and Bnip3l genes involved in mitophagy. CONCLUSIONS In this highly selected long-term hemodialysis population, a low oxidative phenotype could be defined by a poor endurance, a fiber-type switch, and an alteration of mitochondria structure, without evidence of sarcopenia. This phenotype could be related to uremia through the activation of autophagy/mitophagy. CLINICAL TRIAL REGISTRATION NUMBERS NCT02794142 and NCT02040363.
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Affiliation(s)
- Jean-Sébastien Souweine
- Department of Biochemistry, University Hospital of Montpellier and Department of Biochemistry and Hormonology, Montpellier, France,PhyMedExp, University of Montpellier, INSERM, Montpellier, France
| | - Fares Gouzi
- PhyMedExp, University of Montpellier, INSERM, Montpellier, France,Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Éric Badia
- Department of Biochemistry, University Hospital of Montpellier and Department of Biochemistry and Hormonology, Montpellier, France,PhyMedExp, University of Montpellier, INSERM, Montpellier, France
| | - Pascal Pomies
- Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Valérie Garrigue
- Department of Nephrology, University Hospital of Montpellier, Montpellier, France
| | - Marion Morena
- Department of Biochemistry, University Hospital of Montpellier and Department of Biochemistry and Hormonology, Montpellier, France,PhyMedExp, University of Montpellier, INSERM, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, Montpellier, France,Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Jacques Mercier
- PhyMedExp, University of Montpellier, INSERM, Montpellier, France,Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Bronia Ayoub
- PhyMedExp, University of Montpellier, INSERM, Montpellier, France,Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Moglie Le Quintrec
- Department of Nephrology, University Hospital of Montpellier, Montpellier, France
| | - Fabrice Raynaud
- Department of Biochemistry, University Hospital of Montpellier and Department of Biochemistry and Hormonology, Montpellier, France,PhyMedExp, University of Montpellier, INSERM, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, University Hospital of Montpellier and Department of Biochemistry and Hormonology, Montpellier, France,PhyMedExp, University of Montpellier, INSERM, Montpellier, France
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13
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Bellafronte NT, Vega-Piris L, Cuadrado GB, Chiarello PG. Performance of Bioelectrical Impedance and Anthropometric Predictive Equations for Estimation of Muscle Mass in Chronic Kidney Disease Patients. Front Nutr 2021; 8:683393. [PMID: 34095195 PMCID: PMC8177428 DOI: 10.3389/fnut.2021.683393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Natália Tomborelli Bellafronte
- Post-graduate Program in Health Sciences, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Lorena Vega-Piris
- Methodology Unit, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Paula Garcia Chiarello
- Department of Health Sciences, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
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14
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Bioelectrical Impedance Analysis and Manual Measurements of Neck Circumference Are Interchangeable, and Declining Neck Circumference Is Related to Presarcopenia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6622398. [PMID: 33860044 PMCID: PMC8024069 DOI: 10.1155/2021/6622398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/26/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023]
Abstract
Purpose Preventive medicine is important in an aging society. Presarcopenia is the preliminary stage of sarcopenia. Recent advances in bioelectrical impedance analysis (BIA) devices have enabled automatic estimation of neck circumference (NC). However, the agreement between and interchangeability of NC measured manually and that calculated with BIA have not been evaluated. We performed these analyses in the context of health checkups and investigated their associations with presarcopenia. Methods We enrolled 318 participants who underwent anthropometric measurements, including NC measured manually and by BIA; assessment of physical function; and blood testing. We used Bland-Altman analysis to calculate the agreement between and interchangeability of NC measurements by BIA and by the manual method. We then statistically compared normal participants and those with presarcopenia. Using multivariable analysis, we subsequently investigated significant risk factors for presarcopenia. We defined presarcopenia according to the appendicular skeletal muscle index (aSMI; the ratio of arm and leg skeletal muscle mass to height2). Results Bland-Altman analysis showed that bias (BIA-manual) was negative overall (−1.07), for male participants (−1.23), and for female participants (−0.96). This finding suggests that BIA measurement is an underestimate in comparison with manual measurement. NC measurement by BIA was found to be interchangeable with that by manual methods, inasmuch as the percentage error was less than 5% overall (4.38%), for male participants (3.81%), and for female participants (4.58%). Univariable analysis revealed that NC was significantly smaller in the participants with presarcopenia than in those without. Multivariable analysis, adjusted for confounding factors, revealed that a decrease in NC was significantly correlated with presarcopenia. Conclusions BIA measurements of NC are interchangeable within about 95% with manual measurements. The decrease in NC measured by BIA was significantly associated with presarcopenia in both genders. NC measurement can be used for early detection of presarcopenia.
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15
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Changes in body composition in peritoneal dialysis patients after kidney transplantation. Int Urol Nephrol 2021; 53:383-390. [PMID: 33387221 DOI: 10.1007/s11255-020-02713-6] [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: 08/10/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Serial follow-up data of body composition from peritoneal dialysis (PD) initiation until 1 year after kidney transplantation (KT) would be useful in identifying pathologic or physiologic changes, related to each modality or during the exchange of the modality. METHODS Body composition analysis was performed 1 month after PD initiation, repeated annually, immediately before KT, 1 month and 1 year after KT (n = 43). Body composition analysis was performed using a bioimpedance analysis (BIA) machine. The body composition parameters measured using BIA included the water contents, fat mass index (FMI), appendicular muscle mass index (aMMI), and bone mineral content (BMC). RESULTS The aMMI values 1 month and 1 year after PD initiation, immediately before KT, and 1 month and 1 year after KT were 7.6 ± 1.5, 7.8 ± 1.4, 8.0 ± 1.4, 6.8 ± 0.9, and 7.0 ± 1.0 kg/m2, respectively. The aMMI increased during the first year of PD (P = 0.029) and was maintained during the remaining period of PD (P = 0.413). The value decreased during the first month after KT (P < 0.001) and recovered during the first year after KT (P = 0.010). FMI increased during the first year of PD (P < 0.001) and was maintained during the remaining period of PD (P = 0.214). The value increased during the first year of KT (P < 0.001). BMC was stable during the PD period but decreased after KT. Body waters were maintained during PD and decreased after KT. The presence of low muscle mass (LMM) 1 month after PD initiation or 1 month after KT, was associated with development of LMM 1 year after KT. CONCLUSION Our study showed that body composition was significantly changed during the first year after PD or the first month after KT, as evidenced by a decrease in aMMI and BMC and an increase in FMI. Adequate interventions provided at these two points might help maintain proper body composition.
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