Sarcopenia is a risk factor for adverse clinical outcomes in chronic kidney disease (CKD) patients, including mortality. Diagnosis depends on adopted consensus definition and cutoff values; thus, ...prevalence rates are generally heterogeneous. We conducted a systematic review and meta‐analysis to investigate the global prevalence of sarcopenia and its traits across the wide spectrum of CKD. A systematic search was conducted using databases, including MEDLINE and EMBASE, for observational studies reporting the prevalence of sarcopenia. We considered sarcopenia according to the consensus definition of the European Working Group on Sarcopenia in Older People (EWGSOP), the Asian Working Group for Sarcopenia, the Foundation for the National Institutes of Health Sarcopenia Project, and the International Working Group on Sarcopenia (IWGS). Subgroup analyses by CKD stages, consensus, and gender were performed. Pooled prevalence was obtained from random‐effect models. A total of 140 studies (42 041 patients) across 25 countries were included in this systematic review and meta‐analyses. Global prevalence of sarcopenia was 24.5% 95% confidence interval (CI): 20.9–28.3) and did not differ among stages (P = 0.33). Prevalence varied according to the consensus definition from 11% to 30%, with no significant difference (P = 0.42). Prevalence of severe sarcopenia was 21.0% (95% CI: 11.7–32.0), with higher rates for patients on dialysis (26.2%, 95% CI: 16.6–37.1) compared to non‐dialysis (3.0%, 95% CI: 0–11.1; P < 0.01). Sarcopenic obesity was observed in 10.8% (95% CI: 3.5–21.2). Regarding sarcopenia traits, low muscle strength was found in 43.4% (95%CI: 35.0–51.9), low muscle mass in 29.1% (95% CI: 23.9–34.5), and low physical performance in 38.6 (95% CI: 30.9–46.6) for overall CKD. Prevalence was only higher in patients on dialysis (50.0%, 95% CI: 41.7–57.4) compared to non‐dialysis (19.6%, 95% CI: 12.8–27.3; P < 0.01) for low muscle strength. We found a high global prevalence of sarcopenia in the wide spectrum of CKD. Low muscle strength, the primary sarcopenia trait, was found in almost half of the overall population with CKD. Patients on dialysis were more prevalent to low muscle strength and severe sarcopenia. Nephrology professionals should be aware of regularly assessing sarcopenia and its traits in patients with CKD, especially those on dialysis.
The prevalence of low bone mineral density (LBMD) in people with chronic kidney disease (CKD) remains unknown. We identified a high prevalence of LBMD in CKD population. Thus, public health ...strategies should include efforts to prevent, early detect, and manage LBMD in CKD patients, especially in patients undergoing kidney replacement therapy. Mineral and bone disorders are common among patients with CKD, which affects bone mineral density. We conducted a systematic review and meta-analysis to estimate the prevalence of low bone mineral density (LBMD) in adults with CKD. We searched MEDLINE, EMBASE, Web of Science, CINAHL, and LILACS databases from inception to February 2021. Observational studies that reported the prevalence of LBMD in adults with CKD stages 3a–5D were included. The LBMD was defined according to the World Health Organization criterion (T-score ≤ − 2.5). Random-effect model meta-analyses were used to estimate the pooled prevalence of LBMD. Meta-regressions and subgroup analyses were conducted for stages of CKD, dialysis modality, gender, bone sites and morphology, and geographical region. This study was registered in PROSPERO, number CRD42020211077. One-hundred and fifty-three studies with 78,092 patients were included. The pooled global prevalence of LBMD in CKD was 24.5% (95% CI, 21.3 − 27.8%). Subgroup analyses indicated a higher prevalence of LBMD in dialysis patients (30%, 95% CI 25 − 35%) compared with non-dialysis CKD patients (12%, 95% CI 8 − 16%), cortical bone sites (28%, 95% CI 23 − 35%) relative to trabecular sites (19%, 95% CI 14 − 24%), while similar estimates in the European and the Asiatic continents (26%, 95% CI 21 − 30% vs 25%, 95% CI 21 − 29). The prevalence of LBMD in CKD patients is high, particularly in those undergoing dialysis and in cortical bone sites. Therefore, efforts to early diagnosis and management strategies should be implemented in clinical routine for an epidemiological control of LBMD in CKD patients.
Background
The SARC‐F questionnaire assesses sarcopenia risk. The addition of a calf circumference measurement, known as SARC‐CalF, has been recently proposed. We investigated possible associations ...of SARC‐F and SARC‐CalF with sarcopenia traits in patients undergoing hemodialysis.
Methods
Thirty patients (17 men; 57 ± 15 years) were enrolled. Sarcopenia risk was assessed by SARC‐F (≥4) and SARC‐CalF (≥11). Probable (low muscle strength or low skeletal muscle mass SMM) and confirmed (both) sarcopenia were diagnosed as recommended by the revised European Working Group on Sarcopenia in Older People. Muscle strength was assessed by handgrip strength (HGS) and five‐time sit‐to‐stand test (STS‐5), and physical performance was evaluated by gait speed. SMM was assessed by bioelectrical impedance.
Results
Sarcopenia risk by the SARC‐F and SARC‐CalF were found in 23% (n = 7) and 40% (n = 12) patients, respectively. The SARC‐F and SARC‐CalF were both associated with physical function, but not with SMM. Probable sarcopenia by HGS was associated with SARC‐F and SARC‐CalF. Moreover, both showed moderate Kappa agreement with slowness and probable sarcopenia by HGS and/or STS‐5, but only SARC‐CalF with probable sarcopenia by HGS. A larger sensitivity was found for SARC‐CalF than SARC‐F in detecting probable sarcopenia by HGS (70% vs 30%) and by HGS and/or STS‐5 (63% vs 44%).
Conclusion
SARC‐F and SARC‐CalF are associated with sarcopenia traits in patients undergoing hemodialysis. SARC‐CalF seems to be more strongly associated with sarcopenia traits and present a higher sensitivity for probable sarcopenia than SARC‐F, as it adds a direct measurement.
Background
The interplay between serum bicarbonate levels and kidney outcomes is not fully understood. We conducted a prospective cohort study in three intensive care units (ICUs) to evaluate the ...association of serum bicarbonate levels with acute kidney injury (AKI) and kidney function recovery in critically ill patients.
Methods
A prospective cohort study in three intensive care units (ICUs) was performed. The serum bicarbonate level in the first 24 h after ICU admission was categorized as low (< 22 mEq/L), normal (22–26 mEq/L), or high (> 26 mEq/L). Serum creatinine (SCr) levels according to the KDIGO AKI guideline were used for defining AKI within the first 7 days of ICU stay. At ICU admission, SCr ≥ 1.1 for women and ≥ 1.3 mg/dL for men were indicative of impaired kidney function. Mortality outcome was tracked up to 28 days, and kidney function recovery was assessed at hospital discharge.
Results
A total of 2732 patients (66 ± 19 years and 55% men) were analyzed, with 32% having impaired kidney function at ICU admission. Overall, 26% of patients had low bicarbonate levels, while 32% had high bicarbonate levels. Notably, patients with preserved kidney function showed a lower prevalence of low bicarbonate levels compared to those with impaired kidney function (20% vs. 39%,
p
< 0.001), while higher rates were observed for high bicarbonate (35% vs. 24%,
p
< 0.001). Compared with patients with normal serum bicarbonate levels, those with low bicarbonate were 81% more likely to develop AKI (OR = 1.81; 95% CI 1.10–2.99), whereas those with high bicarbonate were 44% less likely (OR = 0.56; 95% CI 0.32–0.98) in the adjusted model for confounders. Neither those with high nor low serum bicarbonate levels were associated with an increased risk of mortality (HR = 1.03; 95% CI 0.68–1.56 and 0.99; 95% CI 0.68–1.42, respectively). In subgroup analysis, regardless of the kidney function at ICU admission, serum bicarbonate levels were not associated with the development of AKI and all-cause mortality. Regarding kidney function recovery, higher non-recovery rates were found for those with low bicarbonate.
Conclusion
In critically ill ICU patients, low bicarbonate levels were associated with the more likely development of AKI and subsequent non-recovery of kidney function, while high bicarbonate levels showed no such association. Therefore, low bicarbonate levels may be considered a risk factor for adverse kidney outcomes in critically ill patients.
Background
Pediatric patients with chronic kidney disease (CKD) frequently present an inadequate nutritional profile and musculoskeletal impairments. We investigated sarcopenia and its related traits ...in children and adolescents with CKD.
Methods
A cross-sectional study that enrolled pediatric patients with CKD (≥ 4 and < 18 years old). Physical function was assessed by handgrip strength and the 60-s sit-to-stand (STS-60) tests. Body composition measurement was performed by bioelectrical impedance analysis and anthropometry through mid-upper arm circumference (MUAC). Normative reference values from healthy pediatrics were used for identifying poor physical function and low MUAC. Probable sarcopenia was considered as low handgrip strength, whereas sarcopenia was defined by adding low MUAC.
Results
Twenty-two pediatric patients with CKD (11 ± 4 years and 59% boys) were evaluated; eight on peritoneal dialysis (36%), six on hemodialysis (27%), and eight non-dialysis (36%). Regarding sarcopenia traits, we observed low physical function by handgrip strength and STS-60 in 59% and 100% of the patients, respectively, while low MUAC in 77%. Probable sarcopenia was found in 9% and sarcopenia in 50%, but prevalence did not differ among stages. Handgrip strength was strongly associated with MUAC (r = 0.90;
p
< 0.001); on the other hand, the STS-60 was not significantly associated with any of the body composition variables.
Conclusion
Among pediatric patients with CKD, the prevalence of sarcopenia and its related traits was high. Nephrology professionals should consider the assessment of sarcopenia in this population, while more evidence is needed to determine its prognostic value.
Graphical Abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information
Objective
To explore the association between physical activity levels and nutritional biomarkers in hemodialysis patients.
Methods
Eighty‐six patients responded to the short version of the ...International Physical Activity Questionnaire to estimate the metabolic equivalent of tasks (MET) per week. A MET‐min per week <600 was considered as sedentary. The nutritional biomarkers (i.e., albumin, globulin, and albumin/globulin ratio) were collected.
Results
Sixty‐five patients (75.6%) were sedentary. Binary logistic regression showed that patients with low albumin levels had an 89% lower chance to be physically active (p = 0.037), but it was not significant in the adjusted analysis (p = 0.052). Albumin and albumin/globulin ratio levels were correlated with MET‐min per week (r = 0.34 and 0.30; both p < 0.05). Additionally, lower median albumin and albumin/globulin ratio levels were found in the sedentary patients (p = 0.021 and p = 0.031), respectively.
Conclusion
The physical activity levels were associated with albumin and albumin/globulin ratio, surrogates of nutritional status in hemodialysis patients. These nutritional biomarkers were lower in sedentary patients.
Hemodialysis (HD) patients experience hemodynamic instability and intradialytic exercise seems to attenuate it. This study aimed to verify the acute hemodynamic response to different intradialytic ...handgrip exercise intensities in HD patients. In a randomized, cross‐over, experimental pilot study, eight patients completed two experimental sessions and one control in random order: (a) regular HD; (b) low‐intensity isometric handgrip exercise; and (c) moderate‐intensity isometric handgrip exercise. BP and heart rate variability were recorded immediately before and every 15 minutes. Isometric handgrip exercise protocols, regardless of the intensity, did not lead to significant changes in hemodynamic stability, nor when compared to the control condition (P > .05). The systolic BP and double product significantly increased immediately after the moderate‐intensity protocol (122.0 ± 15.9 vs 131.3 ± 19.8, P < .05; 9094.7 ± 1705.7 vs 9783.0 ± 1947.9, P < .05, respectively) but returned to the pre‐exercise values 10 minutes later. We conclude that intradialytic isometric handgrip exercise does not induce hemodynamic instability at low and moderate intensities.
Individuals with chronic kidney disease (CKD) have a systemic inflammatory state. We assessed the effects of exercise on inflammatory markers in individuals with CKD. An electronic search was ...conducted, including MEDLINE. Experimental clinical trials that investigated the effects of exercise on inflammatory markers in individuals with CKD at all stages were included. Meta-analyses were conducted using the random-effects model and standard mean difference (SMD). Subgroup analyses were performed for resistance, aerobic, and combined exercise interventions. Twenty-nine studies were included in the meta-analyses. Exercise interventions showed significant reductions in C-reactive protein (CRP) (SMD: -0.23; 95% CI: -0.39 to -0.06), interleukin (IL)-6 (SMD: -0.35; 95% CI: -0.57, -0.14), and tumor necrosis factor-alpha (TNF-α) (SMD: -0.63, 95% CI: -1.01, -0.25) when compared with the controls. IL-10 levels significantly increased (SMD: 0.66, 95% CI: 0.09, 1.23) with exercise interventions. Resistance interventions significantly decreased CRP (SMD: -0.39, 95% CI: -0.69, -0.09) and TNF-α (SMD: -0.72, 95% CI: -1.20, -0.23) levels, while increasing IL-10 levels (SMD: 0.57, 95% CI: 0.04, 1.09). Aerobic interventions only significantly reduced IL-6 levels (SMD: -0.26, 95% CI: -0.51, -0.01). No significant changes in any inflammatory markers were observed with combined exercise interventions. Exercise interventions are effective as an anti-inflammatory therapy in individuals with CKD compared to usual care control groups. Resistance interventions seem to promote greater anti-inflammatory effects.
Background:
The arteriovenous fistula is the main vascular access in hemodialysis. Arteriovenous fistula access is generally evaluated by a vascular surgeon after 2 weeks of its surgery, however, ...exercise programs may begin earlier for improving outcomes. Therefore, we propose this guide with simple, but potentially effective exercises, using low-cost materials that can be safely performed by the patients at home or in the dialysis center. It also provides to the dialysis staff team a starting point for implementing an upper-limb exercise program that may facilitate arteriovenous fistula maturation and maintenance.
Methods:
This exercise routine for arteriovenous fistula maturation can be performed three to four times a day, every day, from 2 to 4 weeks. After its maturation, it can be performed on every non-dialysis day for conventional treatment and every other day, before dialysis, for short daily treatment.
Conclusions:
Based on the available evidence, we have gathered some exercises, in a very easy and understandable language, that may potentially help arteriovenous fistula maturation and maintenance for hemodialysis patients.
Hemodialysis patients have chronic systemic inflammation, musculoskeletal impairments, and body composition changes from several factors and exercise may attenuate. We evaluated the effects of an ...intradialytic resistance training program on body composition, physical function, and inflammatory markers in patients under short daily hemodialysis treatment.
A quasi-experimental study in clinical routine was conducted over eight months. Measures of physical function (handgrip strength, five-time sit-to-stand, timed-up and go, and gait speed), body composition (by bioelectrical impedance), and inflammatory markers (interleukin IL-1 beta, IL-6, IL-8, IL-10, IL-12p70, and tumor necrosis factor-α) were assessed at baseline as well as at four and eight months past continued intervention. Patients underwent two intradialytic resistance training sessions per week supervised by exercise professionals.
A total of 18 patients (62 ± 14 years; 55.6% ≥ 60 years; 44% female) were included. Significant increases in body mass index and basal metabolic rate were found at four and eight months compared to baseline. For physical function, timed-up and go performance improved at four and eight months compared to baseline. The other body composition and physical function measures, as well as all inflammatory markers, did not significantly change over time.
A supervised intradialytic resistance training program for patients on short daily hemodialysis treatment, as part of the clinical routine, may induce modest changes in body mass index, basal metabolic rate, and timed-up and go performance.
