Sarcopenia commonly occurs in patients with non-dialysis dependent chronic kidney disease (NDD-CKD), particularly in advanced stages, and is associated with an increased death risk, investigators reported at the 58th European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Congress.
Of 43 patients with NDD-CKD (mean age 71 years; 56% male; 98% White), 9 women and 7 men (37.3%) were sarcopenic, defined as a skeletal muscle index (SMI) lower than 41 cm2/m2 in women and 43 cm2/m2 in men. Sarcopenia was highly prevalent in stage 3 and 4 CKD (54.5% and 50.0%, respectively), Beatriz Donato, MD, of Hospital Beatriz Ângelo in Loures, Portugal, and colleagues reported.
With respect to mortality, 18 patients (41.9%) died over a mean 4.3 years, and significantly more patients who died than survived had sarcopenia (68.8% vs 25.9%), the investigators reported. In univariate logistic regression, mortality significantly increased by 10% for every 1-unit decrease in SMI.
Age did not differ significantly between groups. The sarcopenia group, however, had significantly lower body mass index (24.4 vs 28.4 kg/m2) and shorter height (65.9 vs 77.6 inches). They also had significantly lower serum albumin levels (2.9 vs 3.7 g/dL) and higher LDL levels (135 vs 67.5 mg/dL).
“Our study highlights the importance of early diagnosis and implementation of therapeutic strategies to minimize the adverse outcomes in CKD patients,” Dr Donato’s team stated.
In the study, skeletal muscle area was measured on computed tomography to calculate the skeletal muscle index (SMI).
“Computed tomography (CT) is the gold standard for studying sarcopenia because of its capacity to identify quantitative and qualitative changes in muscle mass,” according to the investigators.
In a separate review on the topic published in the Journal of Nephrology, Carla Maria Avesani, PhD, of Karolinska Institute, Stockholm, Sweden, and colleagues asserted that the presence of protein degradation differentiates CKD-related sarcopenia from aging-related sarcopenia:
“CKD-related sarcopenia can occur early in adult life and may develop rapidly as a consequence of the negative energy-protein balance coming from insufficient food intake coupled with increased protein catabolism in patients exposed to the uremic milieu, and in [hemodialysis] patients it may be further enhanced by catabolic effects of the hemodialysis procedure.”
Donato B, Paixão Fernandes A, Raimundo M, et al. The evaluation of sarcopenia in nondialysis chronic kidney disease stages by computed tomography. Presented at the 58th ERA-EDTA Congress 2021, June 5-8, 2021. Abstract MO591.
Sabatino A, Cuppari L, Stenvinkel P, Lindholm B, Avesani CM. Sarcopenia in chronic kidney disease: what have we learned so far? J Nephrol. Published online on September 2, 2020. doi:10.1007/s40620-020-00840-y