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.
The prevalence of sarcopenia on elderly maintenance hemodialysis (MHD) has been scarcely investigated.
Objectives
To investigate the prevalence of decreased muscle mass and strength alone or combined ...(true sarcopenia) in elderly patients on MHD according to different methods and cutoff limits. Additionally, we evaluated the agreement between dual energy x-ray absorptiometry (DXA) and surrogate methods for the assessment of muscle mass.
Design
Observational and cross-sectional study.
Participants
Non-institutionalized 102 elderly (age > 60 years) patients on MHD.
Measurements
Sarcopenia was considered when the patient fit one criteria for low muscle mass assessed by DXA, bioelectrical impedance (BIA), sum of skinfold thicknesses (SKF), calf circumference and mid-arm muscle circumference (MAMC) and one for low muscle strength evaluated by handgrip dynamometer.
Results
Decreased muscle strength was found in 85% of the patients. The prevalence of decreased muscle mass varied from 4 to 73.5% and of sarcopenia (decreased muscle mass and strength combined) from 4 to 63%, depending on the method and cutoff limit applied. A small percentage of patients (2 to 15%) were classified as sarcopenic by more than one diagnostic criteria. The agreement between DXA and the surrogate methods to assess muscle mass showed better kappa coefficients with BIA (r=0.36; P<0.01) and SKF (r=0.40; P<0.01).
Conclusion
A wide prevalence of sarcopenia is observed depending on the method and cutoff limit applied. This may limit extrapolate on to clinical practice. BIA and SKF were the surrogate methods to assess muscle mass with the best concordance with DXA in elderly MHD patients.
•In older adults on MHD, nutritional markers indicating PEW varied from 6.9 to 59.5% depending on the method applied.•Worse nutritional status increased hospitalization events and mortality ...rates.•Among the methods tested, SGA, MIS, BMI, GNRI and calf circumference predicted worse outcomes in older adults on MHD.•SGA and MIS stand out as the strongest predictors of hospitalization and mortality.
The aim of this study was to investigate nutritional status in older patients undergoing maintenance hemodialysis (MHD) to determine the prevalence of nutritional markers indicating protein-energy wasting (PEW) as assessed by subjective global assessment (SGA) and other methods, and to explore which nutritional markers can best predict clinical outcomes.
The study included 173 patients (median age 69 y; 65% men; 38% diabetes) undergoing MHD for >3 mo. Nutritional markers included SGA, malnutrition-inflammation score (MIS), geriatric nutritional risk index (GNRI), handgrip strength (HGS), midarm muscle circumference (MAMC), triceps skinfold thickness (SKF), calf circumference, and albumin. Associations between PEW (diagnosed by different measures and thresholds) and risk for hospitalization (by Poisson regression) and all-cause mortality (by Cox proportional hazards model) were analyzed.
Depending on methods and thresholds used, the prevalence of nutritional markers indicatingPEW varied from 6.9% to 59.5%. In the Poisson models adjusted for age, sex, dialysis length, and diabetes, low SGA, HGS, albumin, and high MIS score were associated with high hospitalization events, whereas in the bivariate Cox regression models adjusted for the same variables, low SGA, GNRI, BMI, calf circumference, and high MIS score were associated with high hazard ratio (HR) for mortality. In addition, in the multivariate models, SGA showed the strongest association with mortality (HR, 2.32; 95% confidence interval CI, 1.27–4.24) and together with MIS (HR, 2.09; 95% CI, 1.20–3.64), the highest values of C-statistics.
Among older MHD patients, the prevalence of nutritional markers indicating PEW varies substantially depending on methods applied. SGA, MIS, BMI, GNRI, calf circumference, and HGS predicted worse outcomes. SGA and MIS showed the strongest association with hospitalization and mortality risk in the adjusted models.
We analyzed the dietary patterns of Brazilian individuals with a self-declared diagnosis of chronic kidney disease (CKD) and explored associations with treatment modality.
Weekly consumption of 14 ...food intake markers was analyzed in 839 individuals from the 2013 Brazil National Health Survey with a self-declared diagnosis of CKD undergoing nondialysis (
= 480), dialysis (
= 48), or renal transplant (
= 17) treatment or no CKD treatment (
= 294). Dietary patterns were derived by exploratory factor analysis of food intake groups. Multiple linear regression models, adjusted by sociodemographic and geographical variables, were used to evaluate possible differences in dietary pattern scores between different CKD treatment groups.
Two food patterns were identified: an "Unhealthy" pattern (red meat, sweet sugar beverages, alcoholic beverages, and sweets and a negative loading of chicken, excessive salt, and fish) and a "Healthy" pattern (raw and cooked vegetables, fruits, fresh fruit juice, and milk). The Unhealthy pattern was inversely associated with nondialysis and dialysis treatment (β: -0.20 (95% CI: -0.33; -0.06) and β: -0.80 (-1.16; -0.45), respectively) and the Healthy pattern was positively associated with renal transplant treatment (β: 0.32 (0.03; 0.62)).
Two dietary patterns were identified in Brazilian CKD individuals and these patterns were linked to CKD treatment modality.
The chronic kidney disease (CKD) population is aging. Currently a high percentage of patients treated on dialysis are older than 65 years. As patients get older, several conditions contribute to the ...development of malnutrition, namely protein energy wasting (PEW), which may be compounded by nutritional disturbances associated with CKD and from the dialysis procedure. Therefore, elderly patients on dialysis are vulnerable to the development of PEW and awareness of the identification and subsequent management of nutritional status is of importance. In clinical practice, the nutritional assessment of patients on dialysis usually includes methods to assess PEW, such as the subjective global assessment, the malnutrition inflammation score, and anthropometric and laboratory parameters. Studies investigating measures of nutritional status specifically tailored to the elderly on dialysis are scarce. Therefore, the same methods and cutoffs used for the general adult population on dialysis are applied to the elderly. Considering this scenario, the aim of this review is to discuss specific considerations for nutritional assessment of elderly patients on dialysis addressing specific shortcomings on the interpretation of markers, in addition to providing clinical practice guidance to assess the nutritional status of elderly patients on dialysis.
Summary Background & aims Studies assessing the performance of 7-point subjective global assessment (7p-SGA) and malnutrition inflammation score (MIS) to assess longitudinal changes in nutritional ...status are lacking. Thus, we aimed to investigate whether longitudinal changes in 7p-SGA and MIS were associated with changes in objective parameters of nutritional status, as well as to evaluate the prognostic value of 7p-SGA and MIS on hospitalization events. Methods One hundred and four patients aged ≥60 years (70.2% male, age: 70.9 ± 6.9 years) on maintenance hemodialysis were studied. The 7p-SGA, MIS and objective parameters of nutritional status (anthropometrics, muscle strength, body cell mass and phase angle assessed by bioelectrical impedance analysis – BIA, albumin, creatinine and C-reactive protein) were assessed at baseline and 12 months after the enrollment. Follow-up for hospitalization events were carried out at 13.0 (interquartile range: 3.0; 21.0) months after the first year of enrollment. Results Analysis of repeated measures, stratified by gender, and adjusted for age and dialysis vintage, showed that for men, a 1-unit change in 7p-SGA was significantly associated (P < 0.05) with changes in all anthropometrics, muscle strength and BIA parameters. For women, changes in 7p-SGA were associated with most of the anthropometrics, muscle strength and BIA parameters. Similarly, for both genders, changes in MIS were associated with changes in most anthropometric, muscle strength, BIA measurements, albumin (only for men), and creatinine (only for women). In addition, when assessed by 7p-SGA, patients with a declining nutritional status had a higher relative risk (RR) of hospitalization events RR: 2.08 (95 CI: 1.44–2.99; p < 0.001) and length of hospital stay (days) RR: 3.73 (95 CI: 3.29–4.22; p < 0.001). Conclusions Longitudinal changes in 7p-SGA and MIS were associated with changes in most of the objective parameters tested during 12 months of follow-up. Furthermore, a declining 7p-SGA score predicted a greater number of hospitalization events and days of hospital stay.
Aim:
Sarcopenia and malnutrition are highly prevalent in older adults undergoing hemodialysis (HD) and are associated with negative outcomes. This study aimed to evaluate the role of sarcopenia and ...malnutrition combined on the nutritional markers, quality of life, and survival in a cohort of older adults on chronic HD.
Methods:
This was an observational, longitudinal, and multicenter study including 170 patients on HD aged >60 years. Nutritional status was assessed by 7-point-subjective global assessment (7p-SGA), body composition (anthropometry and bioelectrical impedance), and appendicular skeletal muscle mass (Baumgartner's prediction equation). Quality of life was assessed by KDQoL-SF. The cutoffs for low muscle mass and low muscle strength established by the 2019 European Working group on sarcopenia for Older People (EWGSOP) were used for the diagnosis of sarcopenia. Individuals with a 7p-SGA score ≤5 were considered malnourished, individuals with low strength or low muscle mass were pre-sarcopenic, and those with low muscle mass and low muscle strength combined as sarcopenic. The sample was divided into four groups: sarcopenia and malnutrition; sarcopenia and no-malnutrition; no-sarcopenia with malnutrition; and no-sarcopenia and no-malnutrition. Follow-up for survival lasted 23.5 (12.2; 34.4) months.
Results:
Pre-sarcopenia, sarcopenia, and malnutrition were present in 35.3, 14.1, and 58.8% of the patients, respectively. The frequency of malnutrition in the group of patients with sarcopenia was not significantly higher than in the patients without sarcopenia (66.7 vs. 51.2%;
p
= 0.12). When comparing groups according to the occurrence of sarcopenia and malnutrition, the sarcopenia and malnutrition group were older and presented significantly lower BMI, calf circumference, body fat, phase angle, body cell mass, and mid-arm muscle circumference. In the survival analysis, the group with sarcopenia and malnutrition showed a higher hazard ratio 2.99 (95% CI: 1.23: 7.25) for mortality when compared to a group with no-sarcopenia and no-malnutrition.
Conclusion:
Older adults on HD with sarcopenia and malnutrition combined showed worse nutritional parameters, quality of life, and higher mortality risk. In addition, malnutrition can be present even in patients without sarcopenia. These findings highlight the importance of complete nutritional assessment in patients on dialysis.
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