1
|
Herreros-Carretero Á, Berlanga-Macías C, Martínez-Vizcaíno V, Torres-Costoso A, Pascual-Morena C, Hernández-Castillejo LE, Sequí-Domínguez I, Garrido-Miguel M. Prevalence of Musculoskeletal and Metabolic Disorders in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis. Transpl Int 2024; 37:12312. [PMID: 38720821 PMCID: PMC11076774 DOI: 10.3389/ti.2024.12312] [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: 10/26/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024]
Abstract
Introduction Musculoskeletal disorders could be associated with metabolic disorders that are common after kidney transplantation, which could reduce the quality of life of patients. The aim of this study was to assess the prevalence of both musculoskeletal and metabolic disorders in kidney transplant patients. Methods MEDLINE, CINAHL, Cochrane Library, EMBASE and Web of Science were searched from their inception up to June 2023. DerSimonian and Laird random-effects method was used to calculate pooled prevalence estimates and their 95% confidence intervals (CIs). Results 21,879 kidney transplant recipients from 38 studies were analysed. The overall proportion of kidney transplant patients with musculoskeletal disorders was 27.2% (95% CI: 18.4-36.0), with low muscle strength (64.5%; 95% CI: 43.1-81.3) being the most common disorder. Otherwise, the overall proportion of kidney transplant patients with metabolic disorders was 37.6% (95% CI: 21.9-53.2), with hypovitaminosis D (81.8%; 95% CI: 67.2-90.8) being the most prevalent disorder. Conclusion The most common musculoskeletal disorders were low muscle strength, femoral osteopenia, and low muscle mass. Hypovitaminosis D, hyperparathyroidism, and hyperuricemia were also the most common metabolic disorders. These disorders could be associated with poorer quality of life in kidney transplant recipients. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier [CRD42023449171].
Collapse
Affiliation(s)
| | - Carlos Berlanga-Macías
- Facultad de Enfermería, Universidad de Castilla-La Mancha, Albacete, Spain
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Investigación en Cuidados de la Salud Cardiovascular (CARVASCARE), Centro de Estudio Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Ana Torres-Costoso
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Carlos Pascual-Morena
- Facultad de Enfermería, Universidad de Castilla-La Mancha, Albacete, Spain
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Luis Enrique Hernández-Castillejo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Irene Sequí-Domínguez
- Facultad de Enfermería, Universidad de Castilla-La Mancha, Albacete, Spain
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| | - Miriam Garrido-Miguel
- Facultad de Enfermería, Universidad de Castilla-La Mancha, Albacete, Spain
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Cuenca, Spain
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Costa MSD, Pontes KSDS, Guedes MR, Barreto Silva MI, Klein MRST. Association of habitual coffee consumption with obesity, sarcopenia, bone mineral density and cardiovascular risk factors: A two-year follow-up study in kidney transplant recipients. Clin Nutr 2023; 42:1889-1900. [PMID: 37625318 DOI: 10.1016/j.clnu.2023.08.004] [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: 03/18/2023] [Revised: 07/06/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND & AIMS Recent evidence suggests that moderate coffee intake is associated with multiple health benefits, including lower risk of obesity, sarcopenia and cardiovascular disease (CVD) in the general population. However, to date, no study has evaluated these associations in kidney transplant recipients (KTR). The aim of the present study was to evaluate the association of habitual coffee consumption with obesity, sarcopenia, bone mineral density and CVD risk factors in KTR. METHODS This prospective 2 years-follow-up study included 170 KTR (59% men) aged 49.5 (42.0-57.0) years. At baseline participants were submitted to the following evaluations: clinical, laboratorial, dietary intake (including coffee), muscle strength, anthropometric and body composition by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). After two years 163 KTR were re-evaluated by anthropometry, BIA and muscle strength. Sarcopenia was defined according to EWGSOP2. Risk factors for CVD were hypertension, diabetes mellitus, dyslipidemia, metabolic syndrome and hyperhomcysteinemia. Participants were stratified according to coffee intake: 0 or 1 time/day (Gr0-1) and 2 or 3 times/day (Gr2-3). RESULTS The median coffee consumption was 200 (150-250)mL/day and 112 (71-155)mL/1000 kcal/day. At baseline, Gr2-3 vs. Gr0-1 exhibited significantly higher values of waist circumference, waist-to-height ratio (WHtR) and presented a higher odds ratio for central obesity according to WHtR (2.68; 95%CI:1.19-6.02; p = 0.02) after adjustment for confounders. Coffee consumption (mL/1000 kcal/day) showed, even after adjustment for confounders, (1) a positive association with all parameters of body adiposity (anthropometry, BIA and DXA) and (2) a negative association with muscle quality index. After two years, coffee intake (mL/1000 kcal/day) at baseline presented a positive correlation with changes in fat mass (kg) by BIA (r = 0.22, p = 0.01) after adjustment for confounders. CONCLUSION This study suggests that in KTR, higher coffee consumption is associated with increased adiposity, specially, central adiposity and lower muscle quality, but is not related with the other evaluated parameters.
Collapse
Affiliation(s)
- Mariana Silva da Costa
- Post Graduation Program in Medical Science, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| | - Karine Scanci da Silva Pontes
- Post-Graduation Program in Clinical and Experimental Pathophysiology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
| | - Marcella Rodrigues Guedes
- Post-Graduation Program in Clinical and Experimental Pathophysiology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
| | - Maria Inês Barreto Silva
- Department of Applied Nutrition, Nutrition Institute, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil; Department of Applied Nutrition, Nutrition School, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil; Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Alberta, Canada.
| | | |
Collapse
|
4
|
Piccoli GB, Cederholm T, Avesani CM, Bakker SJL, Bellizzi V, Cuerda C, Cupisti A, Sabatino A, Schneider S, Torreggiani M, Fouque D, Carrero JJ, Barazzoni R. Nutritional status and the risk of malnutrition in older adults with chronic kidney disease - implications for low protein intake and nutritional care: A critical review endorsed by ERN-ERA and ESPEN. Clin Nutr 2023; 42:443-457. [PMID: 36857954 DOI: 10.1016/j.clnu.2023.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
Increased life expectancy is posing unprecedented challenges to healthcare systems worldwide. These include a sharp increase in the prevalence of chronic kidney disease (CKD) and of impaired nutritional status with malnutrition-protein-energy wasting (PEW) that portends worse clinical outcomes, including reduced survival. In older adults with CKD, a nutritional dilemma occurs when indications from geriatric nutritional guidelines to maintain the protein intake above 1.0 g/kg/day to prevent malnutrition need to be adapted to the indications from nephrology guidelines, to reduce protein intake in order to prevent or slow CKD progression and improve metabolic abnormalities. To address these issues, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Renal Nutrition group of the European Renal Association (ERN-ERA) have prepared this conjoint critical review paper, whose objective is to summarize key concepts related to prevention and treatment of both CKD progression and impaired nutritional status using dietary approaches, and to provide guidance on how to define optimal protein and energy intake in older adults with differing severity of CKD. Overall, the authors support careful assessment to identify the most urgent clinical challenge and the consequent treatment priority. The presence of malnutrition-protein-energy wasting (PEW) suggests the need to avoid or postpone protein restriction, particularly in the presence of stable kidney function and considering the patient's preferences and quality of life. CKD progression and advanced CKD stage support prioritization of protein restriction in the presence of a good nutritional status. Individual risk-benefit assessment and appropriate nutritional monitoring should guide the decision-making process. Higher awareness of the challenges of nutritional care in older adult patients with CKD is needed to improve care and outcomes. Research is advocated to support evidence-based recommendations, which we still lack for this increasingly large patient subgroup.
Collapse
Affiliation(s)
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Uppsala University. Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Carla Maria Avesani
- Department of Clinical Science, Technology and Intervention, Division of Renal Medicine and Baxter Novum, Karolinska Institute, Stockholm, Sweden
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Vincenzo Bellizzi
- Nephrology and Dialysis Division - Department of Medical Sciences, Hospital "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Alice Sabatino
- UO Nefrologia, Azienda Ospedaliera- Universitaria Parma, Parma, Italy
| | - Stephane Schneider
- Gastroenterology and Nutrition, Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Massimo Torreggiani
- Néphrologie et dialyse, Centre Hospitalier Le Mans, Avenue Rubillard, 72037, Le Mans, France
| | - Denis Fouque
- Renal Department, Lyon SUD Hospital, Hospices Civils de Lyon, Université de Lyon, Pierre Benite, France
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| |
Collapse
|
5
|
Fleetwood VA, Caliskan Y, Rub FAA, Axelrod D, Lentine KL. Maximizing opportunities for kidney transplantation in older adults. Curr Opin Nephrol Hypertens 2023; 32:204-211. [PMID: 36633323 DOI: 10.1097/mnh.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW To summarize the current state of evidence related to the outcomes of older adults who need and receive kidney transplants, and strategies to facilitate appropriate transplant access in this at-risk group. RECENT FINDINGS Older adults are a rapidly growing subgroup of the kidney transplant waitlist. Compared to younger adults, older kidney transplant recipients have increased mortality after kidney transplant and lower death-censored graft survival. In determining suitability for transplantation in older patients, clinicians must balance procedural and immunosuppression-related risk with incremental survival when compared with dialysis. To appropriately increase access to transplantation in this population, clinicians and policy makers consider candidates' chronological age and frailty, as well as the quality of and waiting time for a donated allograft. Given risk of deterioration prior to transplant, candidates should be rapidly evaluated, listed, and transplanted using living donor and or less than ideal deceased donor organs when available. SUMMARY Access to transplantation for older adults can be increased through targeted interventions to address frailty and reduce waiting times through optimized organ use. Focused study and educational interventions for patients and providers are needed to improve the outcomes of this vulnerable group.
Collapse
Affiliation(s)
- Vidya A Fleetwood
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| | - Yasar Caliskan
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| | - Fadee Abu Al Rub
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| | | | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital
| |
Collapse
|
6
|
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: 13] [Impact Index Per Article: 13.0] [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.
Collapse
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
| |
Collapse
|
7
|
Dos Santos Mantovani M, Coelho de Carvalho N, Ferreira Minicucci M, Gustavo Modelli de Andrade L, de Souza Cavalcante R, Berg de Almeida G, Aline Costa N, de Fátima da Silva J, Augusto Monteiro de Barros Almeida R. Transitions in frailty state 12 months after kidney transplantation: a prospective cohort study. J Nephrol 2022; 35:2341-2349. [PMID: 36048368 DOI: 10.1007/s40620-022-01436-4] [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: 05/24/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frailty is associated with several unfavorable outcomes after kidney transplantation (KTx). However, limited information is available regarding the transitions in frailty state and its components after KTx. This study aimed to evaluate the transitions in physical frailty phenotype and its components over a period of 12 months after KTx. METHODS In this prospective single-center cohort study, we measured physical frailty phenotype (PFP) and its components at the time of admission for KTx and 12 months after KTx. The evaluation includes five components: weakness (grip strength analysed by sex and body mass index quartiles), physical activity (kcals/week based on the Minnesota Leisure Time Physical Activity questionnaire), exhaustion (self-report using the Center for Epidemiological Studies Depression Scale), gait speed (time taken to walk 15 feet based on sex and height-specific cutoff), and unintentional weight loss (self-report of unintentional weight loss > 10 lbs in the last year). The exhaustion and physical activity components are validated in the Brazilian population. Each component is scored as 0 or 1 according to its presence or absence, and a PFP score of 3-5 defines frailty, 2 is intermediate, and 0-1 is rated as non-frail. We used the McNemar and Wilcoxon test to compare physical frailty phenotype and its components between the two periods. RESULTS Among 87 patients included in the study, 16.1% were classified as frail, 20.7% as intermediately frail, and 63.2% as non-frail. Sixty-four patients were included in the analysis to evaluate transitions in frailty. At the time of admission for KTx, 15.6% of patients were defined as frail compared to 4.7% of patients at 12 months after KTx (p = 0.023). Among the physical frailty phenotype components, the proportion of patients who scored in the weight loss category 12 months after KTx was significantly lower than that at the time of KTx (6.3% vs 34.4%, p < 0.001). CONCLUSIONS There was a 69.9% reduction in the prevalence of frail patients at the end of the 12-month follow-up after KTx. Among the components of frailty, weight loss showed a significant improvement.
Collapse
Affiliation(s)
| | | | - Marcos Ferreira Minicucci
- Internal Medicine Department, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | | | - Ricardo de Souza Cavalcante
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Gabriel Berg de Almeida
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Nara Aline Costa
- Faculty of Nutrition, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Julhiany de Fátima da Silva
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | | |
Collapse
|
8
|
van Vliet IMY, Post A, Kremer D, Boslooper-Meulenbelt K, van der Veen Y, de Jong MFC, Pol RA, Jager-Wittenaar H, Navis GJ, Bakker SJL, Gan C, Sanders J, Verschuuren E, Damman K, Lexmond W, Blokzijl J, de Borst M, Erasmus M, Porte R, de Boer M, Pol R, Berger S, Eisenga M, Neto AG, Kremer D, van Londen M, Jong JA, Siebelink M, van Pelt L, Niesters H, Bodewes F, Hepkema B, Ranchor A, Douwes R, Jager‐Wittenaar H, Navis GJ, Bakker SJ. Muscle mass, muscle strength and mortality in kidney transplant recipients: results of the TransplantLines Biobank and Cohort Study. J Cachexia Sarcopenia Muscle 2022; 13:2932-2943. [PMID: 36891995 PMCID: PMC9745460 DOI: 10.1002/jcsm.13070] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/10/2022] [Accepted: 07/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Survival of kidney transplant recipients (KTR) is low compared with the general population. Low muscle mass and muscle strength may contribute to lower survival, but practical measures of muscle status suitable for routine care have not been evaluated for their association with long-term survival and their relation with each other in a large cohort of KTR. METHODS Data of outpatient KTR ≥ 1 year post-transplantation, included in the TransplantLines Biobank and Cohort Study (ClinicalTrials.gov Identifier: NCT03272841), were used. Muscle mass was determined as appendicular skeletal muscle mass indexed for height2 (ASMI) through bio-electrical impedance analysis (BIA), and by 24-h urinary creatinine excretion rate indexed for height2 (CERI). Muscle strength was determined by hand grip strength indexed for height2 (HGSI). Secondary analyses were performed using parameters not indexed for height2. Cox proportional hazards models were used to investigate the associations between muscle mass and muscle strength and all-cause mortality, both in univariable and multivariable models with adjustment for potential confounders, including age, sex, body mass index (BMI), estimated glomerular filtration rate (eGFR) and proteinuria. RESULTS We included 741 KTR (62% male, age 55 ± 13 years, BMI 27.3 ± 4.6 kg/m2), of which 62 (8%) died during a median [interquartile range] follow-up of 3.0 [2.3-5.7] years. Compared with patients who survived, patients who died had similar ASMI (7.0 ± 1.0 vs. 7.0 ± 1.0 kg/m2; P = 0.57), lower CERI (4.2 ± 1.1 vs. 3.5 ± 0.9 mmol/24 h/m2; P < 0.001) and lower HGSI (12.6 ± 3.3 vs. 10.4 ± 2.8 kg/m2; P < 0.001). We observed no association between ASMI and all-cause mortality (HR 0.93 per SD increase; 95% confidence interval [CI] [0.72, 1.19]; P = 0.54), whereas CERI and HGSI were significantly associated with mortality, independent of potential confounders (HR 0.57 per SD increase; 95% CI [0.44, 0.81]; P = 0.002 and HR 0.47 per SD increase; 95% CI [0.33, 0.68]; P < 0.001, respectively), and associations of CERI and HGSI with mortality remained independent of each other (HR 0.68 per SD increase; 95% CI [0.47, 0.98]; P = 0.04 and HR 0.53 per SD increase; 95% CI [0.36, 0.76]; P = 0.001, respectively). Similar associations were found for unindexed parameters. CONCLUSIONS Higher muscle mass assessed by creatinine excretion rate and higher muscle strength assessed by hand grip strength are complementary in their association with lower risk of all-cause mortality in KTR. Muscle mass assessed by BIA is not associated with mortality. Routine assessment using both 24-h urine samples and hand grip strength is recommended, to potentially target interdisciplinary interventions for KTR at risk for poor survival to improve muscle status.
Collapse
Affiliation(s)
- Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrian Post
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Boslooper-Meulenbelt
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne van der Veen
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research Group Healthy Ageing, Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C.T. Gan
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - J.S.F. Sanders
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - E.A.M. Verschuuren
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - K. Damman
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - W.S. Lexmond
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - J. Blokzijl
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.H. de Borst
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.E. Erasmus
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - R.J. Porte
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.T. de Boer
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - R.A. Pol
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - S.P. Berger
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.F. Eisenga
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - A.W. Gomes Neto
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - D. Kremer
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M. van Londen
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - J.H. Annema‐de Jong
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.J. Siebelink
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - L.J. van Pelt
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - H.G.M. Niesters
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - F.A.J.A. Bodewes
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - B.G. Hepkema
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - A.V. Ranchor
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - R.M. Douwes
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Harriët Jager‐Wittenaar
- Department of Oral and Maxillofacial Surgery University of Groningen, University Medical Center Groningen Groningen The Netherlands
- Research Group Healthy Ageing, Health Care and Nursing Hanze University of Applied Sciences Groningen The Netherlands
| | - Gerjan J. Navis
- Department of Internal Medicine, Division of Nephrology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | | |
Collapse
|
9
|
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: 0] [Impact Index Per Article: 0] [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.
Collapse
|
10
|
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.
Collapse
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;
| |
Collapse
|
11
|
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: 4] [Impact Index Per Article: 1.3] [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.
Collapse
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
| |
Collapse
|
12
|
Wallengren O, Bosaeus I, Frändin K, Lissner L, Falk Erhag H, Wetterberg H, Rydberg Sterner T, Rydén L, Rothenberg E, Skoog I. Comparison of the 2010 and 2019 diagnostic criteria for sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP) in two cohorts of Swedish older adults. BMC Geriatr 2021; 21:600. [PMID: 34702174 PMCID: PMC8547086 DOI: 10.1186/s12877-021-02533-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background The operational definition of sarcopenia has been updated (EWGSOP2) and apply different cut-off points compared to previous criteria (EWGSOP1). Therefore, we aim to compare the sarcopenia prevalence and the association with mortality and dependence in activities of daily living using the 2010 (EWGSOP1 and 2019 (EWGSOP2 operational definition, applying cut-offs at two levels using T-scores. Methods Two birth cohorts, 70 and 85-years-old (n = 884 and n = 157, respectively), were assessed cross-sectionally (57% women). Low grip strength, low muscle mass and slow gait speed were defined below − 2.0 and − 2.5 SD from a young reference population (T-score). Muscle mass was defined as appendicular lean soft tissue index by DXA. The EWGSOP1 and EWGSOP2 were applied and compared with McNemar tests and Cohen’s kappa. All-cause mortality was analyzed with the Cox-proportional hazard model. Results Sarcopenia prevalence was 1.4–7.8% in 70-year-olds and 42–62% in 85 years-old’s, depending on diagnostic criteria. Overall, the prevalence of sarcopenia was 0.9–1.0 percentage points lower using the EWGSOP2 compared to EWGSOP1 when applying uniform T-score cut-offs (P < 0.005). The prevalence was doubled (15.0 vs. 7.5%) using the − 2.0 vs. -2.5 T-scores with EWGSOP2 in the whole sample. The increase in prevalence when changing the cut-offs was 5.7% (P < 0.001) in the 70-year-olds and 17.8% (P < 0.001) in the 85-year-olds (EWGSP2). Sarcopenia with cut-offs at − 2.5 T-score was associated with increased mortality (hazard ratio 2.4–2.8, P < 0.05) but not at T-score − 2.0. Conclusions The prevalence of sarcopenia was higher in 85-year-olds compared to 70-year-olds. Overall, the differences between the EWGSOP1 and EWGSOP2 classifications are small. Meaningful differences between EWGSOP1 and 2 in the 85-year-olds could not be ruled out. Prevalence was more dependent on cut-offs than on the operational definition. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02533-y.
Collapse
Affiliation(s)
- Ola Wallengren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Clinical Nutrition Unit, Sahlgrenska University hospital, Gothenburg, Sweden.
| | - Ingvar Bosaeus
- Clinical Nutrition Unit, Sahlgrenska University hospital, Gothenburg, Sweden
| | - Kerstin Frändin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Falk Erhag
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Hanna Wetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Therese Rydberg Sterner
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Lina Rydén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | | | - Ingmar Skoog
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Mediterranean Diet Adherence and Nutritional Status in Dalmatian Kidney Transplant Recipients-Are They Related? Nutrients 2021; 13:nu13093246. [PMID: 34579123 PMCID: PMC8471203 DOI: 10.3390/nu13093246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to evaluate adherence to Mediterranean diet (MeDi) and possible correlation of MeDi adherence and nutritional status parameters in Dalmatian kidney transplant recipients (KTRs). One hundred and sixteen KTRs were included in this study. Data about Mediterranean Diet Serving Score (MDSS), body mass composition, anthropometric parameters, clinical and laboratory parameters were collected for each study participant. The results showed 25% adherence to the MeDi in Dalmatian KTRs. MDSS showed association with higher serum albumin and phosphorus level and higher skeletal muscle mass. Also, significant association between diabetic status and MDSS was found. Adherence to olive oil intake suggested by the MeDi showed significant association with lower level of triglycerides and adherence to nuts suggestions was associated with lower level of fat mass. Following MeDi recommendations for consumption of other foods (cereals, potato, eggs, vegetables, fruits and dairy) were also associated with body mass composition parameters and laboratory findings. In conclusion, low adherence to the MeDi in Dalmatian KTRs raises high concerns. The results showed that MeDi can have favorable effects on nutritional status in KTRs. A structured nutritional approach is needed to enhance adherence to the MeDi and prevent possible adverse effects in this patient population.
Collapse
|
15
|
Ryu H, Yang YJ, Kang E, Ahn C, Yang SJ, Oh KH. Greater adherence to the dietary approaches to stop hypertension dietary pattern is associated with preserved muscle strength in patients with autosomal dominant polycystic kidney disease: a single-center cross-sectional study. Nutr Res 2021; 93:99-110. [PMID: 34461351 DOI: 10.1016/j.nutres.2021.07.006] [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: 05/07/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
The present study aimed to determine whether certain diets lower the risk of low muscle strength in patients with autosomal dominant polycystic kidney disease (ADPKD). In this cross-sectional study, outpatient ADPKD patients were enrolled from a tertiary care hospital. Muscle strength was assessed on the basis of handgrip strength (HGS), and dietary pattern indices were calculated using dietary intake data. Among the 68 participants included in this study, 19 (27.9%) had low HGS. Cystatin C concentrations were significantly higher in all participants, and in women in the low compared to the normal HGS group in the unadjusted analyses (P = 0.004). Among analyzed dietary pattern indices, the Dietary Approaches to Stop Hypertension (DASH) score was lower, for all participants and men, in the low compared to the normal HGS group (P < 0.05). Especially, the component score for whole grains of the DASH score was significantly lower in men in the low compared to the normal HGS group in unadjusted analyses. The DASH score was positively correlated with HGS in men (r = 0.387, P = 0.046). In addition, logistic regression analysis showed that the DASH score was negatively associated with low HGS, for all participants (odds ratio = 0.851, P = 0.049) and men (odds ratio = 0.716, P = 0.043), after adjusting for age, sex, and body weight. These findings suggest that the DASH dietary pattern may promote the preservation of muscle strength in ADPKD patients. The DASH diet can be considered as a nutritional strategy to maintain muscle strength and prevent sarcopenia in ADPKD patients.
Collapse
Affiliation(s)
- Hyunjin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Yun Jung Yang
- Department of Food and Nutrition, Seoul Women's University, Seoul, 01797, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, National Medical Center, Seoul, 04564, Republic of Korea
| | - Soo Jin Yang
- Department of Food and Nutrition, Seoul Women's University, Seoul, 01797, Republic of Korea.
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| |
Collapse
|
16
|
Rakusa M, Poglajen G, Vrtovec B, Goricar K, Janez A, Jensterle M. Factors associated with degraded trabecular bone score in heart transplant recipients. Clin Transplant 2021; 35:e14274. [PMID: 33675551 DOI: 10.1111/ctr.14274] [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: 10/24/2020] [Revised: 02/07/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
Trabecular bone score (TBS) is a textural index that provides indirect evaluation of trabecular microarchitecture. It improves fracture risk assessment in several high-risk populations. We aimed to evaluate the role of TBS assessment in heart transplant recipients (HTR). In a cross-sectional study with 87 HTR (69 males and 18 females), we assessed TBS and evaluated potential associations between TBS and factors related to increased fracture risk. We also evaluated the correlations between the presence of vertebral fractures (VF) and degraded TBS. We confirmed degraded TBS in the majority of HTR. 27.6% of HTR had partially degraded, 27.6% had degraded TBS. HTR with degraded TBS were older, had higher body mass index, lower bone mineral density (BMD), and T-score. As opposed to stable BMD over different time points, TBS significantly differed among different post-transplant time periods. TBS did not correlate with current methylprednisolone or past zoledronic acid treatment, presence of hypogonadism or diabetes. TBS did not have additional value over BMD in predicting the presence of VF. Most fractures occurred in patients with osteopenia and in patients with partly degraded TBS. Studies with longitudinal designs and larger sample sizes are warranted to further assess the potential role of TBS in HRT.
Collapse
Affiliation(s)
- Matej Rakusa
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gregor Poglajen
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Advanced Heart Failure and Transplantation Programme, Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Bojan Vrtovec
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Advanced Heart Failure and Transplantation Programme, Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katja Goricar
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Jensterle
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
17
|
De Smet S, Van Craenenbroeck AH. Exercise training in patients after kidney transplantation. Clin Kidney J 2021; 14:ii15-ii24. [PMID: 33981416 PMCID: PMC8101622 DOI: 10.1093/ckj/sfab022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Next to the risk of allograft failure, major obstacles for disease-free survival after kidney transplantation include a higher incidence of cancer, infection and cardiovascular events. Risk factors for adverse clinical outcomes include pre-existent comorbidities, the introduction of an immunodeficient status and (lack of) lifestyle changes after transplantation. Indeed, physical inactivity and poor physical fitness are important targets to address in order to improve clinical outcomes after kidney transplantation. This review summarizes the current evidence on exercise training after kidney transplantation, derived from randomized controlled trials. As much as possible, results are discussed in the perspective of the Standardized Outcomes in Nephrology-Transplantation core outcomes, which were recently described as critically important outcome domains for trials in kidney transplant recipients.
Collapse
Affiliation(s)
- Stefan De Smet
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
18
|
Physical Function in Kidney Transplantation: Current Knowledge and Future Directions. CURRENT TRANSPLANTATION REPORTS 2021; 7:46-55. [PMID: 33457184 DOI: 10.1007/s40472-020-00271-5] [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] [Indexed: 02/07/2023]
Abstract
Purpose of review Low physical function (PF) is common among individuals with end-stage kidney disease. In this review, we explore data on the impacts of PF on access to kidney transplantation (KT) and KT outcomes. We also discuss the latest interventions to improve PF in pre- and post-KT settings. Recent Findings Many US KT programs measure PF or related constructs when assessing KT candidacy. Although carefully selected KT candidates with low PF can benefit from KT with respect to survival and quality of life, low PF decreases the likelihood of being listed for KT and increases the risk of adverse post-KT outcomes. Recent trials suggest that exercise is a promising strategy to improve PF among KT candidates and recipients. Summary PF is a potentially modifiable risk factor for adverse pre- and post-KT outcomes. Research is needed to determine the ideal PF metric for use in KT evaluations and interventions to improve PF.
Collapse
|
19
|
Bellafronte NT, Sizoto GR, Vega-Piris L, Chiarello PG, Cuadrado GB. Bed-side measures for diagnosis of low muscle mass, sarcopenia, obesity, and sarcopenic obesity in patients with chronic kidney disease under non-dialysis-dependent, dialysis dependent and kidney transplant therapy. PLoS One 2020; 15:e0242671. [PMID: 33216775 PMCID: PMC7679152 DOI: 10.1371/journal.pone.0242671] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/08/2020] [Indexed: 01/22/2023] Open
Abstract
Muscle depletion and sarcopenic obesity are related to a higher morbimortality risk in chronic kidney disease (CKD). We evaluated bed-side measures/indexes associated with low muscle mass, sarcopenia, obesity, and sarcopenic obesity in CKD and proposed cutoffs for each parameter. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People revised consensus applying dual energy X-ray absorptiometry (DXA) and hand grip strength (HGS), and obesity according to the International Society for Clinical Densitometry. Anthropometric parameters including calf (CC) and waist (WC) circumferences and WC/height (WC/H); bioelectrical impedance data including appendicular fat free mass (AFFM) and fat mass index (FMI) were assessed. ROC analysis and area under the curve (AUC) were applied for performance analyses. AFFM and CC presented the best performances for low muscle mass diagnosis-AFFM AUC for women was 0.96 and for men, 0.94, and CC AUC for women was 0.89 and for men, 0.85. FMI and WC/H were the best parameters for obesity diagnosis-FMI AUC for women was 0.99 and for men, 0.96, and WC/H AUC for women was 0.94 and for men, 0.95. The cutoffs (sensibility and specificity, respectively) for women were AFFM≤15.87 (90%; 96%), CC≤35.5 (76%; 94%), FMI>12.58 (100%; 93%), and WC/H>0.66 (91%; 84%); and for men, AFFM≤21.43 (98%; 84%), CC≤37 (88%; 69%), FMI>8.82 (93%; 88%), and WC/H>0.60 (95%; 80%). Sensibility and specificity for sarcopenia diagnosis were for AFFM+HGS in women 85% and 99% and in men, 100% and 99%; for CC+HGS in women 85% and 99% and in men, 100% and 100%; and for sarcopenic obesity were for FMI+AFFM in women 75% and 97% and in men, 75% and 95%. The tested bed-side measures/indexes presented excellent performance.
Collapse
Affiliation(s)
- Natália Tomborelli Bellafronte
- Post-Graduate Program in Health Sciences, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Gabriel Ruiz Sizoto
- Nutrition and Metabolism Undergraduate Course, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, 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, São Paulo, Brazil
| | | |
Collapse
|
20
|
Bullo V, Roma E, Gobbo S, Duregon F, Bergamo M, Bianchini G, Doria E, Cugusi L, di Blasio A, Bocalini DS, Ermolao A, Bergamin M. Lower Limb Strength Profile in Elderly with Different Pathologies: Comparisons with Healthy Subjects. Geriatrics (Basel) 2020; 5:geriatrics5040083. [PMID: 33105620 PMCID: PMC7709664 DOI: 10.3390/geriatrics5040083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/25/2022] Open
Abstract
Sarcopenia and muscle strength reduction are a frequent disorder in non-communicable chronic diseases. The aims of this study are: (a) to verify if the absolute and relative to body weight muscle strength of lower limb is affected by the presence of pathology; (b) to verify if the trends are different among knee and ankles joints. One-hundred and forty-five elderly were recruited (16 liver transplant recipients, 48 kidney transplant recipients, 52 elderly with obesity, 30 healthy elderly). Muscular strength of lower limb was evaluated. Evaluation protocol included maximal isometric knee extension, maximal isokinetic knee extension and flexion, maximal isokinetic ankle (both right and left) extension and flexion. A statistically significant interaction between measurement and group membership was found for absolute strength measure (F (4.23, 170.56) = 3.316, p = 0.011, partial η2 (η2p) = 0.076), and relative strength measure(F (4.44, 174.72) = 16.407, p < 0.01, partial η2 (η2p) = 0.294). Elderly patients living with kidney transplants showed the lower level of absolute muscular strength, while relative muscular strength is mainly lacking in the elderly with obesity. The strength profile of elderly subjects is affected by obesity, liver transplantation, and kidney transplantation.
Collapse
Affiliation(s)
- Valentina Bullo
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2-35128 Padova, Italy; (V.B.); (E.R.); (F.D.); (M.B.); (A.E.); (M.B.)
| | - Enrico Roma
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2-35128 Padova, Italy; (V.B.); (E.R.); (F.D.); (M.B.); (A.E.); (M.B.)
| | - Stefano Gobbo
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2-35128 Padova, Italy; (V.B.); (E.R.); (F.D.); (M.B.); (A.E.); (M.B.)
- Correspondence: ; Tel.: +39-049-8277455
| | - Federica Duregon
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2-35128 Padova, Italy; (V.B.); (E.R.); (F.D.); (M.B.); (A.E.); (M.B.)
| | - Manuele Bergamo
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2-35128 Padova, Italy; (V.B.); (E.R.); (F.D.); (M.B.); (A.E.); (M.B.)
| | - Gioia Bianchini
- GymHub S.r.l., Spin-off of the University of Padova, Via O. Galante 67/a, 35129 Padova, Italy; (G.B.); (E.D.)
| | - Eleonora Doria
- GymHub S.r.l., Spin-off of the University of Padova, Via O. Galante 67/a, 35129 Padova, Italy; (G.B.); (E.D.)
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Andrea di Blasio
- Department of Medicine and Sciences of Aging, G. d’Annunzio University of Chieti-Pescara, Via dei Vestini, 31-66100 Chieti, Italy;
| | - Danilo Sales Bocalini
- Laboratorio de Fisiologia e Bioquimica Experimental, Centro de Educacao Fisica e Deportos, Universidade Federal do Espirito Santo (UFES), Vitoria, ES, Rua Vergueiro, 235, Liberdade, Sao Paulo, SP 01504-00, Brazil;
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2-35128 Padova, Italy; (V.B.); (E.R.); (F.D.); (M.B.); (A.E.); (M.B.)
| | - Marco Bergamin
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2-35128 Padova, Italy; (V.B.); (E.R.); (F.D.); (M.B.); (A.E.); (M.B.)
| |
Collapse
|
21
|
Sabatino A, Cuppari L, Stenvinkel P, Lindholm B, Avesani CM. Sarcopenia in chronic kidney disease: what have we learned so far? J Nephrol 2020; 34:1347-1372. [PMID: 32876940 PMCID: PMC8357704 DOI: 10.1007/s40620-020-00840-y] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
The term sarcopenia was first introduced in 1988 by Irwin Rosenberg to define a condition of muscle loss that occurs in the elderly. Since then, a broader definition comprising not only loss of muscle mass, but also loss of muscle strength and low physical performance due to ageing or other conditions, was developed and published in consensus papers from geriatric societies. Sarcopenia was proposed to be diagnosed based on operational criteria using two components of muscle abnormalities, low muscle mass and low muscle function. This brought awareness of an important nutritional derangement with adverse outcomes for the overall health. In parallel, many studies in patients with chronic kidney disease (CKD) have shown that sarcopenia is a prevalent condition, mainly among patients with end stage kidney disease (ESKD) on hemodialysis (HD). In CKD, sarcopenia is not necessarily age-related as it occurs as a result of the accelerated protein catabolism from the disease and from the dialysis procedure per se combined with low energy and protein intakes. Observational studies showed that sarcopenia and especially low muscle strength is associated with worse clinical outcomes, including worse quality of life (QoL) and higher hospitalization and mortality rates. This review aims to discuss the differences in conceptual definition of sarcopenia in the elderly and in CKD, as well as to describe etiology of sarcopenia, prevalence, outcome, and interventions that attempted to reverse the loss of muscle mass, strength and mobility in CKD and ESKD patients.
Collapse
Affiliation(s)
- Alice Sabatino
- Division of Nephrology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lilian Cuppari
- Division of Nephrology, Federal University of São Paulo and Oswaldo Ramos Foundation, São Paulo, Brazil
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden
| | - Carla Maria Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden.
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| |
Collapse
|
22
|
de Almeida MM, Dias-Rocha CP, Reis-Gomes CF, Wang H, Cordeiro A, Pazos-Moura CC, Joss-Moore L, Trevenzoli IH. Maternal high-fat diet up-regulates type-1 cannabinoid receptor with estrogen signaling changes in a sex- and depot- specific manner in white adipose tissue of adult rat offspring. Eur J Nutr 2020; 60:1313-1326. [PMID: 32671459 DOI: 10.1007/s00394-020-02318-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Obesity and high-fat (HF) diet are associated with over activation of the endocannabinoid system (ECS). We have demonstrated that maternal HF diet induces early obesity and modulates cannabinoid signaling in visceral (VIS) and subcutaneous (SUB) white adipose tissue (WAT) in weanling rat offspring. We hypothesized that perinatal maternal HF diet would program the expression of ECS in adipose tissue in a long-term way in parallel to alterations in epigenetic markers and sex hormone signaling. METHODS Progenitor female rats received control diet (C, 9% fat) or isocaloric high-fat diet (HF, 28% fat) for 8 weeks before mating, gestation, and lactation. All pups were weaned to C diet and they were euthanized at 180 days old. RESULTS Maternal HF diet induced overweight and increased SUB WAT mass of male and female adult offspring. Maternal HF diet induced hypertrophy of VIS and SUB adipocytes only in female offspring associated with increased type 1 cannabinoid receptor protein (CB1) and mRNA (Cnr1) levels. These changes were associated with increased estrogen receptor α binding to Cnr1 promoter in SUB WAT of adult female offspring, which may contribute to higher expression of Cnr1. CONCLUSION Increased CB1 signaling in adipose tissue might contribute to higher adiposity programmed by maternal HF diet because endocannabinoids stimulate the accumulation of fat in the adipose tissue. Our findings provide molecular insights into sex-specific targets for anti-obesity therapies based on the endocannabinoid system.
Collapse
Affiliation(s)
- Mariana Macedo de Almeida
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. .,Laboratory of Molecular Endocrinology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Rio de Janeiro, 21941-902, Brazil.
| | - Camilla P Dias-Rocha
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Clara F Reis-Gomes
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Haimei Wang
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Aline Cordeiro
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Carmen C Pazos-Moura
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lisa Joss-Moore
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Isis H Trevenzoli
- Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|