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de M Ribeiro G, Nehme R, de F Mendonça ME, Morais DM, Limirio LS, de Oliveira EP. Handgrip strength is not correlated with the five-times sit-to-stand test in kidney transplant patients. Int Urol Nephrol 2025:10.1007/s11255-025-04496-0. [PMID: 40208449 DOI: 10.1007/s11255-025-04496-0] [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: 12/19/2024] [Accepted: 03/27/2025] [Indexed: 04/11/2025]
Abstract
INTRODUCTION Low muscle strength is the primary criterion proposed by the European Working Group on Sarcopenia in Older People (EWGSOP2) for diagnosing sarcopenia, a prevalent condition in the kidney transplant population. The EWGSOP2 recommends either handgrip strength (HGS) or the five-times sit-to-stand test (5TST) to evaluate muscle strength. However, it remains unclear whether these tests are equivalent for assessing muscle strength in kidney transplant patients (KTPs). AIM This study aimed to evaluate the correlation between HGS and the 5TST in KTPs. METHODS A cross-sectional study was conducted with 127 KTPs. Muscle strength was assessed using HGS and 5TST. HGS was measured using a dynamometer on the dominant hand, with the highest recorded value used for analysis. The 5TST was conducted by instructing participants to sit and stand from a chair five times as quickly as possible without using their hands. Pearson's correlation was conducted to assess the relationship between HGS and 5TST. In addition, odds ratio analyses were performed to evaluate the likelihood of inadequate 5TST in relation to inadequate HGS. Cohen's kappa (κ) test was also performed to determine the level of agreement between HGS and 5TST. RESULTS No correlation was observed between HGS and 5TST (r = 0.093; p = 0.295). After adjusting for BMI, sex, age and glomerular filtration rate, the results remained uncorrelated (r = 0.025; p = 0.777). Individuals with inadequate 5TST did not have a higher likelihood of inadequate HGS (OR = 1.391 [0.254-7.596]). A slight agreement between HGS and 5TST was observed (k = 0.0370). CONCLUSION HGS is not correlated with 5TST in KTPs. These results suggest that HGS and 5TST are not equivalent measures of muscle strength in this population.
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Affiliation(s)
- Giovanna de M Ribeiro
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Minas Gerais, Brazil
| | - Rafaela Nehme
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Minas Gerais, Brazil
| | - Maria Eduarda de F Mendonça
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Minas Gerais, Brazil
| | - Débora M Morais
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Minas Gerais, Brazil
| | - Larissa S Limirio
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Minas Gerais, Brazil
| | - Erick P de Oliveira
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Minas Gerais, Brazil.
- Faculdade de Medicina, Universidade Federal de Uberlândia, Av. Pará, 1.720 Bloco 2U - Sala 20 - Campus Umuarama, CEP: 38400902, Uberlândia, MG, Brazil.
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2
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Troutman AD, Arroyo E, Sheridan EM, D'Amico DJ, Brandt PR, Hinrichs R, Chen X, Lim K, Avin KG. Skeletal muscle atrophy in clinical and preclinical models of chronic kidney disease: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2024; 15:21-35. [PMID: 38062879 PMCID: PMC10834351 DOI: 10.1002/jcsm.13400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/12/2023] [Accepted: 11/02/2023] [Indexed: 02/03/2024] Open
Abstract
Patients with chronic kidney disease (CKD) are often regarded as experiencing wasting of muscle mass and declining muscle strength and function, collectively termed sarcopenia. The extent of skeletal muscle wasting in clinical and preclinical CKD populations is unclear. We evaluated skeletal muscle atrophy in preclinical and clinical models of CKD, with multiple sub-analyses for muscle mass assessment methods, CKD severity, sex and across the different preclinical models of CKD. We performed a systematic literature review of clinical and preclinical studies that measured muscle mass/size using the following databases: Ovid Medline, Embase and Scopus. A random effects meta-analysis was utilized to determine standard mean difference (SMD; Hedges' g) between healthy and CKD. Heterogeneity was evaluated using the I2 statistic. Preclinical study quality was assessed via the Systematic Review Centre for Laboratory Animal Experimentation and clinical studies quality was assessed via the Newcastle-Ottawa Scale. This study was registered in PROSPERO (CRD42020180737) prior to initiation of the search. A total of 111 studies were included in this analysis using the following subgroups: 106 studies in the primary CKD analysis, 18 studies that accounted for diabetes and 7 kidney transplant studies. Significant atrophy was demonstrated in 78% of the preclinical studies and 49% of the clinical studies. The random effects model demonstrated a medium overall SMD (SMD = 0.58, 95% CI = 0.52-0.64) when combining clinical and preclinical studies, a medium SMD for the clinical population (SMD = 0.48, 95% CI = 0.42-0.55; all stages) and a large SMD for preclinical CKD (SMD = 0.95, 95% CI = 0.76-1.14). Further sub-analyses were performed based upon assessment methods, disease status and animal model. Muscle atrophy was reported in 49% of the clinical studies, paired with small mean differences. Preclinical studies reported significant atrophy in 78% of studies, with large mean differences. Across multiple clinical sub-analyses such as severity of CKD, dialysis modality and diabetes, a medium mean difference was found. Sub-analyses in both clinical and preclinical studies found a large mean difference for males and medium for females suggesting sex-specific implications. Muscle atrophy differences varied based upon assessment method for clinical and preclinical studies. Limitations in study design prevented conclusions to be made about the extent of muscle loss with disease progression, or the impact of dialysis. Future work would benefit from the use of standardized measurement methods and consistent clinical staging to improve our understanding of atrophy changes in CKD progression, and analysis of biological sex differences.
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Affiliation(s)
- Ashley D Troutman
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, Indianapolis, Indiana, USA
| | - Eliott Arroyo
- Department of Medicine, Division of Nephrology & Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elizabeth M Sheridan
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, Indianapolis, Indiana, USA
| | - Duncan J D'Amico
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, Indianapolis, Indiana, USA
| | - Peyton R Brandt
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, Indianapolis, Indiana, USA
| | - Rachel Hinrichs
- University Library, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Kenneth Lim
- Department of Medicine, Division of Nephrology & Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keith G Avin
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, Indianapolis, Indiana, USA
- Department of Medicine, Division of Nephrology & Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
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3
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Neutrophil-lymphocyte Ratio and C-Reactive Protein Levels are not Associated with Strength, Muscle Mass, and Functional Capacity in Kidney Transplant Patients. Inflammation 2022; 45:2465-2476. [PMID: 35727395 DOI: 10.1007/s10753-022-01705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/02/2021] [Accepted: 06/08/2022] [Indexed: 11/05/2022]
Abstract
Chronic inflammation has been associated with components of sarcopenia; however, these associations are unknown in kidney transplant patients (KTPs). The aim of this study was to associate neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) with strength, muscle mass, and functional capacity in KTPs. A cross-sectional study evaluating 108 KTPs was performed. Strength was evaluated by handgrip strength and five-times-sit-to-stand test (5STS), and appendicular skeletal muscle mass (ASM) was estimated by bioelectrical impedance analysis. The ASM index (ASMI) was calculated using the ASM (kg)/height (m2). Functional capacity was assessed by the 4-m gait speed test and short physical performance battery (SPPB). The electrochemiluminescence method was used for analyzing CRP levels, and the cytometric method XN-3000 Sysmex was used for obtaining leukogram values to calculate the NLR. Linear regression analysis was used to assess the association between systemic inflammation and sarcopenia components, adjusting for confounders. NLR and CRP levels were not associated with handgrip strength (β = - 0.231, p = 0.389; β = - 0.291, p = 0.577), 5STS (β = - 0.114, p = 0.288; β = - 0.202, p = 0.334), ASM (β = - 0.027, p = 0.813; β = 0.062, p = 0.788), ASMI (β = - 0.036, p = 0.242; β = 0.040, p = 0.505), 4-m gait speed (β = 0.013, p = 0.082; β = 0.004, p = 0.769), and SPPB (β = 0.076, p = 0.170; β = 0.152, p = 0.157), respectively. In conclusion, NLR and CRP levels were not associated with muscle mass, strength, and functional capacity in KTPs.
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Santos HO, Genario R, Tinsley GM, Ribeiro P, Carteri RB, Coelho-Ravagnani CDF, Mota JF. A scoping review of intermittent fasting, chronobiology, and metabolism. Am J Clin Nutr 2022; 115:991-1004. [PMID: 34978321 DOI: 10.1093/ajcn/nqab433] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/29/2021] [Indexed: 12/19/2022] Open
Abstract
Chronobiology plays a crucial role in modulating many physiologic systems in which there is nutritional synergism with meal timing. Given that intermittent fasting (IF) has grown as a flexible dietary method consisting of delayed or early eating windows, this scoping review addresses the effects of IF protocols on metabolism as they relate to clinical nutrition and the circadian system. Although nocturnal habits are associated with circadian misalignments and impaired cardiometabolic profile-and nutritional physiology is better orchestrated during the day-most findings are based on animal experiments or human studies with observational designs or acute meal tests. Well-controlled randomized clinical trials employing IF protocols of delayed or early eating windows have sometimes demonstrated clinical benefits, such as improved glycemic and lipid profiles, as well as weight loss. However, IF does not appear to be more effective than traditional diets at the group level, and its effects largely depend on energy restriction. Thus, efforts must be made to identify patient biological rhythms, preferences, routines, and medical conditions before individual dietary prescription in clinical practice.
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Affiliation(s)
- Heitor O Santos
- School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil
| | - Rafael Genario
- School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Grant M Tinsley
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Poliana Ribeiro
- Institute of Genetics and Biochemistry, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil
| | - Randhall B Carteri
- Methodist University Center-Porto Alegre Institute, Porto Alegre, Brazil
| | | | - João F Mota
- Clinical and Sports Nutrition Research Laboratory, Faculty of Nutrition, Goiás Federal University, Goiânia, GO, Brazil
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Baker LA, March DS, Wilkinson TJ, Billany RE, Bishop NC, Castle EM, Chilcot J, Davies MD, Graham-Brown MPM, Greenwood SA, Junglee NA, Kanavaki AM, Lightfoot CJ, Macdonald JH, Rossetti GMK, Smith AC, Burton JO. Clinical practice guideline exercise and lifestyle in chronic kidney disease. BMC Nephrol 2022; 23:75. [PMID: 35193515 PMCID: PMC8862368 DOI: 10.1186/s12882-021-02618-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Mark D. Davies
- Betsi Cadwaladr University Health Board and Bangor University, Bangor, UK
| | | | | | | | | | | | - Jamie H. Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - James O. Burton
- University of Leicester and Leicester Hospitals NHS Trust, Leicester, UK
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Yasar E, Tek NA, Tekbudak MY, Yurtdaş G, Gülbahar Ö, Uyar GÖ, Ural Z, Çelik ÖM, Erten Y. THE RELATIONSHIP BETWEEN MYOSTATIN, INFLAMMATORY MARKERS AND SARCOPENIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE. J Ren Nutr 2022; 32:677-684. [PMID: 35122995 DOI: 10.1053/j.jrn.2022.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/20/2021] [Accepted: 01/01/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine the prevalence of sarcopenia in patients with chronic kidney disease (CKD), investigate the relationship of the serum myostatin level with sarcopenia and inflammatory markers. METHODS The study was conducted with four patient groups: renal transplantation (TX), stage 3-5 non-dialysis-dependent CKD (NDD-CKD), hemodialysis (HD), and peritoneal dialysis (PD). Laboratory parameters, serum myostatin, C-reactive protein, and interleukin-6 (IL-6) levels were studied. Body composition was estimated using a multifrequency bioimpedance analysis. Handgrip strength (HGS) was evaluated with a handgrip dynamometer. The HGS and appendicular skeletal muscle index (ASMI) measurements were used to determine sarcopenia presence. RESULTS The study included 130 patients [72(55%) males]. The patient distribution in groups was as follows: 37 in HD, 28 in PD, 37 in renal TX, and 28 in NDD-CKD. The highest level of myostatin was measured in the HD group and the lowest in the TX group (p<0.001). The HGS measurement was significantly lower only in the PD group compared to the TX group (p=0.025). The myostatin was negatively correlated with HGS, albumin, estimated glomerular filtration rate, and Kt/Vurea. However, myostatin had no correlation with inflammatory markers or ASMI. Sarcopenia was present in 37 (29%) of all patients: 15 (40%) in the HD group, nine (32%) in NDD-CKD, seven (25%) in PD, and six (16%) in TX. When the patients with and without sarcopenia were compared, only myostatin was higher in the former (p=0.045). As a result of multivariate analysis, myostatin was the only independent factor which predict sarcopenia (OR: 1.002, 95% CI:1.001-1.005, p=0.048). CONCLUSION To prevent devastating events associated with sarcopenia in patients with CKD, renal transplantation seems to be the best treatment solution. For the early recognition of sarcopenia, the measurement of the serum myostatin level may be a promising diagnostic approach.
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Affiliation(s)
- Emre Yasar
- Gazi University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey.
| | - Nilüfer Acar Tek
- Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | | | - Gamze Yurtdaş
- Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey; Izmir Katip Celebi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Izmir, Turkey
| | - Özlem Gülbahar
- Gazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Gizem Özata Uyar
- Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Zeynep Ural
- Gazi University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey
| | - Özge Mengi Çelik
- Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Yasemin Erten
- Gazi University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey
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Yildirim S, Colak T, Bayraktar N, Sezer S. Evaluation of Dynapenia and Sarcopenia and Their Associations With Serum Insulin-Like Growth Factor-1 Levels in Renal Transplant Recipients. J Ren Nutr 2021; 32:354-362. [PMID: 34716090 DOI: 10.1053/j.jrn.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Dynapenia and sarcopenia are related to increased morbidity and mortality in the general population. Chronic kidney disease (CKD) causes sarcopenia and dynapenia with different mechanisms. The aim of this study is to compare the muscle parameters in renal transplant recipients to CKD patients and patients without kidney disease and assess their associations with serum insulin-like growth factor-1 (IGF-1) levels. METHOD In total, 120 renal transplant recipients (mean age: 40.4 ± 10.5 years), 60 CKD patients (mean age: 41.9 ± 11.4 years), and 60 control subjects with normal kidney function (mean age: 38.8 ± 9.9 years) were enrolled. Body mass index, hand grip strength, bioelectrical impedance analysis, 6-minute walking test, and serum IGF-1 level were measured and compared between groups. Muscle parameters were evaluated according to The Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia Project criteria. RESULTS IGF-1 levels were highest in the renal transplantation group and lowest in the control group (P = .029). In total, 12.5% of patients in the renal transplantation group (13.3% overweight, 20% obese), 11.6% in the CKD group, and 1.6% in the control group had dynapenia (P = .015). In addition, 8.3% of patients in the CKD group, 3.3% in the renal transplantation group (50% overweight), and none of the patients in the control group had sarcopenia (P = .054). In multivariate analyses, muscle strength was associated with IGF-1 levels in renal transplant recipients (beta = 2.314, t = 3.456, P = .001). CONCLUSIONS Serum IGF-1 is closely associated with muscle strength in renal transplant recipients. The negative effects of CKD on muscle system cannot be completely resolved with renal transplantation. Sarcopenic obesity and dynapenic obesity need special attention and therefore body mass index cannot be used as the only parameter to evaluate frailty in renal transplant recipients.
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Affiliation(s)
- Saliha Yildirim
- Baskent University Faculty of Medicine, Internal Medicine Department, Ankara, Turkey.
| | - Turan Colak
- Baskent University Faculty of Medicine, Nephrology Department, Ankara, Turkey
| | - Nilufer Bayraktar
- Baskent University Faculty of Medicine, Biochemistry Department, Ankara, Turkey
| | - Siren Sezer
- Baskent University Faculty of Medicine, Nephrology Department, Ankara, Turkey
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Koito Y, Yanishi M, Kimura Y, Tsukaguchi H, Kinoshita H, Matsuda T. Serum Brain-Derived Neurotrophic Factor and Myostatin Levels Are Associated With Skeletal Muscle Mass in Kidney Transplant Recipients. Transplant Proc 2021; 53:1939-1944. [PMID: 34253381 DOI: 10.1016/j.transproceed.2021.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/01/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sarcopenia, or reduced muscle mass, can be an important complication in kidney transplant recipients. The skeletal muscles were recently reported to secrete various myokines, such as brain-derived neurotrophic factor (BDNF) and myostatin, to regulate their mass, function, or both. The aim of the present study was to analyze the interrelationship between myokines (BDNF and myostatin) and skeletal muscle mass in kidney transplant recipients. METHODS The study population comprised 40 patients who underwent kidney transplantation at Kansai Medical University Hospital. Twenty patients had low skeletal muscle mass index (SMI) values, as measured on dual-energy x-ray absorptiometry, and were categorized into 2 groups (low SMI and normal). RESULTS Mean serum BDNF levels were 15.7 ng/mL in the low SMI group and 17.8 ng/mL in the normal group (P = .013). Mean serum myostatin levels were 362 pg/mL in the low SMI and 267 pg/mL in the normal group (P = .024). There was a significant positive correlation among metabolic equivalents and serum BDNF levels (r = 0.817; P < .001) and a significant negative correlation among metabolic equivalents and serum myostatin levels (r = -0.541; P < .001). Receiver operating characteristic analysis showed that serum BDNF and level of area under curve was 0.712, and serum myostatin level of area under the curve was 0.690. Serum BDNF and myostatin levels showed no significant difference. CONCLUSION These results suggest that BDNF and myostatin are potential biomarkers of reduced muscle mass in kidney transplant recipients.
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Affiliation(s)
- Yuya Koito
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Masaaki Yanishi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
| | - Yutaka Kimura
- Health Science Center, Kansai Medical University, Osaka, Japan
| | - Hiroyasu Tsukaguchi
- Second Department of Internal Medicine, Division of Nephrology, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Maintenance of Skeletal Muscle to Counteract Sarcopenia in Patients with Advanced Chronic Kidney Disease and Especially Those Undergoing Hemodialysis. Nutrients 2021; 13:nu13051538. [PMID: 34063269 PMCID: PMC8147474 DOI: 10.3390/nu13051538] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/18/2022] Open
Abstract
Life extension in modern society has introduced new concepts regarding such disorders as frailty and sarcopenia, which has been recognized in various studies. At the same time, cutting-edge technology methods, e.g., renal replacement therapy for conditions such as hemodialysis (HD), have made it possible to protect patients from advanced lethal chronic kidney disease (CKD). Loss of muscle and fat mass, termed protein energy wasting (PEW), has been recognized as prognostic factor and, along with the increasing rate of HD introduction in elderly individuals in Japan, appropriate countermeasures are necessary. Although their origins differ, frailty, sarcopenia, and PEW share common components, among which skeletal muscle plays a central role in their etiologies. The nearest concept may be sarcopenia, for which diagnosis techniques have recently been reported. The focus of this review is on maintenance of skeletal muscle against aging and CKD/HD, based on muscle physiology and pathology. Clinically relevant and topical factors related to muscle wasting including sarcopenia, such as vitamin D, myostatin, insulin (related to diabetes), insulin-like growth factor I, mitochondria, and physical inactivity, are discussed. Findings presented thus far indicate that in addition to modulation of the aforementioned factors, exercise combined with nutritional supplementation may be a useful approach to overcome muscle wasting and sarcopenia in elderly patients undergoing HD treatments.
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Tantisattamo E, Kalantar-Zadeh K, Halleck F, Duettmann W, Naik M, Budde K. Novel approaches to sarcopenic obesity and weight management before and after kidney transplantation. Curr Opin Nephrol Hypertens 2021; 30:14-26. [PMID: 33186218 DOI: 10.1097/mnh.0000000000000673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Although a widely recognized and complex pathophysiological condition, sarcopenic obesity remains less appreciated and may elude diagnosis and workup in both kidney transplant waitlisted candidates and kidney transplant recipients. The lack of consensus definition, and practical diagnostic tools for evaluating waitlisted candidates and transplant recipients are barriers to early detect and initiate therapeutic management for sarcopenic obesity. Although sarcopenia leads to poor clinical outcomes, posttransplant obesity yields conflicting results. Exercise and nutritional managements are common therapies for sarcopenic obese patients; however, surgery weight loss or bariatric surgery in both transplant candidates and potential living kidney donors shows promising benefits for kidney transplant access in waitlist obese candidates but may require to be selected for appropriate patients. RECENT FINDINGS Pathogenesis and management for sarcopenia and obesity are interconnected. The benefits of exercise to improve muscle mass and function is clear in waitlist kidney transplant candidates and transplant recipients. However, there are several barriers for those to increase exercise and improve physical activity including patient, provider, and healthcare or environmental factors. The advantages of fat mass reduction to lose weight can promote muscle mass and strength. However, epidemiological data regarding the obesity paradox in dialysis-dependent patients when overnutrition provides survival benefits for this population should be taken into account when performing weight loss especially bariatric surgery. SUMMARY Barriers in providing optimal care to kidney transplant waitlisted candidates and transplant recipients may partly result from underdiagnosis of sarcopenic obesity; notwithstanding that this entity has increasingly been more recognized. Mechanistic studies to better understand pathogenesis of sarcopenic obesity will help determine pathogenesis and clinical tools for diagnosis of this entity, which can facilitate further studies related to the outcomes and weight management to ultimately improve kidney transplant outcomes.
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Affiliation(s)
- Ekamol Tantisattamo
- Division of Nephrology, Hypertension and Kidney Transplantation, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange
- Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, California
- Section of Nephrology, Department of Internal Medicine, Multi-Organ Transplant Center, Oakland University William Beaumont School of Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange
- Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, California
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wiebke Duettmann
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marcel Naik
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
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11
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Martins CA, França AKTDC, Dias RSC, Costa RCDO, Lemos APL, Santos AMD, Hortegal EV, Brito DJDA. Prevalence of sarcopenia in kidney transplants and their association with determinant factors of muscle homeostasis. ACTA ACUST UNITED AC 2020; 66:1235-1240. [PMID: 33027451 DOI: 10.1590/1806-9282.66.9.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/26/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Sarcopenia is characterized by the involuntary loss of lean body mass associated with a progressive reduction of muscle strength. OBJECTIVE To determine the prevalence of sarcopenia in kidney transplant recipients and its association with the determining factors that control muscle homeostasis. METHODS We evaluated renal transplant recipients undergoing follow-up at the University Hospital of the Federal University of Maranhão from June 2017 to July 2018 and who met the inclusion criteria. Sarcopenia was defined according to the European criteria. The skeletal muscle mass index was measured by dual-energy radiological absorptiometry; the values <7,26 kg/m2 for men and <5,5 kg/m2 for women were adopted for muscle depletion. For handgrip strength, values of <30 kg for men and <20 kg for women were considered as reduced muscle strength. In both sexes, the cutoff point for walking speed was <0,8 m/s. RESULTS We evaluated 83 renal transplant recipients with a mean age of 48.8 ± 12,1 years and predominantly males (57,8%). The prevalence of sarcopenia was 19,3%. Among individuals without sarcopenia, 17,9% had a decrease in handgrip strength and 40,3% has altered gait speed. DISCUSSION Individuals submitted to renal transplant may develop sarcopenia while still young and already present altered muscle function and strength even before the depletion of lean body mass. CONCLUSION Early diagnosis may allow the prevention of sarcopenia and provide a better quality of life for patients.
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Affiliation(s)
- Cleodice Alves Martins
- Universidade Federal do Maranhão, Hospital Universitário Presidente Dutra, Programa de Residência Multiprofissional em Saúde, São Luis, MA, Brasil
| | - Ana Karina Teixeira da Cunha França
- Universidade Federal do Maranhão, Departamento de Ciências Fisiológicas, Curso de Nutrição, São Luis, MA, Brasil.,Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde Coletiva, São Luis, MA, Brasil
| | - Raimunda Sheyla Carneiro Dias
- Universidade Federal do Maranhão, Hospital Universitário Presidente Dutra, Serviço de Nefrologia, São Luis, MA, Brasil
| | - Rayanna Cadilhe de Oliveira Costa
- Universidade Federal do Maranhão, Hospital Universitário Presidente Dutra, Programa de Residência Multiprofissional em Saúde, São Luis, MA, Brasil
| | - Antônio Pedro Leite Lemos
- Universidade Federal do Maranhão, Hospital Universitário Presidente Dutra, Programa de Residência Multiprofissional em Saúde, São Luis, MA, Brasil
| | | | - Elane Viana Hortegal
- Universidade Federal do Maranhão, Departamento de Ciências Fisiológicas, Curso de Nutrição, São Luis, MA, Brasil.,Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde Coletiva, São Luis, MA, Brasil
| | - Dyego José de Araújo Brito
- Universidade Federal do Maranhão, Hospital Universitário Presidente Dutra, Serviço de Nefrologia, São Luis, MA, Brasil
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12
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Dos Reis AS, Limirio LS, Santos HO, de Oliveira EP. Intake of polyunsaturated fatty acids and ω-3 are protective factors for sarcopenia in kidney transplant patients. Nutrition 2020; 81:110929. [PMID: 32745708 DOI: 10.1016/j.nut.2020.110929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/29/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to associate dietary intake with sarcopenia and its components in kidney transplant patients (KTPs). METHODS A cross-sectional study was performed with 125 KTPs. Strength was evaluated by handgrip strength (HGS) and appendicular muscle mass was estimated by bioelectrical impedance. Functional capacity was assessed by 4-m walking test. Sarcopenia was diagnosed by revised European Consensus on Definition and Diagnosis (2019). Dietary assessment was carried out through two 24-h dietary recalls. It evaluated the consumption of energy (kcal), carbohydrates, protein (total and from animal and vegetable food sources), total fat, saturated fatty acids, monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and ω-3 (g) and ω-6 (g). RESULTS Intake of ω-3 was positively associated with appendicular skeletal muscle mass index (ASMI; kg/m2). The greater intake of PUFA (g and %) and ω-3 (g) was associated with lower chance to present low ASMI and sarcopenia. None of the other dietary components evaluated in the present study were associated with ASMI and sarcopenia. Walking speed and HGS were not associated with dietary variables. CONCLUSIONS Intake of ω-3 and PUFAs are protective factors for sarcopenia and low muscle mass, but not for strength and functional capacity, in KTPs.
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Affiliation(s)
- Aline S Dos Reis
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil
| | - Larissa S Limirio
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil
| | - Heitor O Santos
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil
| | - Erick P de Oliveira
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil.
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13
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Barreto Silva MI, Menna Barreto APM, Pontes KSDS, Costa MSD, Rosina KTDC, Souza E, Bregman R, Prado CM, Klein MRST. Accuracy of surrogate methods to estimate skeletal muscle mass in non-dialysis dependent patients with chronic kidney disease and in kidney transplant recipients. Clin Nutr 2020; 40:303-312. [PMID: 32536581 DOI: 10.1016/j.clnu.2020.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/02/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS Bioelectrical impedance analysis (BIA) and anthropometric predictive equations have been proposed to estimate whole-body (SMM) and appendicular skeletal muscle mass (ASM) as surrogate for dual energy X-ray absorptiometry (DXA) in distinct population groups. However, their accuracy in estimating body composition in non-dialysis dependent patients with chronic kidney disease (NDD-CKD) and kidney transplant recipients (KTR) is unknown. The aim of this study was to investigate the accuracy and reproducibility of BIA and anthropometric predictive equations in estimating SMM and ASM compared to DXA, in NDD-CKD patients and KTR. METHODS A cross-sectional study including adult NDD-CKD patients and KTR, with body mass index (BMI) ≥18.5 kg/m2. ASM and estimated SMM were evaluated by DXA, BIA (Janssen, Kyle and MacDonald equations) and anthropometry (Lee and Baumgartner equations). Low muscle mass (LowMM) was defined according to cutoffs proposed by guidelines for ASM, ASM/height2 and ASM/BMI. The best performing equation as surrogate for DXA, considering both groups of studied patients, was defined based in the highest Lin's concordance correlation coefficient (CCC) value, the lowest Bland-Altman bias (<1.5 kg) combined with the narrowest upper and lower limits of agreement (LoA), and the highest Cohen's kappa values for the low muscle mass diagnosis. RESULTS Studied groups comprised NDD-CKD patients (n = 321: males = 55.1%; 65.4 ± 13.1 years; eGFR = 28.8 ± 12.7 ml/min) and KTR (n = 200: males = 57.7%; 47.5 ± 11.3 years; eGFR = 54.7 ± 20.7 ml/min). In both groups, the predictive equations presenting the best accuracy compared to DXA were SMM-BIA-Janssen (NDD-CKD patients: CCC = 0.88, 95%CI = 0.83-0.92; bias = 0.0 kg; KTR: CCC = 0.89, 95%CI = 0.86-0.92, bias = -1.2 kg) and ASM-BIA-Kyle (NDD-CKD patients: CCC = 0.87, 95%CI = 0.82-0.90, bias = 0.7 kg; KTR: CCC = 0.89, 95%CI = 0.86-0.92, bias = -0.8 kg). In NDD-CKD patients and KTR, LowMM frequency was similar according to ASM-BIA-Kyle versus ASM-DXA. The reproducibility and inter-agreement to diagnose LowMM using ASM/height2 and ASM/BMI estimated by BIA-Kyle equation versus DXA was moderate (kappa: 0.41-0.60), in both groups. Whereas female patients showed higher inter-agreement (AUC>80%) when ASM/BMI index was used, male patients presented higher AUC (70-74%; slightly <80%) for ASM/height2 index. CONCLUSIONS The predictive equations with best performance to assess muscle mass in both NDD-CKD patients and KTR was SMM-BIA by Janssen and ASM-BIA by Kyle. The reproducibility to diagnose low muscle mass, comparing BIA with DXA, was high using ASM/BMI in females and ASM/height2 in males in both groups.
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Affiliation(s)
- Maria Inês Barreto Silva
- Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, 20550-900, Brazil; Department of Applied Nutrition, Nutrition School, Federal University of the State of Rio de Janeiro, Rio de Janeiro, 22290-240, Brazil; Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada.
| | | | - Karine Scanci da Silva Pontes
- Post Graduation Program in Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, 20550-170, Brazil.
| | - Mariana Silva da Costa
- Post Graduation Program in Medical Science, Rio de Janeiro State University, Rio de Janeiro, 20550-170, Brazil.
| | | | - Edison Souza
- Nephrology Division, Rio de Janeiro State University, Rio de Janeiro, 20551900, Brazil.
| | - Rachel Bregman
- Nephrology Division, Rio de Janeiro State University, Rio de Janeiro, 20551900, Brazil.
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada.
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14
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Alconchel F, Martínez-Alarcón L, Nicolás-López T, Khiri F, Febrero B, Cascales-Campos PA, Martínez-Insfran LA, Ríos A, Fernández-Hernández JA, Rodríguez JM, López-López V, Sánchez-Bueno F, Robles-Campos R, Parrilla P, Ramírez P. Psoas Muscle Index Does Not Predict Post-Transplant Outcomes: A Series of 57 Liver Transplant Recipients. Transplant Proc 2020; 52:549-552. [PMID: 32029312 DOI: 10.1016/j.transproceed.2019.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/15/2019] [Accepted: 12/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sarcopenia is defined as the loss of muscle mass and function. Our aim is to evaluate the degree of sarcopenia by measuring the patients on the waiting list for liver transplantation and its influence on the different post-liver transplant outcomes in our group. METHODS The psoas muscle index (PMI, cm2/m2) was calculated (right psoas muscle area [cm2]/the square of the body height [m2]) in 57 patients on the waiting list for liver transplantation in our center, and the post-transplant variables relevant to our study were collected. RESULTS The 57 recipients had a mean age of 57 years (range, 35-73) and had a mean of 7.4 months (range, 0-39) on the liver transplant waiting list. The mean psoas muscle index was 2.39 (range, 1-4), and the mean body mass index was 28.01kg/m2 (range, 22-36). After multivariate analysis we found a positive correlation between the PMI and the body mass index of the recipients (r = 0.320, P = .017), intensive care unit length of stay, and donor age (r = 0.319, P = .042), and between cold ischemia time and graft survival (r = 0.366, P = .009). We found no correlation in our sample between PMI and post-liver transplant complications either in terms of graft or patient survival. CONCLUSION PMI is not representative of total muscle mass and sarcopenia and is not effective in adequately predicting the survival of patients on the waiting list for liver transplantation.
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Affiliation(s)
- F Alconchel
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
| | - L Martínez-Alarcón
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - T Nicolás-López
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - F Khiri
- University College of Nursing, University of Murcia, Murcia, Spain
| | - B Febrero
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - P A Cascales-Campos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - L A Martínez-Insfran
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - A Ríos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - J A Fernández-Hernández
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - J M Rodríguez
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - V López-López
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - F Sánchez-Bueno
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - R Robles-Campos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - P Parrilla
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - P Ramírez
- Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
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15
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Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc 2020; 21:300-307.e2. [PMID: 32033882 DOI: 10.1016/j.jamda.2019.12.012] [Citation(s) in RCA: 3590] [Impact Index Per Article: 718.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022]
Abstract
Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.
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Affiliation(s)
- Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Prasert Assantachai
- Division of Geriatric Medicine, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tung-Wai Auyeung
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Ming-Yueh Chou
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Beijing, China
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Jenny S W Lee
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Chih-Kuang Liang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Wee Shiong Lim
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ken Sugimoto
- Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoki Tanaka
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Teimei Zhang
- Beijing Institute of Geriatrics, Beijing Hospital, Ministry of Health, Beijing, China
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
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Association of sarcopenia with phase angle and body mass index in kidney transplant recipients. Sci Rep 2020; 10:266. [PMID: 31937826 PMCID: PMC6959331 DOI: 10.1038/s41598-019-57195-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
Malnutrition is an important risk factor for the development of sarcopenia. Recently, phase angle (PhA) obtained from the bioelectrical impedance analysis is increasingly becoming known as a nutritional status marker and may be considered a good indicator to identify elderly patients at risk of sarcopenia. In this study, we investigated the prevalence of sarcopenia and the relationship between sarcopenia and PhA or body mass index (BMI) as nutritional factors, and evaluated the discrimination performance of these nutritional factors for sarcopenia in 210 kidney transplant recipients. The median age was 55 years and 11.1% had sarcopenia. This prevalence of sarcopenia was lower than previous reports in kidney transplant recipients, maybe because of the differences in sarcopenia definitions and population demographics such as age, sex, race, and comorbidities. Both PhA and BMI were negatively correlated with sarcopenia after adjusting for age, sex, dialysis vintage, time after transplant, presence of diabetes mellitus, hemoglobin, estimated glomerular filtration rate, and the other nutritional factor. The discrimination performance for PhA and BMI had enough power to detect sarcopenia. These results suggest that PhA and BMI can be used in clinical practice to predict sarcopenia in kidney transplant patients.
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Deterioration of presarcopenia and its risk factors following kidney transplantation. Clin Exp Nephrol 2019; 24:379-383. [PMID: 31875933 DOI: 10.1007/s10157-019-01835-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sarcopenia is prevalent in patients with chronic kidney disease and is associated with increased mortality; however, limited data are available on whether kidney transplantation can improve muscle wasting. Therefore, the present study aimed to assess changes in body composition before and after kidney transplantation. METHODS Between April 2015 and January 2018, 80 de novo consecutive adult patients with end-stage kidney disease who underwent kidney transplantation were prospectively enrolled. Muscle and fat masses were measured via bioelectrical impedance analysis using InBody 770 at - 2 and 7 days and 3, 6, and 12 months after transplantation. Presarcopenia is characterized by low muscle mass according to the skeletal muscle mass index. Changes in body composition and prevalence of presarcopenia were compared before and after transplantation. Risk factors for presarcopenia were identified using logistic regression analysis. RESULTS Muscle mass significantly decreased at 3 months after transplantation. Consequently, the prevalence of presarcopenia was significantly higher after transplantation (3 months: 47.5%, 6 months: 42.5%, and 12 months: 38.8%) than that before transplantation (25.0%). Similarly, the body fat percentage was significantly higher at 3 months after transplantation than that before transplantation. Presarcopenia before transplantation was an independent risk factor for presarcopenia at 12 months after transplantation (odds ratio: 51.8, 95% CI 5.77-464, p < 0.001). CONCLUSIONS Muscle wasting deteriorated and body fat percentage increased from 3 months after kidney transplantation. Presarcopenia before transplantation led to presarcopenia after transplantation, which may deteriorate with an increase in body fat percentage.
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18
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Carey EJ, Lai JC, Sonnenday C, Tapper EB, Tandon P, Duarte-Rojo A, Dunn MA, Tsien C, Kallwitz ER, Ng V, Dasarathy S, Kappus M, Bashir MR, Montano-Loza AJ. A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation. Hepatology 2019; 70:1816-1829. [PMID: 31220351 PMCID: PMC6819202 DOI: 10.1002/hep.30828] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022]
Abstract
Loss of muscle mass and function, or sarcopenia, is a common feature of cirrhosis and contributes significantly to morbidity and mortality in this population. Sarcopenia is a main indicator of adverse outcomes in this population, including poor quality of life, hepatic decompensation, mortality in patients with cirrhosis evaluated for liver transplantation (LT), longer hospital and intensive care unit stay, higher incidence of infection following LT, and higher overall health care cost. Although it is clear that muscle mass is an important predictor of LT outcomes, many questions remain, including the best modality for assessing muscle mass, the optimal cut-off values for sarcopenia, the ideal timing and frequency of muscle mass assessment, and how to best incorporate the concept of sarcopenia into clinical decision making. For these reasons, we assembled a group of experts to form the North American Working Group on Sarcopenia in Liver Transplantation to use evidence from the medical literature to address these outstanding questions regarding sarcopenia in LT. We believe sarcopenia assessment should be considered in all patients with cirrhosis evaluated for liver transplantation. Skeletal muscle index (SMI) assessed by computed tomography constitutes the best-studied technique for assessing sarcopenia in patients with cirrhosis. Cut-off values for sarcopenia, defined as SMI < 50 cm2 /m2 in male and < 39 cm2 /m2 in female patients, constitute the validated definition for sarcopenia in patients with cirrhosis. Conclusion: The management of sarcopenia requires a multipronged approach including nutrition, exercise, and additional pharmacological therapy as deemed necessary. Future studies should evaluate whether recovery of sarcopenia with nutritional management in combination with an exercise program is sustainable as well as how improvement in muscle mass might be associated with improvement in clinical outcomes.
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Affiliation(s)
- Elizabeth J. Carey
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jennifer C. Lai
- Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA, USA
| | | | - Elliot B. Tapper
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Puneeta Tandon
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Andres Duarte-Rojo
- Center for Liver Diseases, Thomas E. Starzl Transplantation Institute, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael A. Dunn
- Center for Liver Diseases, Thomas E. Starzl Transplantation Institute, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cynthia Tsien
- Gastroenterology Department, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Vicky Ng
- Transplant and Regenerative Medicine Centre, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Matthew Kappus
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
| | - Mustafa R. Bashir
- Division of Abdominal Imaging, Duke University Medical Center Durham, NC, USA
| | - Aldo J. Montano-Loza
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
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19
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Factors Related to Osteosarcopenia in Kidney Transplant Recipients. Transplant Proc 2018; 50:3371-3375. [DOI: 10.1016/j.transproceed.2018.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/26/2018] [Accepted: 04/12/2018] [Indexed: 12/25/2022]
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20
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Yanishi M, Kinoshita H, Tsukaguchi H, Kimura Y, Koito Y, Sugi M, Matsuda T. The creatinine/cystatin C ratio provides effective evaluation of muscle mass in kidney transplant recipients. Int Urol Nephrol 2018; 51:79-83. [PMID: 30361963 DOI: 10.1007/s11255-018-2015-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/19/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Measuring muscle mass is an important step in detecting sarcopenia. The evaluation of sarcopenia is also important for kidney transplant recipients. Methods for estimating muscle mass have been established using computed tomography or magnetic resonance imaging, which are considered the gold standards. But these methods are invasive and costly, and there is a need for a more practical and simple method using blood samples from kidney transplant recipients. METHODS The study population was 62 patients who underwent kidney transplantation at Kansai Medical University Hospital, and were evaluated from August to October 2017. Muscle mass was measured using dual-energy X-ray absorptiometry. Serum creatinine and cystatin C levels were measured by immunoassay. RESULTS We analyzed 62 transplant recipients who met the inclusion criteria (20 females and 42 males, mean age of 45.6 ± 12.7 years). The creatinine/cystatin C ratio in the male group was > 1, whereas the creatinine/cystatin C ratio in the female group was < 1. Muscle mass was significantly larger in the male group than the female group. There was a significant positive correlation between the skeletal muscle index and creatinine/cystatin C ratio in the male (r = 0.553; p < 0.001) and female groups (r = 0.675; p < 0.001). CONCLUSION The creatinine/cystatin C ratio is appropriate for evaluating muscle mass in kidney transplant recipients.
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Affiliation(s)
- Masaaki Yanishi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan. .,Department of Urology and Andrology, Graduate School of Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Hiroyasu Tsukaguchi
- 2nd Department of Internal Medicine, Division of Nephrology, Kansai Medical University, Osaka, Japan
| | - Yutaka Kimura
- Health Science Center, Kansai Medical University, Osaka, Japan
| | - Yuya Koito
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Motohiko Sugi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Takamoto D, Kawahara T, Mochizuki T, Makiyama K, Teranishi J, Uemura H. A Longer History of Hemodialysis Can Lead to Sarcopenia in Renal Transplantation Patients. Transplant Proc 2018; 50:2447-2450. [DOI: 10.1016/j.transproceed.2018.02.192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
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Fukuda Y, Asaoka T, Eguchi H, Sasaki K, Iwagami Y, Yamada D, Noda T, Kawamoto K, Gotoh K, Kobayashi S, Ito T, Takeda Y, Tanemura M, Mori M, Doki Y. Clinical Impact of Preoperative Sarcopenia on the Postoperative Outcomes After Pancreas Transplantation. World J Surg 2018; 42:3364-3371. [DOI: 10.1007/s00268-018-4639-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Yanishi M, Kinoshita H, Tsukaguchi H, Kimura Y, Koito Y, Jino E, Watanabe M, Sugi M, Matsuda T. Dual Energy X-ray Absorptiometry and Bioimpedance Analysis are Clinically Useful for Measuring Muscle Mass in Kidney Transplant Recipients With Sarcopenia. Transplant Proc 2018; 50:150-154. [DOI: 10.1016/j.transproceed.2017.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/13/2017] [Indexed: 12/19/2022]
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Yanishi M, Tsukaguchi H, Kimura Y, Koito Y, Yoshida K, Seo M, Jino E, Sugi M, Kinoshita H, Matsuda T. Evaluation of physical activity in sarcopenic conditions of kidney transplantation recipients. Int Urol Nephrol 2017; 49:1779-1784. [DOI: 10.1007/s11255-017-1661-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/14/2017] [Indexed: 12/31/2022]
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