1
|
Bildaci YD, Esme M, Korucu B, Erbay E, Yigitbasi B, Dilek B, Senturk ZS, Cavdar C, Deger SM. Effects of Medium Cut-Off Dialyzers on Fat Tissue and Muscle Mass Indices. Artif Organs 2025. [PMID: 40078041 DOI: 10.1111/aor.14997] [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: 12/04/2024] [Revised: 02/11/2025] [Accepted: 03/04/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND Medium cut-off (MCO) dialyzers are designed to provide clearance of large-middle molecular weight uremic toxins and cytokines that are also responsible for the pathogenesis of sarcopenia. AIM To investigate the short- and long-term effects of MCO dialyzers on fat and muscle mass. METHODS This single-center prospective, cross-over study includes 20 maintenance hemodialysis (MHD) patients treated with low-flux (LF) dialyzers. Baseline parameters were measured under LF dialyzers and repeated at 2nd week and 6th month after switching to MCO dialyzers. Fat tissues were measured with a skinfold caliper and mid-upper arm circumference. Muscle thickness and strength parameters were measured with ultrasound and handgrip tests. RESULTS Median skinfold thickness showed a statistically significant increase in the second week of HD with MCO dialyzers [15 mm (10, 17) to 16 mm (13.3, 19.8), p = 0.04] and remained similar in the 6th month (p = 0.08). There was a gradual increase in median mid-upper arm circumference with a significant increase in the 6th month [28 (27, 29.5), 28.5 cm (27, 30), and 30.6 cm (26.7, 32), respectively, p = 0.03]. Significant increases were detected in the measurements of all four abdominal muscle groups (p = 0.03 for rectus abdominis and external oblique; p = 0.002 for internal oblique and transversus abdominis) in the 2nd week of MCO dialyzers and remained similar in the 6th month. Median RF and GCM thicknesses also significantly increased in the 2nd week (p = 0.001 and p < 0.001, respectively). The thicknesses of the external oblique, internal oblique, transversus abdominis, and rectus femoris muscles showed no significant differences in the 6th month. We also observed significant increases in the median GCM fibril length and GCM fibril pennation (p = 0.01 and p = 0.008, respectively) in the 2nd week, which also remained similar in the 6th month. The handgrip strength test showed a gradual increase at each time point without statistical significance. CONCLUSION MCO dialyzers provide increased fat and muscle mass, which might be due to their better clearance of uremic toxins compared to low-flux dialyzers. This study serves as a hypothesis-generating investigation; larger randomized controlled trials are required to validate the hypothesis.
Collapse
Affiliation(s)
- Yelda Deligoz Bildaci
- Faculty of Medicine, Department of Nephrology, Dokuz Eylül University, Izmir, Turkey
| | - Mert Esme
- Faculty of Medicine, Department of Geriatrics, Hacettepe University, Ankara, Turkey
| | - Berfu Korucu
- Faculty of Medicine, Department of Nephrology, Dokuz Eylül University, Izmir, Turkey
| | - Ege Erbay
- Faculty of Medicine, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Barkin Yigitbasi
- Faculty of Medicine, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Banu Dilek
- Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Zekiye Selin Senturk
- Faculty of Medicine, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Caner Cavdar
- Faculty of Medicine, Department of Nephrology, Dokuz Eylül University, Izmir, Turkey
| | - Serpil Muge Deger
- Faculty of Medicine, Department of Nephrology, Dokuz Eylül University, Izmir, Turkey
| |
Collapse
|
2
|
Zicarelli M, Duni A, Leivaditis K, Lin YL, Baciga F, Pugliese S, Fiorentino M, Hsu BG, Roumeliotis S, Battaglia Y, Dounousi E, Bolignano D. Comprehensive Insights into Sarcopenia in Dialysis Patients: Mechanisms, Assessment, and Therapeutic Approaches. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:449. [PMID: 40142260 PMCID: PMC11944051 DOI: 10.3390/medicina61030449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 02/25/2025] [Accepted: 02/28/2025] [Indexed: 03/28/2025]
Abstract
Sarcopenia, defined as the progressive loss of muscle mass, strength, and function, is largely prevalent but still clinically underrecognized among patients undergoing chronic dialysis therapy. The pathogenesis involves a complex interplay of chronic inflammation, oxidative stress, metabolic acidosis, hormonal imbalances, protein waste, malnutrition, and reduced physical activity. This multifactorial condition profoundly impairs quality of life and may lead to significant clinical consequences, including frailty, an increased risk of falls and hospitalization, and elevated mortality. Despite its clinical relevance, sarcopenia often remains underdiagnosed due to inconsistent diagnostic criteria and challenges in assessing body composition in dialysis populations. Therapeutic strategies, including tailored exercise programs, nutritional interventions, and pharmacological treatments, are essential to mitigate muscle loss and improve patient outcomes. Early identification and routine sarcopenia assessment in clinical practice could play a pivotal role in enhancing the management of dialysis patients. A multidisciplinary, personalized approach is necessary to address the diverse factors contributing to sarcopenia and to improve the overall prognosis and quality of life for this vulnerable population.
Collapse
Affiliation(s)
- Mariateresa Zicarelli
- Department of Health Sciences, University “Magna-Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Anila Duni
- 2nd Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Konstantinos Leivaditis
- 2nd Department of Nephrology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Yu-Li Lin
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970473, Taiwan
| | - Federica Baciga
- Department of Medicine, University of Verona, 37129 Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Peschiera del Garda, 37129 Verona, Italy
| | - Sara Pugliese
- School of Medicine, University “Magna-Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Marco Fiorentino
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970473, Taiwan
| | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Yuri Battaglia
- Department of Medicine, University of Verona, 37129 Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Peschiera del Garda, 37129 Verona, Italy
| | - Evangelia Dounousi
- 2nd Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Davide Bolignano
- Department of Medical and Surgical Sciences, University “Magna-Graecia” of Catanzaro, 88100 Catanzaro, Italy
| |
Collapse
|
3
|
Yajima T. Can ultrasound be applied to the diagnosis of sarcopenia? J Nephrol 2024; 37:2061-2062. [PMID: 38836998 DOI: 10.1007/s40620-024-01970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/27/2024] [Indexed: 06/06/2024]
Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu, Japan.
| |
Collapse
|
4
|
Abdulsalam AJ, Kara M, Özçakar L. Ultrasound is mightier than bioimpedance spectrometry but not ad lib. J Nephrol 2024; 37:1005-1006. [PMID: 38653926 DOI: 10.1007/s40620-024-01943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Ahmad J Abdulsalam
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey.
- Department of Physical Medicine and Rehabilitation, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
| | - Murat Kara
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey
| |
Collapse
|