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Şahin K, Acar Tek N. Energy Expenditure in Chronic Kidney Disease: Affecting Factors and Evaluation Methods. Nutr Rev 2025; 83:1144-1151. [PMID: 39812783 DOI: 10.1093/nutrit/nuae213] [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] [Indexed: 01/16/2025] Open
Abstract
Chronic kidney disease (CKD) is a chronic health problem whose prevalence is increasing. Nutrition and nutrition-related factors, one of the modifiable risk factors for CKD, are of primary importance. The key to planning optimal nutritional therapy is accurately determining energy requirements and total energy expenditure. Many health problems can accompany CKD, such as protein-energy malnutrition, sarcopenia, etc, and increase the mortality rate. This study aims to present the specific factors affecting energy expenditure specific to CKD in line with the current literature, to discuss the methods used to determine energy expenditure, and to examine these methods according to groups receiving and not receiving renal replacement therapy (hemodialysis, peritoneal dialysis, and renal transplantation).
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Affiliation(s)
- Kezban Şahin
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Türkiye
| | - Nilüfer Acar Tek
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara 06495, Türkiye
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2
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Caputo V, Letteri I, Santini SJ, Sinatti G, Balsano C. Towards Precision in Sarcopenia Assessment: The Challenges of Multimodal Data Analysis in the Era of AI. Int J Mol Sci 2025; 26:4428. [PMID: 40362666 PMCID: PMC12073030 DOI: 10.3390/ijms26094428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2025] [Revised: 05/03/2025] [Accepted: 05/05/2025] [Indexed: 05/15/2025] Open
Abstract
Sarcopenia, a condition characterised by the progressive decline in skeletal muscle mass and function, presents significant challenges in geriatric healthcare. Despite advances in its management, complex etiopathogenesis and the heterogeneity of diagnostic criteria underlie the limited precision of existing assessment methods. Therefore, efforts are needed to improve the knowledge and pave the way for more effective management and a more precise diagnosis. To this purpose, emerging technologies such as artificial intelligence (AI) can facilitate the identification of novel and accurate biomarkers by modelling complex data resulting from high-throughput technologies, fostering the setting up of a more precise approach. Based on such considerations, this review explores AI's transformative potential, illustrating studies that integrate AI, especially machine learning and deep learning, with heterogeneous data such as clinical, anthropometric and molecular data. Overall, the present review will highlight the relevance of large-scale, standardised studies to validate biomarker signatures using AI-driven approaches.
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Affiliation(s)
- Valerio Caputo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, P.le Salvatore Tommasi, 67100 L’Aquila, Italy; (V.C.); (I.L.); (S.J.S.); (G.S.)
| | - Ivan Letteri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, P.le Salvatore Tommasi, 67100 L’Aquila, Italy; (V.C.); (I.L.); (S.J.S.); (G.S.)
| | - Silvano Junior Santini
- Department of Life, Health and Environmental Sciences, University of L’Aquila, P.le Salvatore Tommasi, 67100 L’Aquila, Italy; (V.C.); (I.L.); (S.J.S.); (G.S.)
| | - Gaia Sinatti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, P.le Salvatore Tommasi, 67100 L’Aquila, Italy; (V.C.); (I.L.); (S.J.S.); (G.S.)
| | - Clara Balsano
- Department of Life, Health and Environmental Sciences, University of L’Aquila, P.le Salvatore Tommasi, 67100 L’Aquila, Italy; (V.C.); (I.L.); (S.J.S.); (G.S.)
- Geriatric Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, P.le Salvatore Tommasi, 67100 L’Aquila, Italy
- Fondazione Francesco Balsano, via Giovanni Battista Martini, 00198 Rome, Italy
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3
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Freire-Filho WA, Dalboni MA, Elias RM. Effects of aging on chronic kidney disease mineral and bone disorder. Curr Opin Nephrol Hypertens 2025:00041552-990000000-00231. [PMID: 40314085 DOI: 10.1097/mnh.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2025]
Abstract
PURPOSE OF REVIEW Aging and chronic kidney disease mineral and bone disorder (CKD-MBD) interact to worsen bone health, vascular calcification, and frailty in older patients. The altered FGF23-Klotho axis and disrupted mineral homeostasis emphasize the need for early interventions to mitigate fractures and cardiovascular complications in this vulnerable population. This review provides an updated overview of the current knowledge on CKD-MBD in older patients. RECENT FINDINGS CKD-MBD exacerbates bone fragility and vascular calcification in older populations. Early vascular aging and cognitive decline are associated with increased mortality. Disruptions in calcium, phosphate, and vitamin D homeostasis accelerate bone loss and fracture risk, whereas secondary hyperparathyroidism worsens cardiovascular outcomes. Additionally, polypharmacy, sarcopenia, and cognitive impairment further intensified the clinical burden in aging CKD patients. SUMMARY Aging potentially worsens CKD-MBD, vascular calcification, and cardiovascular disease in older patients. This growing field offers promising opportunities for further research to enhance understanding, improve bone health outcomes, and reduce fracture risk.
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Affiliation(s)
| | | | - Rosilene M Elias
- Department of Medicine, Service of Nephrology, Universidade de Sao Paulo
- Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil
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4
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Ena J, Carretero Gómez J, Suárez Tembra M, Lajara Villar L, Fernández Peña C, Rosales Castillo A, Domínguez Pinilla N, Carrasco Sánchez FJ, Bustos Merlo A, Rabassa Soler A. Evaluating chronic kidney disease in Spanish people with diabetes: a study from internal medicine clinics. Rev Clin Esp 2025; 225:102279. [PMID: 40216157 DOI: 10.1016/j.rceng.2025.102279] [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: 08/28/2024] [Accepted: 01/22/2025] [Indexed: 04/16/2025]
Abstract
AIM To determine the prevalence and characteristics of chronic kidney disease (CKD) in a cross-sectional population of people with type 2 diabetes treated at internal medicine clinics in Spain. METHODS We collected data from 25 hospitals that recruited 354 people with type 2 diabetes in an observational study carried out in May 2024. Information collected included demographic data, comorbidities, nutritional status, presence of sarcopenia and frailty, as well as laboratory data and therapy administered. RESULTS We included a total of 314 subjects, of whom 185 (58.9%; 95% confidence interval: 53.4-64.3%) had CKD. Compared with people with no CKD, those with CKD were older (77.4 ± 9.7 vs. 65.9 ± 12.5 years; p < 0.001), more often male (53.1% vs. 46.9%; p = 0.021), with more prevalence of ischemic heart disease (22.4% vs. 10.9%; p = 0.006) and longer duration of diabetes disease (14.1 ± 8.6 vs. 10.0 ± 7.0 years; p < 0.001). Malnutrition (37.3% vs. 25%; p = 0.017), sarcopenia (24.6% vs. 11.2%; p = 0.003), and frailty (74.3% vs. 59%; p = 0.006) were more often associated in people with CKD compared with those without CKD. CONCLUSION Internal medicine specialists treat a significant number of people with diabetes and CKD. These people are characteristically elderly, with high proportion of cardiovascular disease showing malnutrition, sarcopenia, and frailty, which could determine the target for metabolic control.
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Affiliation(s)
- J Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
| | - J Carretero Gómez
- Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | - C Fernández Peña
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | | | | | - A Bustos Merlo
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - A Rabassa Soler
- Hospital Universitario Sant Joan de Reus, Reus, Tarragona, Spain
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Marynissen S, Daminet S, Meyer E, Demeyere K, Stock E, Delanghe J, Duchateau L, Paepe D. Longitudinal Study of Renal Health Screening in Apparently Healthy Aging Dogs. J Vet Intern Med 2025; 39:e70116. [PMID: 40317952 PMCID: PMC12046565 DOI: 10.1111/jvim.70116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 04/18/2025] [Accepted: 04/18/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND Combined measurement of functional, glomerular, and tubular markers in aging dogs is essential to detect early renal disease. OBJECTIVES Prospective longitudinal study to describe renal function and assess which biomarkers are associated with the development of early renal disease or death. ANIMALS One hundred and twenty-two apparently healthy senior and geriatric dogs. METHODS Prospective longitudinal study. Renal function was evaluated at baseline (T0) and every 6-12 months over 2 years, using systolic blood pressure measurements (SBP) and validated serum (creatinine, symmetric dimethylarginine, cystatin C [sCysC]), and urinary (specific gravity [USG], protein:creatinine [UPC], albumin:creatinine, retinol-binding protein:creatinine [uRBPcr]) biomarkers. Glomerular filtration rate (GFR) was measured in a subgroup. Survival models were used to assess the predictive value of measured biomarkers at baseline for the onset of azotemic chronic kidney disease (CKD) or death, respectively. RESULTS A total of 122 dogs were included; follow-up was available in 106 (T12) and 92 (T24); and GFR was estimated in 18 (T0), 11 (T12), and 10 (T24) dogs. Throughout the study, 15/122 (12%) dogs showed evidence of non-azotemic CKD, and in 11/106 (10%) dogs, azotemic CKD developed. Proteinuria was not associated with azotemic CKD, in contrast to muscle condition score, functional markers, and uRBPcr. Death was weakly associated with USG, UPC, and sCysC. CONCLUSIONS AND CLINICAL IMPORTANCE Over a 2-year period, 20% (26/122) of older dogs developed CKD, mostly persistent renal proteinuria (15/122). Muscle wasting and functional markers combined with uRBPcr had the best predictive value for the onset of azotemic CKD in these older, previously apparently healthy dogs.
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Affiliation(s)
- Sofie Marynissen
- Department of Small Animals, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Sylvie Daminet
- Department of Small Animals, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Evelyne Meyer
- Department of Veterinary and Biosciences, Lab of BiochemistryGhent UniversityMerelbekeBelgium
| | - Kristel Demeyere
- Department of Veterinary and Biosciences, Lab of BiochemistryGhent UniversityMerelbekeBelgium
| | - Emmelie Stock
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Joris Delanghe
- Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Luc Duchateau
- Department of Veterinary and Biosciences, Lab of BiochemistryGhent UniversityMerelbekeBelgium
| | - Dominique Paepe
- Department of Small Animals, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
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Huang Q, Chen L, Ouyang W, Jie XN, Fu LZ, Tang F, Wang J, Wu Y, Liu X. The association between hand grip strength and chronic kidney disease progression: insights from SMP-CKD studies. Int Urol Nephrol 2025:10.1007/s11255-025-04457-7. [PMID: 40310508 DOI: 10.1007/s11255-025-04457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 03/09/2025] [Indexed: 05/02/2025]
Abstract
PURPOSE This study aims to investigate the relationship between handgrip strength (HGS) and the progression of chronic kidney disease (CKD) in non-dialysis patients in China, as part of the Self-Management Program for Patients with CKD Cohort (SMP-CKD). METHODS In the SMP-CKD cohort, we utilized Cox regression and Kaplan-Meier survival analysis to explore the association between HGS and CKD progression. Data were stratified by sex-specific HGS quartiles, sarcopenia status, and HGS thresholds. The HGS thresholds were determined through curve analysis of HGS against composite renal outcomes. Group differences were compared to assess the impact of HGS on CKD outcomes. RESULTS A total of 441 participants (mean age 57.0 ± 17 years, 56.0% male) with CKD stages 3-5 from the SMP-CKD cohort who underwent grip strength evaluation between April 2019 and June 2024 were included in the analysis. The findings revealed that participants in the highest bilateral HGS quartile had a significantly lower risk of renal endpoints, with a hazard ratio (HR) of 0.102 (95% CI 0.041-0.255) compared to those in the lowest quartile. Patients without sarcopenia had a significantly lower risk of CKD composite outcomes, including increased serum creatinine or acute CKD exacerbations (HR 0.422, 95% CI 0.211-0.844, p < 0.012), as well as severe renal endpoints (HR 0.265, 95% CI 0.101-0.694, p < 0.003). Gender-specific cutoffs identified through log-rank test were 63.7 kg for men and 34.6 kg for women. Participants with bilateral HGS above these thresholds demonstrated better renal outcomes, underscoring the protective effect of higher HGS against CKD progression. CONCLUSION The study provides strong evidence that HGS is a crucial factor in reducing the risk of CKD progression. Higher levels of HGS are significantly associated with a lower occurrence of renal endpoint events.
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Affiliation(s)
- Qiong Huang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Nephropathy, Luohu District Traditional Chinese Medicine Hospital, No. 16 Xian Tong Road, Shenzhen, 518000, Guangdong, China
| | - Linyi Chen
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenwei Ouyang
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Department of Global Public Health, Global Health - Health Systems and Policy, Karolinska Institute, Stockholm, Sweden
| | - Xi-Na Jie
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China
- Chronic Disease Management Outpatient Clinic, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Li-Zhe Fu
- Chronic Disease Management Outpatient Clinic, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Fang Tang
- Chronic Disease Management Outpatient Clinic, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jing Wang
- Department of Nephropathy, Luohu District Traditional Chinese Medicine Hospital, No. 16 Xian Tong Road, Shenzhen, 518000, Guangdong, China.
| | - Yifan Wu
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China.
| | - Xusheng Liu
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China.
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Hu X, Wu B, Yang Y, Zhang L, Xue C. Sarcopenia in Peritoneal Dialysis: Prevalence, Pathophysiology, and Management Strategies. Kidney Med 2025; 7:100989. [PMID: 40247955 PMCID: PMC12005912 DOI: 10.1016/j.xkme.2025.100989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2025] Open
Abstract
Sarcopenia, defined as the loss of skeletal muscle mass, strength, and function, is a significant complication in patients with chronic kidney disease, particularly those undergoing peritoneal dialysis (PD). This review explores the prevalence, pathophysiology, diagnostic challenges, and management strategies of sarcopenia in the PD population. The multifactorial etiology of sarcopenia in PD, including protein-energy wasting, chronic inflammation, insulin resistance, and hormonal imbalances, underscores the complexity of its management. The prevalence of sarcopenia in patients treated with PD is influenced by age, duration of dialysis, and comorbid conditions, presenting a considerable variation across studies due to differing diagnostic criteria. Diagnostic challenges arise from fluid overload and the PD process, affecting the accuracy of muscle mass measurements. Intervention strategies focusing on nutritional supplementation and physical exercise have shown promise; however, the need for PD-specific diagnostic criteria and treatment protocols remains. This review highlights the critical effect of sarcopenia on functional status and survival in patients treated with PD, emphasizing the importance of addressing this condition to improve patient outcomes. Future directions call for comprehensive, longitudinal studies to better understand sarcopenia's progression in patients treated with PD and the development of tailored interventions.
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Affiliation(s)
- Xiaohua Hu
- Department of Nephrology, Zhabei Central Hospital of Jing’an District, Shanghai, China
| | - Bibo Wu
- Department of Nephrology, Zhabei Central Hospital of Jing’an District, Shanghai, China
| | - Yang Yang
- Department of Nephrology, 981th Hospital of PLA, Chengde, Hebei province, China
| | - Liming Zhang
- Department of Nephrology, Zhabei Central Hospital of Jing’an District, Shanghai, China
| | - Cheng Xue
- Department of Nephrology, Zhabei Central Hospital of Jing’an District, Shanghai, China
- Department of Nephrology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai, China
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Furukawa Y, Miyamoto A, Asai K, Tsutsumi M, Hirai K, Ueda T, Toyokura E, Nishimura M, Sato K, Yamada K, Watanabe T, Kawaguchi T. Respiratory Muscle Strength as a Predictor of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease. Respirology 2025; 30:408-416. [PMID: 40009650 PMCID: PMC12060743 DOI: 10.1111/resp.70003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 11/13/2024] [Accepted: 01/21/2025] [Indexed: 02/28/2025]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) is closely related to skeletal muscle dysfunction, and the evaluation of respiratory muscle function has recently been recommended. We aimed to investigate the effects of respiratory muscle dysfunction on clinical outcomes. METHODS We retrospectively reviewed the medical records of patients with COPD whose respiratory muscle strength was measured between June 2015 and December 2021. We then analysed the effects of respiratory muscle strength on moderate-to-severe exacerbations after adjusting for confounding factors, including sex, age, forced expiratory volume in 1-s percent predicted, hand grip strength, and skeletal muscle mass index. We also compared the temporal relationship between respiratory and systemic skeletal muscle dysfunctions. RESULTS Respiratory muscle weakness (RMW) was observed in 48.1% (100) of the 208 patients. Low percent predicted maximal inspiratory pressure was an independent risk factor for moderate-to-severe exacerbations within 1 year in the Cox regression analysis (adjusted hazard ratio per 1 standard deviation increase, 0.521; 95% confidence interval, 0.317-0.856). Approximately half of the patients already exhibited RMW at the mild systemic skeletal muscle dysfunction, while those with sarcopenia had higher RMW rates. More patients with RMW experienced progressive systemic skeletal muscle dysfunction within 1 year compared to those without RMW. CONCLUSION Lower respiratory muscle strength is associated with an increased risk of exacerbation. Respiratory muscle function could serve as a marker of disease status and early prognosis in COPD.
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Affiliation(s)
- Yuichiro Furukawa
- Department of Respiratory Medicine, Graduate School of MedicineOsaka City UniversityOsakaJapan
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Atsushi Miyamoto
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Masaya Tsutsumi
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Kaho Hirai
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Takahiro Ueda
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Erika Toyokura
- Department of Respiratory Medicine, Graduate School of MedicineOsaka City UniversityOsakaJapan
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Misako Nishimura
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Kanako Sato
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Kazuhiro Yamada
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of MedicineOsaka Metropolitan UniversityOsakaJapan
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Duarte MP, Nóbrega OT, Vogt BP, Pereira MS, Silva MZC, Mondini DR, Disessa HS, Adamoli AN, Bündchen DC, Sant'Helena BRM, Krug RR, Bohlke M, Inda-Filho AJ, Lima RM, Avesani CM, Nakamura LR, Reboredo MM, Ribeiro HS. Reference values for handgrip strength, five times sit-to-stand and gait speed in patients on hemodialysis. Nephrol Dial Transplant 2025; 40:987-996. [PMID: 39415426 DOI: 10.1093/ndt/gfae232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND Low levels of muscle strength and physical performance predict adverse clinical outcomes in patients on hemodialysis; however, reference values remain lacking. We described reference values for handgrip strength, five times sit-to-stand (STS-5) and 4-m gait speed in a large-scale sample of patients on hemodialysis. METHODS Baseline data from the SARCopenia trajectories and associations with adverse clinical outcomes in patients on HemoDialysis (SARC-HD) study were analyzed. Muscle strength was evaluated using handgrip strength and the STS-5, whereas physical performance was evaluated using usual 4-m gait speed before a midweek dialysis session. Sex- and age-specific smoothed reference curves for each test at the 3rd, 15th, 50th, 85th and 97th percentiles were constructed using generalized additive models for location shape and scale. Comparisons between sex and age were also performed. RESULTS Data from 1004 patients (39% female; 19-96 years; 49% ≥60 years) were analyzed. Declines in muscle strength and physical performance were observed with advancing age in both sexes. However, among males, muscle strength and performance were similar between 18 and 49 years of age. Males exhibited substantially greater performance in handgrip strength [10.3 kg, 95% confidence interval (CI) 9.1 to 11.4] and 4-m gait speed (0.10 s, 95% CI 0.05 to 0.14) compared with females. Older patients, independent of sex, exhibited poorer performance on most tests. Lower handgrip strength in the arm with arteriovenous fistula was observed in both sexes (males -2.3 kg, 95% CI -2.8 to -1.7; and females -2.1 kg, 95% CI -2.6 to -1.6). CONCLUSION Reference values obtained in this study may be used in clinical and research settings to identify patients on hemodialysis with low physical function according to sex and age. Future studies should test these reference values as potential predictors of adverse clinical outcomes.
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Affiliation(s)
- Marvery P Duarte
- University of Brasilia, Faculty of Health Sciences, Brasília, Brazil
| | - Otávio T Nóbrega
- University of Brasilia, Faculty of Health Sciences, Brasília, Brazil
| | - Barbara P Vogt
- Medicine Faculty, Federal University of Uberlandia, Uberlândia, Brazil
| | - Marina S Pereira
- School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Maryanne Z C Silva
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil
| | - Dario R Mondini
- Applied Kinesiology Laboratory, School of Physical Education, Universidade Estadual de Campinas, Campinas, Brazil
| | - Henrique S Disessa
- Department of Physical Education, School of Sciences, Sao Paulo State University, UNESP, Bauru, Brazil
| | - Angélica N Adamoli
- Serviço de Educação Física e Terapia Ocupacional, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Daiana C Bündchen
- Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil
| | | | | | - Maristela Bohlke
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Ricardo M Lima
- University of Brasilia, Faculty of Physical Education, Brasília, Brazil
| | - Carla M Avesani
- Department of Clinical Science, Technology and Intervention, Division of Renal Medicine and Baxter Novum, Karolinska Institute, Stockholm, Sweden
| | - Luiz R Nakamura
- Department of Statistics, Federal University of Lavras, Lavras, Brazil
| | - Maycon M Reboredo
- School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Heitor S Ribeiro
- University of Brasilia, Faculty of Health Sciences, Brasília, Brazil
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10
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Memel Z, Gold SL, Pearlman M, Muratore A, Martindale R. Impact of GLP- 1 Receptor Agonist Therapy in Patients High Risk for Sarcopenia. Curr Nutr Rep 2025; 14:63. [PMID: 40289060 DOI: 10.1007/s13668-025-00649-w] [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] [Accepted: 03/26/2025] [Indexed: 04/29/2025]
Abstract
PURPOSE OF REVIEW Glucagon-like peptide- 1 receptor agonists (GLP- 1 RA) are a rapidly expanding class of medications used to treat many chronic diseases. This review explores factors that may contribute to accelerated muscle loss among higher-risk patient populations and describes tailored interventions to reduce the risk of accelerated sarcopenia and frailty. RECENT FINDINGS While GLP- 1 RA can result in total weight loss upwards of 25%, recent studies show that they can also lead to significant loss of lean body mass, reaching as high as 15-40% of total weight lost. This rapid and significant decline in muscle mass while taking GLP- 1 RA places certain patient populations already predisposed to sarcopenia at higher risk for muscle loss and adverse events. Currently, there is insufficient evidence delving into the impact of GLP- 1 RA on body composition among older adults, patients with chronic kidney disease, liver disease, and inflammatory bowel disease. However, research suggests that a high protein diet and resistance training may help prevent loss of muscle mass during GLP- 1 RA usage. A targeted and individualized nutrition and physical activity regimen should be instituted for each patient with a focus on optimizing protein intake and performing frequent resistance training in order to minimize loss of muscle mass while promoting the loss of fat mass. Future research should evaluate the impact of GLP- 1 RA on sarcopenia in high-risk patient populations.
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Affiliation(s)
- Zoe Memel
- Department of Gastroenterology, University of California San Francisco, San Francisco, California, USA
| | - Stephanie L Gold
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Michelle Pearlman
- Gastroenterologist and Obesity Medicine Specialist, Co-Founder Prime Institute, Coral Gables, Florida, USA
| | - Alicia Muratore
- Department of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert Martindale
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
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11
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Xie D, Wu C, Yao L, Zhu Q, Lu J, Ding W. Clinic- and home-based renal rehabilitation improves spKt/V and uremic syndrome in hemodialysis patients: a case report. BMC Nephrol 2025; 26:187. [PMID: 40217508 PMCID: PMC11987303 DOI: 10.1186/s12882-025-04102-6] [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: 04/22/2024] [Accepted: 03/28/2025] [Indexed: 04/14/2025] Open
Abstract
There was an increasing uptake of hemodialysis and patient life expectancy due to improved treatment efficiency. However, the quality of life (QOL) of chronic kidney disease (CKD) patients is not parallelly improved, leading to a shift in focus towards promoting the QOL. Among the common complications of CKD such as anaemia and mineral bone disorder, uremic syndrome has been found as the main contributor to poor QOL. We present the case of an 80-year-old man with hemodialysis, who presented with poor appetite and weakness following recovering from COVID-19. Biochemical, echocardiographic, body composition, psychological, nutritional, and QOL assessments suggested multi-organ dysfunction attributable to uremic syndrome. Renal rehabilitation involving the combination of clinic- and home-based exercise and nutritional interventions effectively improved his symptoms while elevating spKt/V. Our case report not only demonstrated exercise and nutritional rehabilitation as an effective approach to managing uremic syndrome in hemodialysis patients, but also provided insight into the effects of improved nutritional status on spKt/V.
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Affiliation(s)
- Danshu Xie
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, PR China
| | - Chaolun Wu
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, PR China
- Department of Rehabilitation, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, PR China
| | - Lu Yao
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, PR China
| | - Qin Zhu
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, PR China
| | - Jianxin Lu
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, PR China.
| | - Wei Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, PR China.
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Li X, Zhang K, Guo Q, Ding W, Niu J, Zhao J, Zhang L, Qi H, Zhang S, Yu C. Impedance-derived phase angle as an indicator of physical function in maintenance hemodialysis patients. Nutrition 2025; 136:112795. [PMID: 40373354 DOI: 10.1016/j.nut.2025.112795] [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: 10/19/2024] [Revised: 03/24/2025] [Accepted: 04/03/2025] [Indexed: 05/17/2025]
Abstract
OBJECTIVES Maintenance hemodialysis (MHD) patients often impairs physical function, leading to reduced quality of life and increased mortality. Phase angle (PhA), derived by bioelectrical impedance analysis, has been proposed as a predictor of sarcopenia, holds promise as a potential indicator of physical function. The aim of this study was to identify the association between PhA and physical function in MHD patients. METHODS This was a multicenter, cross-sectional study included MHD patients from seven dialysis centers from 2020 to 2021. Physical function was measured by handgrip strength (HGS), Short Physical Performance Battery (SPPB), 4-meter gait speed, and timed up and go test (TUGT). Nutritional status was assessed by malnutrition inflammation score (MIS). Body composition, including PhA at 50kHz, was measured by bioelectrical impedance analysis. Sarcopenia was diagnosed according to the 2019 update version of the Asian Working Group for Sarcopenia. Multivariable linear regression models were performed to determine the association between PhA and physical function. RESULTS A total of 864 patients (61% male, median age 63 years) were analyzed. The median PhA was 4.5 (interquartile range: 3.9-5.2)°. PhA was negatively associated with age, MIS, Charlson comorbidity index, extracellular water/total body water, visceral fat area, and TUGT, and positively associated with hemoglobin, serum albumin, body mass index, height, weight, skeletal muscle mass index (SMI), SPPB, 4-meter gait speed, and HGS. These associations were consistent across PhA values of whole body and five body segments-right arm, left arm, trunk, right leg, and left leg. Multivariable linear regression analyses indicated that PhA was independently associated with higher SPPB scores (β = 0.33, P < 0.001), faster gait speed (β = 0.29, P < 0.001), greater HGS (β = 0.28, P < 0.001) and shorter TUGT time (β = -0.20, P < 0.001) after fully adjusted for age, sex, spKt/V, dialysis vintage, Charlson comorbidity index, MIS and skeletal muscle index. Subgroup analyses confirmed the robust association of PhA with physical function across different patient characteristics including sarcopenia, malnutrition, age, sex, and diabetes. CONCLUSIONS Higher PhA was independently associated with better physical function in MHD patients. Our study suggested that PhA may serve as a non-invasive, reliable clinical indicator for assessing functional status in this population.
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Affiliation(s)
- Xin Li
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kun Zhang
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Wei Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianying Niu
- Department of Nephrology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Junli Zhao
- Department of Nephrology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Liming Zhang
- Department of Nephrology, Zhabei Central Hospital of JingAn District of Shanghai, Shanghai, China
| | - Hualin Qi
- Department of Nephrology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Suhua Zhang
- Department of Nephrology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
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13
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Yajima T, Noda K, Yajima K. Changes in body composition and handgrip strength during dapagliflozin administration in patients with chronic kidney disease. Clin Kidney J 2025; 18:sfaf075. [PMID: 40226371 PMCID: PMC11986814 DOI: 10.1093/ckj/sfaf075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Indexed: 04/15/2025] Open
Abstract
Background Dapagliflozin improves renal endpoints; however, concerns exist regarding safety in patients with chronic kidney disease. We examined the effects of dapagliflozin on body composition, handgrip strength, and sarcopenia. Methods This prospective observational study included 55 patients with chronic kidney disease (type 2 diabetes, n = 27) treated with dapagliflozin 10 mg/day for 24 weeks. Handgrip strength, bio-impedance analysis-estimated skeletal muscle index, and extracellular water-to-total body water ratio were measured at baseline, 12 weeks, and 24 weeks after dapagliflozin administration. Sarcopenia was diagnosed as reduced handgrip strength (women: <18 kg; men: <28 kg) and decreased skeletal muscle index (women: <5.7 kg/m2; men: <7.0 kg/m2). Results During dapagliflozin therapy, skeletal muscle index significantly decreased from 7.51 ± 1.36 kg/m2 at baseline to 7.40 ± 1.28 kg/m2 at 12 weeks (P < 0.0001) and 7.32 ± 1.35 kg/m2 at 24 weeks (P < 0.0001). The extracellular water-to-total body water ratio decreased from 0.391 ± 0.012 at baseline to 0.390 ± 0.011 at 12 weeks (P = 0.17) and 0.389 ± 0.010 at 24 weeks (P = 0.002). Conversely, handgrip strength was unchanged from 32.9 ± 12.2 kg at baseline to 34.0 ± 12.1 kg at 12 weeks (P = 0.022) and 33.9 ± 12.4 kg at 24 weeks (P = 0.14). Sarcopenia prevalence did not change during dapagliflozin treatment [10.9% (n = 6) at baseline, 14.5% (n = 8) at 12 weeks, 10.9% (n = 6) at 24 weeks; P = 0.45. Conclusions During the 24-week dapagliflozin treatment, there was a decrease in skeletal muscle index and extracellular water-to-total body water ratio with unchanged handgrip strength in patients with chronic kidney disease. Sarcopenia prevalence remained constant. Therefore, regarding sarcopenia, short-term dapagliflozin administration might be safe. However, further long-term studies are required to determine the safety of dapagliflozin in these patients.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu, Japan
| | - Kaoru Noda
- Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
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García-Menéndez E, Portolés J, Pérez Rodrigo I, Tato Ribera A, Yuste Lozano C, Ossorio González M, Álvarez López MJ, López Sánchez P, Janeiro Marín D. POCUS ultrasound: A tool for the detection and monitoring of sarcopenia in peritoneal dialysis. Nefrologia 2025; 45:302-311. [PMID: 40155221 DOI: 10.1016/j.nefroe.2025.03.003] [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: 05/16/2024] [Accepted: 12/09/2024] [Indexed: 04/01/2025] Open
Abstract
The prevalence of Sarcopenia varies between 1.5% and 68% among patients with chronic kidney disease (CKD). This wide range is due to the different diagnostic tools and the cut-off points used. Early diagnosis and intervention of sarcopenia are essential because of its association with poorer quality of life (QoL), higher hospitalization rates, and adverse events. The "European Working Group on Sarcopenia in Older People (EWGSOP2)" consensus review suggests ultrasound as an emerging tool to quantify muscle mass. Our objective is to describe the prevalence of sarcopenia risk in peritoneal dialysis (PD) and the utility of ultrasound in our setting. MATERIAL AND METHODS We conducted an observational study in prevalent PD patients at the Puerta de Hierro University Hospital between January and October 2023. Clinical, efficacy, analytical and nutritional parameters were collected, along with functional performance measured by SPPB, frailty (FRAIL scale), risk of malnutrition (MIS scale), bioimpedance (BCM) and estimation of appendicular skeletal muscle mass using Lin's formula. Ultrasound measurement of supramuscular fat, Axes (X and Y) and the area of the rectus femoris muscle (RFM) were also included, adjusted for height and body surface area. We classified patients at risk of sarcopenia based on handgrip strength according to EWGSOP2 criteria, adjusted for sex. This study was approved by the Ethics Committee of Puerta de Hierro University Hospital (No. 16/2023). RESULTS We evaluated 38 patients, with a mean age of 65.4 years (SD 14.9), 65.8% were male. 52.6% had a reduced lean tissue index (LTI) and 23.7% had a reduced fat tissue index (FTI), with a mean phase angle (PA) of 4.5 (SD 1.1). We classified 42.1% as patients at risk of sarcopenia based on handgrip strength. They were older, had more comorbidities, poorer nutrition according to the MIS scale, and showed worse scores on frailty and functional capacity. Similary, they had a lower LTI, lower appendicular skeletal muscle mass, and lower quadriceps muscle thickness (Y axis 8.5 mm (SD 2.4) vs 11.8 mm (SD 3.3) p = 0.002). Patients at risk of sarcopenic had lower phosphorus levels and higher C-reactive protein (CRP) levels. The predictive capacity of ultrasound for classifying patients at risk of sarcopenia was AUC 0.78 (0.64-0.93) for Y Axis, similar to those obtained with the LTI and PA of bioimpedance. CONCLUSIONS Sarcopenia risk is highly prevalent in PD and is related to age, comorbidity, malnutrition and inflammation in patients. Ultrasound is an accessible, safe, low-cost and easy-to-use tool at the bedside. This method helps us to quantify muscle mass and assess its quality. We propose the thickness of the RFM (Y axis) as the best complementary parameter given its good correlation with bioimpedance and its diagnostic value for sarcopenic risk. Our experience will serve as a basis for future studies that allow us to define specific cut-off points in PD and design monitoring and intervention protocols.
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Affiliation(s)
- Estefanya García-Menéndez
- Departamento de Nefrología, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Jose Portolés
- Departamento de Nefrología, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Irene Pérez Rodrigo
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Tato Ribera
- Departamento de Nefrología, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain
| | - Claudia Yuste Lozano
- Departamento de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain; RICORS ISCIII; RD21/0005/, Spain
| | - Marta Ossorio González
- Departamento de Nefrología, Hospital Universitario La Paz, Madrid, Spain; RICORS ISCIII; RD21/0005/, Spain
| | - María Jesús Álvarez López
- Departamento de Nefrología, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Paula López Sánchez
- Departamento de Nefrología, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Darío Janeiro Marín
- Departamento de Nefrología, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
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15
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Caldiroli L, Molinari P, D'Alessandro C, Cupisti A, Alfieri C, Castellano G, Vettoretti S. Osteosarcopenia in Chronic Kidney Disease: An Overlooked Syndrome? J Cachexia Sarcopenia Muscle 2025; 16:e13787. [PMID: 40192621 PMCID: PMC11974265 DOI: 10.1002/jcsm.13787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 02/13/2025] [Accepted: 02/26/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Healthy ageing relies on maintaining physiological systems, particularly the musculoskeletal system (MKS). After 50, declines in bone density, muscle mass and strength increase the risk of osteoporosis and sarcopenia, leading to frailty, fractures and higher healthcare costs. Osteosarcopenia, combining osteoporosis and sarcopenia, is rising because of the ageing population. Chronic kidney disease (CKD) exacerbates this condition through disruptions in mineral metabolism, hormonal imbalances and inflammation, further compromising musculoskeletal health. AIMS This review examines the pathophysiology of osteosarcopenia associated with CKD, focusing on the role of mineral and hormonal disturbances, chronic inflammation and endocrine dysfunction. It aims to increase clinical awareness and highlight the need for early diagnosis and intervention to mitigate the burden of osteosarcopenia on the quality of life and healthcare systems in ageing CKD populations. METHODS A narrative review of the current literature was conducted, summarising evidence on the mechanisms underlying osteosarcopenia in CKD, including mineral metabolism alterations, inflammatory processes and hormonal imbalances. RESULTS Osteosarcopenia is a recognised consequence of CKD, contributing to increased morbidity and mortality. The pathophysiology of osteosarcopenia in CKD is multifactorial, involving disruptions in mineral metabolism, inflammation, endocrine dysfunction and physical inactivity. CKD-mineral and bone disorder (CKD-MBD) leads to alterations in calcium, phosphate, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF-23) and vitamin D metabolism, resulting in impaired bone mineralisation and increased fracture risk. Simultaneously, CKD accelerates muscle wasting through systemic inflammation, anabolic resistance and metabolic derangements, increasing the risk of sarcopenia. Sarcopenic obesity, inflammaging and hormonal dysregulation further exacerbate bone muscle deterioration. Emerging evidence suggests that osteosarcopenia in CKD is a consequence of interconnected pathophysiological pathways rather than isolated conditions. Diagnosis remains challenging because of overlapping clinical features, necessitating integrated assessment tools. Targeted therapeutic strategies, including mineral metabolism correction, resistance exercise and anabolic interventions, are essential to mitigate osteosarcopenia's progression and improve patient outcomes in CKD. CONCLUSIONS Osteosarcopenia is a growing concern in ageing CKD populations. Early diagnostic strategies and targeted interventions are essential to mitigate the impact of osteosarcopenia on patient outcomes and reduce associated healthcare costs. Increased clinical awareness and research into effective therapies are crucial for improving the quality of life for individuals affected by CKD and osteosarcopenia.
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Affiliation(s)
- Lara Caldiroli
- Unit of Nephrology, Dialysis and Kidney TransplantationFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di MilanoMilanItaly
| | - Paolo Molinari
- Unit of Nephrology, Dialysis and Kidney TransplantationFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di MilanoMilanItaly
| | | | - Adamasco Cupisti
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Carlo Alfieri
- Unit of Nephrology, Dialysis and Kidney TransplantationFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di MilanoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Giuseppe Castellano
- Unit of Nephrology, Dialysis and Kidney TransplantationFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di MilanoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Simone Vettoretti
- Unit of Nephrology, Dialysis and Kidney TransplantationFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di MilanoMilanItaly
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16
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Solignac J, Dou L, Chermiti R, McKay N, Giaime P, Pedinielli N, Benjelloun H, Lano G, Mancini J, Burtey S, Bataille S. Myostatin Exacerbates Endothelial Dysfunction Induced by Uremic Toxin Indoxyl Sulfate and Is Associated with Hemodialysis Arteriovenous Access Complications. Toxins (Basel) 2025; 17:159. [PMID: 40278657 PMCID: PMC12031316 DOI: 10.3390/toxins17040159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 03/18/2025] [Accepted: 03/20/2025] [Indexed: 04/26/2025] Open
Abstract
Hemodialysis patients exhibit endothelial dysfunction, contributing to elevated cardiovascular risk and complications of the arteriovenous access. These patients have elevated serum levels of myostatin, a member of the transforming growth factor-β (TGFβ) superfamily, and of the uremic toxin indoxyl sulfate, both of which are pro-inflammatory towards endothelial cells. We hypothesized that myostatin and indoxyl sulfate may synergistically induce endothelial dysfunction by impairing endothelial proliferation and promoting a pro-inflammatory phenotype. We first investigated the effect of myostatin on cultured endothelial cells in the presence of indoxyl sulfate. We then examined the association between serum myostatin concentrations and the occurrence of cardiovascular and arteriovenous access complications in hemodialysis patients. In vitro, myostatin exhibited endotheliotoxic effects in the presence of a uremic concentration of indoxyl sulfate, enhanced its antiproliferative effect, and amplified MCP-1 and IL-8 chemokine upregulation. In patients, high myostatin concentrations correlated with indoxyl sulfate concentrations and were associated with an increased risk of arteriovenous access complications. These findings suggest that myostatin amplifies endothelial injury mediated by indolic uremic toxins and might contribute to AV access complications.
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Affiliation(s)
- Justine Solignac
- C2VN, Aix-Marseille University, INSERM, INRAE, 13385 Marseille, France; (J.S.); (R.C.); (N.M.); (G.L.); (S.B.); (S.B.)
- Centre de Néphrologie et Transplantation Rénale, APHM, Hôpital Conception, 13005 Marseille, France
| | - Laetitia Dou
- C2VN, Aix-Marseille University, INSERM, INRAE, 13385 Marseille, France; (J.S.); (R.C.); (N.M.); (G.L.); (S.B.); (S.B.)
| | - Rania Chermiti
- C2VN, Aix-Marseille University, INSERM, INRAE, 13385 Marseille, France; (J.S.); (R.C.); (N.M.); (G.L.); (S.B.); (S.B.)
- Phocean Nephrology Institute, Clinique Bouchard, ELSAN, 13005 Marseille, France; (P.G.); (N.P.)
| | - Nathalie McKay
- C2VN, Aix-Marseille University, INSERM, INRAE, 13385 Marseille, France; (J.S.); (R.C.); (N.M.); (G.L.); (S.B.); (S.B.)
| | - Philippe Giaime
- Phocean Nephrology Institute, Clinique Bouchard, ELSAN, 13005 Marseille, France; (P.G.); (N.P.)
| | - Nathalie Pedinielli
- Phocean Nephrology Institute, Clinique Bouchard, ELSAN, 13005 Marseille, France; (P.G.); (N.P.)
| | - Hamza Benjelloun
- APHM, Hop Timone, Public Health Department (BIOSTIC), 13005 Marseille, France; (H.B.); (J.M.)
| | - Guillaume Lano
- C2VN, Aix-Marseille University, INSERM, INRAE, 13385 Marseille, France; (J.S.); (R.C.); (N.M.); (G.L.); (S.B.); (S.B.)
- Centre de Néphrologie et Transplantation Rénale, APHM, Hôpital Conception, 13005 Marseille, France
| | - Julien Mancini
- APHM, Hop Timone, Public Health Department (BIOSTIC), 13005 Marseille, France; (H.B.); (J.M.)
- Aix-Marseille University, INSERM, IRD, ISSPAM, SESSTIM, 13451 Marseille, France
| | - Stéphane Burtey
- C2VN, Aix-Marseille University, INSERM, INRAE, 13385 Marseille, France; (J.S.); (R.C.); (N.M.); (G.L.); (S.B.); (S.B.)
- Centre de Néphrologie et Transplantation Rénale, APHM, Hôpital Conception, 13005 Marseille, France
| | - Stanislas Bataille
- C2VN, Aix-Marseille University, INSERM, INRAE, 13385 Marseille, France; (J.S.); (R.C.); (N.M.); (G.L.); (S.B.); (S.B.)
- Phocean Nephrology Institute, Clinique Bouchard, ELSAN, 13005 Marseille, France; (P.G.); (N.P.)
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de Geus M, Visser W, van Egmond-de Mik A, Dam M, de Cuyper E, de van der Schueren M, Tieland M, Weijs P, Kruizenga H, Ipema K. Nutritional Intake and Diet Quality in Hemodialysis Patients: Scope for Improvement. J Ren Nutr 2025:S1051-2276(25)00046-9. [PMID: 40097080 DOI: 10.1053/j.jrn.2025.03.004] [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: 08/13/2024] [Revised: 01/24/2025] [Accepted: 03/11/2025] [Indexed: 03/19/2025] Open
Abstract
OBJECTIVE Hemodialysis (HD) patients face challenges in upholding dietary compliance. This study aimed to compare dietary intake against disease-specific guidelines. Secondary, to assess the overall diet quality and to explore the association between dietary potassium intake and serum potassium concentrations. METHODS In this cross-sectional multicenter study, nutrient intake of Dutch adult HD patients was assessed using food frequency questionnaires and diet quality with the Dutch Healthy Diet 15-index. Intake and diet quality were compared to disease-specific dietary recommendations or Dutch Dietary Guidelines. Insufficient intake was defined as <90% of the requirement, sufficient as 90-100%, and excessive as >110%. The association between serum potassium concentration and dietary potassium intake was modeled with linear regression analysis. RESULTS The study population consisted of 248 participants (60% male) from 21 dialysis centers. Energy intake (1789 [872] kcal/day) was insufficient for 45% of the participants, while protein intake (1 [0.5] g/kg/d) was insufficient for 50%. Despite 67% of participants managing to align their energy intake below 110% of the recommended level, a high prevalence of overweight (61%) was observed in this cohort. Saturated fat intake was excessive for 87% of participants, while only 15% met the recommended fiber intake. Overall diet quality was low (74 [20] maximum score of 150). No association was observed between serum potassium and dietary potassium intake after adjusting for relevant confounders (r = 0.163, P = .261). CONCLUSIONS A considerable proportion of Dutch HD patients were unable to meet disease-specific dietary guidelines. Diet quality was shown to be poor.
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Affiliation(s)
- Manon de Geus
- Dutch Association of Nephrology Dietitians, Utrecht, The Netherlands; Division of Dietetics, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Wesley Visser
- Dutch Association of Nephrology Dietitians, Utrecht, The Netherlands; Division of Dietetics, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Anneke van Egmond-de Mik
- Dutch Association of Nephrology Dietitians, Utrecht, The Netherlands; Division of Dietetics, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Manouk Dam
- Dutch Association of Nephrology Dietitians, Utrecht, The Netherlands; Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Evelien de Cuyper
- Dutch Association of Nephrology Dietitians, Utrecht, The Netherlands; Department of Dietetics, Amphia Hospital, Breda, The Netherlands
| | - Marian de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Peter Weijs
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Hinke Kruizenga
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Karin Ipema
- Dutch Association of Nephrology Dietitians, Utrecht, The Netherlands; Department of Dietetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ko H, Le TT, Nguyen NB, Kang SW, Cha KH, Yang N, Jung SH, Kim M. Poncirus trifoliata Extract and Its Active Coumarins Alleviate Dexamethasone-Induced Skeletal Muscle Atrophy by Regulating Protein Synthesis, Mitochondrial Biogenesis, and Gut Microbiota. Phytother Res 2025. [PMID: 40088055 DOI: 10.1002/ptr.8478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 01/30/2025] [Accepted: 02/28/2025] [Indexed: 03/17/2025]
Abstract
Sarcopenia, an age-related decline in skeletal muscle mass and function, contributes to frailty and increased morbidity in the elderly. This necessitates the development of effective interventions to combat muscle atrophy. This study investigated the therapeutic potential of Poncirus trifoliata ethanol extract (PT) and its coumarin derivatives against dexamethasone (DEX)-induced muscle atrophy. We employed in vitro and in vivo models of DEX-induced muscle atrophy. C2C12 myotubes were used for mechanistic studies. C57BL/6J mice received DEX injections and oral PT supplementation (50 mg/kg/day) to evaluate effects on muscle mass, function, gene expression, and gut microbiota composition. In vitro, PT enhanced protein synthesis, mitochondrial biogenesis, and myogenic differentiation in DEX-exposed myotubes, with auraptene, ponciol, and triphasiol identified as key bioactive coumarins. In vivo, PT significantly attenuated DEX-induced muscle atrophy, increasing tibialis anterior muscle mass by 36% (p < 0.01), grip strength by 31% (p < 0.001), and maximal running speed by 18% (p < 0.05). Mechanistically, PT upregulated genes associated with muscle function and mitochondrial health. Furthermore, PT modulated gut microbiota composition, notably increasing Phocaeicola vulgatus abundance 2.2-fold, which correlated with improved muscle performance (R = 0.58, p < 0.01). These findings suggest that PT and its coumarin derivatives, particularly auraptene, ponciol, and triphasiol, hold promise as therapeutic agents for combating muscle atrophy. The observed benefits may be mediated through enhanced protein synthesis, improved mitochondrial function, and modulation of the gut-muscle axis.
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Affiliation(s)
- Hyejin Ko
- Natural Product Research Center, Korea Institute of Science and Technology (KIST), Gangneung, Republic of Korea
| | - Tam Thi Le
- Natural Product Research Center, Korea Institute of Science and Technology (KIST), Gangneung, Republic of Korea
| | - Ngoc Bao Nguyen
- Natural Product Research Center, Korea Institute of Science and Technology (KIST), Gangneung, Republic of Korea
- College of Dentistry, Department of Biochemistry and Molecular Biology, Gangneung Wonju National University, Gangneung, Republic of Korea
| | - Suk Woo Kang
- Natural Product Research Center, Korea Institute of Science and Technology (KIST), Gangneung, Republic of Korea
| | - Kwang Hyun Cha
- Natural Product Informatics Research Center, Korea Institute of Science and Technology (KIST), Gangneung, Republic of Korea
- Division of Bio-Medical Science and Technology, KIST School, University of Science and Technology (UST), Daejeon, Republic of Korea
- Department of Convergence Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Nain Yang
- Natural Product Research Center, Korea Institute of Science and Technology (KIST), Gangneung, Republic of Korea
| | - Sang Hoon Jung
- Natural Product Research Center, Korea Institute of Science and Technology (KIST), Gangneung, Republic of Korea
- Division of Bio-Medical Science and Technology, KIST School, University of Science and Technology (UST), Daejeon, Republic of Korea
| | - Myungsuk Kim
- Natural Product Research Center, Korea Institute of Science and Technology (KIST), Gangneung, Republic of Korea
- Division of Bio-Medical Science and Technology, KIST School, University of Science and Technology (UST), Daejeon, Republic of Korea
- Department of Convergence Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
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Jiang J, Chen G, Li Y, Zhao Q, Chen Z. Serum calcium levels and the risk of sarcopenia in young adults: insights from NHANES 2011-2018. Front Nutr 2025; 12:1526879. [PMID: 40161296 PMCID: PMC11951309 DOI: 10.3389/fnut.2025.1526879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 02/27/2025] [Indexed: 04/02/2025] Open
Abstract
Background Sarcopenia, the accelerated loss of muscle mass and function, is commonly associated with aging, especially in older adults. While low serum calcium has been linked to muscle loss in individuals over 50, its relationship with sarcopenia in younger adults (20-60 years) is unclear. This study examines this association using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Methods This population-based, cross-sectional study analyzed participants aged 20-60 from NHANES 2011-2018. Individuals with missing data were excluded. Sarcopenia was assessed using appendicular skeletal muscle (ASM) measured by dual-energy X-ray absorptiometry, defined by ASM/BMI or ASM/Weight. Multiple logistic regression and stratified analyses were used to explore the correlation between serum calcium levels and sarcopenia prevalence. Results Among 7,309 adults, 578 (7.91%) had sarcopenia by ASM/BMI and 1,363 (18.65%) by ASM/Weight. Higher serum calcium levels were significantly associated with a lower risk of sarcopenia (ASM/BMI: OR 0.07, 95% CI 0.02-0.20; ASM/Weight: OR 0.09, 95% CI 0.04-0.19). The trend was consistent across age, gender, education, poverty income ratio, and race, with some exceptions. Conclusion This study highlights a negative association between serum calcium and sarcopenia risk in young and middle-aged adults, suggesting that calcium interventions could be beneficial in preventing sarcopenia in this population. However, the cross-sectional design precludes any inference of causality, and further longitudinal studies are warranted to confirm these findings.
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Affiliation(s)
| | | | | | - Qinggang Zhao
- Department of Orthopedics and Traumatology, Affiliated Hospital of Yunnan University, Yunnan University, Kunming, China
| | - Zhong Chen
- Department of Orthopedics and Traumatology, Affiliated Hospital of Yunnan University, Yunnan University, Kunming, China
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Boonyapratheeprat N, Pimolbutr K, Rungraungrayabkul D, Meenetkum S, Boongird S, Chuengsaman P, Okuma N, Thanakun S, Kitiyakara C, Sangkhamanee SS. Impact of Dry Mouth and Factors Associated with Sarcopenia on Oral Health-Related Quality of Life in Peritoneal Dialysis Patients. Eur J Dent 2025. [PMID: 40073982 DOI: 10.1055/s-0045-1802567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2025] Open
Abstract
OBJECTIVES This cross-sectional study aimed to investigate the oral health-related quality of life (OHRQoL), its associated factors, and the prevalence of possible sarcopenia in Thai well-maintained patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD). MATERIALS AND METHODS Data were collected from 63 participants undergoing PD at Banphaeo-Charoenkrung Hemodialysis Center. Dry mouth was evaluated through unstimulated salivary flow rate measurement and self-reported xerostomia questionnaires. OHRQoL was assessed using the Thai version of Oral Health Impact Profile (OHIP-14). STATISTICAL ANALYSIS Statistical analyses were conducted using IBM SPSS Statistics version 21.0. Descriptive statistics summarized participant characteristics, and normality was tested with the Kolmogorov-Smirnov test. Continuous variables were expressed as medians and interquartile ranges, while categorical variables were presented as frequencies and percentages. The Mann-Whitney U test and Fisher's exact test were used to assess differences between OHRQoL groups. Partial Spearman's rank correlation examined variable relationships, and logistic regression identified factors linked to a higher negative impact on OHRQoL, adjusting for age, sex, body mass index, chair stand test, and salivary flow rate. A p-value of < 0.05 was considered significant. RESULTS The median age was 59 years (range 27-79), with a possible sarcopenia prevalence of 52.4%. OHIP-14 scores ranged from 0 to 32, with medians of 4 and 13 in a lower (n = 31) and higher (n = 32) negative impact on OHRQoL, respectively. Those with a higher negative impact on OHRQoL exhibited a significantly higher proportion of self-reported xerostomia (p = 0.01), lower salivary flow rate (p = 0.01), and longer 5-time chair stand test (p = 0.04) compared to individuals with the lower negative impact on OHRQoL. Correlation between the time of the chair stand test and the handgrip strength adjusting for age (r = -0.439, p < 0.001) and sex (r = -0.351, p = 0.006) was revealed. Multivariate logistic regression showed a significant association between salivary flow rate and a higher negative impact on OHRQoL (odds ratio 0.018; 95% confidence interval: 0.001, 0.545; p = 0.02). CONCLUSION This finding suggests that reduced salivary flow affected OHRQoL in well-maintained ESRD patients with PD, highlighting the importance of managing dry mouth to alleviate their OHRQoL.
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Affiliation(s)
- Natcha Boonyapratheeprat
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kununya Pimolbutr
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Sasiwimon Meenetkum
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarinya Boongird
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piyatida Chuengsaman
- Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Bangkok, Thailand
| | - Nis Okuma
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Supanee Thanakun
- Division of Oral Diagnostic Science, College of Dental Medicine, Rangsit University, Pathum Thani, Thailand
| | - Chagriya Kitiyakara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Zicarelli M, Duni A, Leivaditis K, Lin YL, Baciga F, Pugliese S, Fiorentino M, Hsu BG, Roumeliotis S, Battaglia Y, Dounousi E, Bolignano D. Comprehensive Insights into Sarcopenia in Dialysis Patients: Mechanisms, Assessment, and Therapeutic Approaches. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:449. [PMID: 40142260 PMCID: PMC11944051 DOI: 10.3390/medicina61030449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 02/25/2025] [Accepted: 02/28/2025] [Indexed: 03/28/2025]
Abstract
Sarcopenia, defined as the progressive loss of muscle mass, strength, and function, is largely prevalent but still clinically underrecognized among patients undergoing chronic dialysis therapy. The pathogenesis involves a complex interplay of chronic inflammation, oxidative stress, metabolic acidosis, hormonal imbalances, protein waste, malnutrition, and reduced physical activity. This multifactorial condition profoundly impairs quality of life and may lead to significant clinical consequences, including frailty, an increased risk of falls and hospitalization, and elevated mortality. Despite its clinical relevance, sarcopenia often remains underdiagnosed due to inconsistent diagnostic criteria and challenges in assessing body composition in dialysis populations. Therapeutic strategies, including tailored exercise programs, nutritional interventions, and pharmacological treatments, are essential to mitigate muscle loss and improve patient outcomes. Early identification and routine sarcopenia assessment in clinical practice could play a pivotal role in enhancing the management of dialysis patients. A multidisciplinary, personalized approach is necessary to address the diverse factors contributing to sarcopenia and to improve the overall prognosis and quality of life for this vulnerable population.
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Affiliation(s)
- Mariateresa Zicarelli
- Department of Health Sciences, University “Magna-Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Anila Duni
- 2nd Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Konstantinos Leivaditis
- 2nd Department of Nephrology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Yu-Li Lin
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970473, Taiwan
| | - Federica Baciga
- Department of Medicine, University of Verona, 37129 Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Peschiera del Garda, 37129 Verona, Italy
| | - Sara Pugliese
- School of Medicine, University “Magna-Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Marco Fiorentino
- Nephrology, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970473, Taiwan
| | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Yuri Battaglia
- Department of Medicine, University of Verona, 37129 Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Peschiera del Garda, 37129 Verona, Italy
| | - Evangelia Dounousi
- 2nd Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Davide Bolignano
- Department of Medical and Surgical Sciences, University “Magna-Graecia” of Catanzaro, 88100 Catanzaro, Italy
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22
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Sun W, Liu L. Nutritional counseling's impact on muscle mass and quality of life in stage 4 chronic kidney disease malnourished patients. Technol Health Care 2025; 33:951-958. [PMID: 40105168 DOI: 10.1177/09287329241291370] [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] [Indexed: 03/20/2025]
Abstract
BackgroundChronic Kidney Disease (CKD) is a significant public health issue, affecting 37 million people in the United States. CKD often leads to malnutrition, particularly in advanced stages, contributing to muscle wasting, reduced quality of life, and increased healthcare costs.ObjectiveThis retrospective study aimed to investigate the impact of early nutritional intervention and counseling on muscle mass and quality of life in malnourished stage 4 chronic kidney disease (CKD) patients.MethodsClinical data from stage 4 CKD patients with concomitant malnutrition admitted to a single center from January 2023 to December 2023 were retrospectively analyzed. Patients were divided into a standard intervention group and an early nutritional intervention and counseling group. Baseline characteristics, muscle mass parameters, quality of life assessments, nutritional parameters, and adverse events were compared between the two groups.ResultsThe baseline characteristics of the study participants were well-balanced between the two groups. The early nutrition intervention group demonstrated significant improvements in muscle mass parameters, including grip strength, skeletal muscle mass, muscle strength, calf circumference, and handgrip measurement, compared to the standard intervention group. Additionally, the early nutrition intervention group showed significant enhancements in several aspects of quality of life, including physical functioning, mental health, energy/fatigue, and general health scores. Improvements in nutritional parameters, such as protein intake, caloric intake, vitamin D levels, iron levels, and zinc levels, were also observed in the early nutrition intervention group. Notably, no significant differences in adverse events were found between the two groups.ConclusionThe study highlights the significant benefits of early nutritional intervention and counseling for malnourished stage 4 CKD patients. Early nutritional support positively impacts muscle mass, quality of life, and nutritional parameters. These findings emphasize the importance of nutrition in CKD management and the need for comprehensive nutritional support as a key component of care. This research paves the way for further studies and clinical initiatives to enhance nutritional care and improve the standard of care for CKD patients.
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Affiliation(s)
- Weiyan Sun
- Department of Nephrology, Wuhan Puren Hospital, Wuhan, China
| | - Lingxi Liu
- Department of Nephrology, Wuhan Puren Hospital, Wuhan, China
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23
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Lim J, Kim B, Han K, Lim JU. Fatty liver index and development of lung cancer: a nationwide cohort study. Korean J Intern Med 2025; 40:275-285. [PMID: 39434606 PMCID: PMC11938715 DOI: 10.3904/kjim.2024.232] [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: 06/28/2024] [Revised: 08/12/2024] [Accepted: 08/19/2024] [Indexed: 10/23/2024] Open
Abstract
BACKGROUND/AIMS This study aimed to evaluate the impact of steatotic liver disease severity on the cumulative incidence of lung cancer utilizing data from the Korea National Health Insurance Service (NHIS). METHODS This study examined the risk of lung cancer in the general population in conjunction with the incidence of steatotic liver disease. The study population consisted of 3,261,438 individuals aged 20 years or older who underwent a general health examination in 2009. RESULTS Individuals with fatty liver index (FLI) of 30-59 exhibited a 1.08-fold increased risk of lung cancer (95% CI: 1.04-1.11), while FLI ≥ 60 was associated with a 1.22-fold elevated risk of lung cancer (95% CI: 1.17-1.28) compared to those with FLI < 30. The risk varied with smoking status; in current smokers, the adjusted HR for the FLI 30-59 group was 1.05 (95% CI: 1.00-1.10), while that in the FLI ≥ 60 group was 1.11 (95% CI: 1.04-1.18). In never- or past-smokers, the adjusted HR for the FLI 30-59 group was 1.10, and that for the FLI ≥ 60 group was 1.31. Subgroup analysis revealed an incidence rate of 1.06 per 1,000 person-years in the consistently high FLI group compared to 1.15 in those with improved FLI. Improving FLI over time was associated with a 0.93-fold decrease in lung cancer risk. CONCLUSION Our study demonstrated a correlational relationship between lung cancer incidence and the severity of steatotic liver disease as measured by FLI.
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Affiliation(s)
- Jihye Lim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Bongseong Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Jeong Uk Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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24
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Wang M, Chen Z, Yu T, You L, Peng Y, Chen H, Zhang P, Shi Z, Fang X, Jia L, Xia Z, Ji C, Tang H, Gao C. Low Skeletal Muscle Density Assessed by Abdominal Computerized Tomography Predicts Outcome in Children With Chronic Kidney Disease. J Ren Nutr 2025; 35:281-288. [PMID: 39549931 DOI: 10.1053/j.jrn.2024.11.003] [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: 05/27/2024] [Revised: 10/11/2024] [Accepted: 11/01/2024] [Indexed: 11/18/2024] Open
Abstract
OBJECTIVES Skeletal muscle loss and abnormal fat distribution are predictors of poor clinical outcomes in adults with chronic kidney disease (CKD). However, the relationship between body composition (muscle mass and adipose tissue) and prognosis in children with CKD has not been well elucidated. METHODS The retrospective single-center study enrolled children with CKD and healthy group who underwent an abdominal computerized tomography examination and compared the body composition of the third lumbar spine (L3) between the 2 groups. We defined the primary outcome as hemodialysis, peritoneal dialysis, kidney transplantation, or death. Logistic regression analysis was applied to assess the connection between low skeletal muscle density (SMD) and clinical and demographic variables. Multivariate Cox regression analysis was used to evaluate the risk factors for progression to the primary outcome. Kaplan-Meier survival analysis was performed to compare the effect of different body composition on event-free survival rate. RESULTS Thirty-two patients with CKD [estimated glomerular filtration rate: 14.89 (8.86, 29.88) (mL/min/1.73 m2)] and 66 heathy subjects [estimated glomerular filtration rate: 135.72 (121.70, 161.29) (mL/min/1.73 m2)] were recruited in our study. From the assessment of body composition assessed by computerized tomography, skeletal muscle area, SMD, and skeletal muscle index in the CKD group was lower than those in the healthy group (P < .05). On the other hand, visceral fat area and visceral fat index in the CKD group were significantly higher than those in the healthy group (P < .05). In logistic regression analysis, triglyceride (odds ratio: 8.635, 95% confidence interval (CI): 1.153-64.687) was independently associated with low SMD. After adjusting clinical data and body composition, high serum albumin (hazard ratio: 0.873, 95% CI: 0.798-0.955) and high SMD (hazard ratio: 0.895, 95% CI: 0.822-0.974) were protective factors for delaying renal failure. Based on the Kaplan-Meier analysis, only the group with low SMD had lower event-free survival in comparison to the reference group (P < .05). CONCLUSIONS These findings suggest that there is significant skeletal muscle loss and decrease in SMD in CKD children. Notably, low SMD is indicative of poor prognosis in CKD children.
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Affiliation(s)
- Meiqiu Wang
- Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zijian Chen
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Tingting Yu
- Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Lianghui You
- Nanjing Women and Children's Healthcare Institute, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China
| | - Yingchao Peng
- Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Huangyu Chen
- Department of Information, Jinling Hospital, Nanjing, China
| | - Pei Zhang
- Department of Pediatrics, Jinling Hospital, Nanjing, China
| | - Zhuo Shi
- Department of Pediatrics, Jinling Hospital, Nanjing, China
| | - Xiang Fang
- Department of Pediatrics, Jinling Hospital, Nanjing, China
| | - LiLi Jia
- Department of Pediatrics, Jinling Hospital, Nanjing, China
| | - Zhengkun Xia
- Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| | - Chenbo Ji
- Nanjing Women and Children's Healthcare Institute, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, China; State Key Laboratory of Reproductive Medicine and Offspring Health, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China; Nanjing Medical Key Laboratory of Female Fertility Preservation and Restoration, Nanjing, China.
| | - Hao Tang
- Department of Radiology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; State Key Laboratory of Reproductive Medicine and Offspring Health, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China.
| | - Chunlin Gao
- Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Takahashi R, Yabe H, Ishikawa H, Hibino T, Suzumura A, Yamada T. Effectiveness of rehabilitation in hospitalized hemodialysis patients as compared with rehabilitation in hospitalized patients not on hemodialysis: a retrospective cohort study. J Nephrol 2025; 38:665-674. [PMID: 39847209 DOI: 10.1007/s40620-024-02192-3] [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: 08/04/2024] [Accepted: 12/04/2024] [Indexed: 01/24/2025]
Abstract
BACKGROUND The effectiveness of rehabilitation aimed at improving the activities of daily living and physical functions may differ between hospitalized patients undergoing hemodialysis (HD) and not undergoing HD (non-HD). The aim of the present study was to compare the outcomes of rehabilitation between hospitalized HD and non-HD patients. METHODS This was a retrospective cohort study of inpatients who underwent rehabilitation. We measured the rehabilitation time (min/day), length of hospital stay (days), and the Barthel index (BI). In addition, at the time of admission and discharge, grip strength, isometric knee extension strength, 10 m walking speed, timed up and go test, and short physical performance battery were examined. The outcomes were then compared between the HD and non-HD groups. RESULTS This study was made up of 902 patients (non-HD group: 765, HD group: 137). Our analysis revealed a lower rehabilitation time [43.3 (0.6) vs. 38.8 (1.2) min/day] and longer hospital stay [48.5 (0.5) vs. 58.1 (2.3) days] in the HD group as compared with the non-HD group (p < 0.05). In addition, the 10 m walking speed [0.75 (0.02) vs. 0.66 (0.03) m/s], timed up and go test [20.8 (0.7) vs. 24.3 (1.0) sec], and short physical performance battery [6.3 (0.6) vs. 4.7 (0.6) points] at discharge were also significantly lower in the HD group as compared with the non-HD group (p < 0.05). CONCLUSION Rehabilitation efforts for HD patients need to be improved by securing more time for inpatient rehabilitation and promoting mobility function improvement for these patients.
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Affiliation(s)
- Ren Takahashi
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan.
| | - Hiroki Yabe
- Department of Physical Therapy, Seirei Christopher University, School of Rehabilitation, Hamamatsu, Shizuoka, Japan
| | - Hideaki Ishikawa
- Department of Internal Medicine, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Akio Suzumura
- Department of Neurology, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Yamada
- Dialysis Division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
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Yajima T, Arao M. Psoas muscle gauge and adverse clinical outcomes in patients on hemodialysis. J Nephrol 2025; 38:655-664. [PMID: 39873869 PMCID: PMC11961518 DOI: 10.1007/s40620-024-02191-4] [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: 07/18/2024] [Accepted: 12/04/2024] [Indexed: 01/30/2025]
Abstract
BACKGROUND The relationship between the psoas muscle gauge (PMG), a combined sarcopenia indicator obtained from psoas muscle index (PMI) and psoas muscle density (PMD), and adverse clinical outcomes in patients on hemodialysis remains unclear. We examined whether psoas muscle gauge could predict all-cause mortality and new cardiovascular events more accurately than psoas muscle index in these patients. METHODS We retrospectively included 217 hemodialysis patients who underwent abdominal computed tomography. We calculated the psoas muscle gauge (arbitrary unit [AU]) at the fourth lumbar vertebra level as follows: PMI (cm2/m2) × PMD (Hounsfield units). We categorized the patients into higher and lower psoas muscle gauge groups based on sex-specific cutoffs obtained from the young Asian population. The outcomes were death and new cardiovascular events. RESULTS The psoas muscle gauge cutoffs were set at 231.1 and 328.8 AU in women and men, respectively. Eighty-five deaths and 95 new cardiovascular events occurred during the follow-up period of 4.4 (2.4-7.3) years. The 5-year survival rates were 59.2% and 94.9% in the lower and higher psoas muscle gauge groups, respectively (p < 0.0001). Moreover, after adjusting for sex and age, history of cardiovascular disease, C-reactive protein, modified creatinine index, and geriatric nutritional risk index, lower psoas muscle gauge was independently associated with increased all-cause death and new cardiovascular events (adjusted hazard ratio (aHR) 7.65; 95% confidence interval (CI) 2.37-24.66 and aHR 2.98; 95% CI 1.54-5.75, respectively). The concordance index (C-index) for predicting all-cause mortality and new cardiovascular events significantly improved when either psoas muscle index or psoas muscle gauge were added to the baseline risk model. Additionally, the C-index of the psoas muscle gauge-added model was significantly higher than that of the psoas muscle index-added model (0.815 vs. 0.784, p = 0.026) only when predicting all-cause mortality. CONCLUSIONS Psoas muscle gauge accurately predicted the risk of all-cause mortality and new cardiovascular events in patients undergoing hemodialysis. For predicting all-cause mortality, psoas muscle gauge may be recommended compared to psoas muscle index.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu, Japan.
| | - Maiko Arao
- Department of Nephrology, Matsunami General Hospital, Gifu, Japan
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Mori K, Yamamoto Y, Hanafusa N, Yamamoto S, Fukuma S, Onishi Y, Emoto M, Inaba M. Author's Reply to the Letter to the Editor: Is the "Nutritional Risk Index for Japanese Hemodialysis" Validated as a Nutritional and Prognostic Indicator? J Ren Nutr 2025; 35:370-372. [PMID: 39674429 DOI: 10.1053/j.jrn.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 12/03/2024] [Indexed: 12/16/2024] Open
Affiliation(s)
- Katsuhito Mori
- Department of Nephrology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shingo Fukuma
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Epidemiology, Infectious Disease Control and Prevention, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Masanori Emoto
- Department of Nephrology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan; Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Padial M, Avesani CM, García-Testal A, Cana-Poyatos A, Lindholm B, Segura-Ortí E. Dietary Needs, Barriers, and Facilitators Among Patients on Hemodialysis and Their Caregivers: The GoodRENal Project in Spain. J Ren Nutr 2025; 35:337-343. [PMID: 39237029 DOI: 10.1053/j.jrn.2024.08.005] [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: 11/22/2023] [Revised: 08/07/2024] [Accepted: 08/18/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE Dietary restrictions are common in patients undergoing hemodialysis (HD). These restrictions result in a complex diet that becomes difficult for patients to understand and to follow. Therefore, we aimed to identify dietary needs, barriers, and facilitators that influence the adherence to dietary recommendations as perceived by patients on HD and their caregivers. METHODS Seventy-two Spanish patients on HD and 57 caregivers participated in this explorative study by replying a questionnaire consisting of 20 and 10 questions respectively. The responses were assessed using a Likert scale varying from 1 to 5 (strongly agree, agree, neither disagree or disagree, disagree, strongly disagree, respectively) to evaluate the perception of patients and caregivers regarding dietary needs, barriers, and facilitators to adhere to the recommended diet. For analysis purposes, the responses were grouped in 3 categories (agree, neither agree or disagree, disagree). RESULTS Seventy percent of the patients agreed that knowing the food sources of potassium, protein and phosphate was a need for them to know to be able to adhere to the dietary recommendations. Moreover, patients stated that not being able to eat what they liked, and feeling thirsty, were important barriers. For caregivers, the support of a renal dietitian was mentioned as an important facilitator to assist those they cared for to adhere to the diet. CONCLUSIONS Knowing food sources of potassium, phosphate, and protein, exploring foods patients like to eat and adjusting fluid intake to avoid feeling thirsty were identified as important by the patients. These findings can be used to develop strategies and educational material to improve the dietary adherence in patients undergoing HD. Moreover, the presence of a renal dietitian was identified as an important resource by the caregivers.
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Affiliation(s)
- Marina Padial
- Servicio de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain; 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
| | | | | | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden
| | - Eva Segura-Ortí
- Universidad Cardenal Herrera-CEU, CEU Universities, Physiotherapy, Alfara del Patriarca, Spain
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Kiyoyama H, Tanabe M, Higashi M, Kamamura N, Kawano Y, Ihara K, Hideura K, Ito K. Association of visceral fat obesity with structural change in abdominal organs: fully automated three-dimensional volumetric computed tomography measurement using deep learning. Abdom Radiol (NY) 2025:10.1007/s00261-025-04834-x. [PMID: 39937214 DOI: 10.1007/s00261-025-04834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 01/13/2025] [Accepted: 02/02/2025] [Indexed: 02/13/2025]
Abstract
The purpose of this study was to explore the association between structural changes in abdominal organs and visceral fat obesity (VFO) using a fully automated three-dimensional (3D) volumetric computed tomography (CT) measurement method based on deep learning algorithm. A total of 610 patients (295 men and 315 women; mean age, 68.4 years old) were included. Fully automated 3D volumetric CT measurements of the abdominal organs were performed to determine the volume and average CT attenuation values of each organ. All patients were divided into 2 groups based on the measured visceral fat area: the VFO group (≥ 100 cm2) and non-VFO group (< 100 cm2), and the structural changes in abdominal organs were compared between these groups. The volumes of all organs were significantly higher in the VFO group than in the non-VFO group (all of p < 0.001). Conversely, the CT attenuation values of all organs in the VFO group were significantly lower than those in the non-VFO group (all of p < 0.001). Pancreatic CT values (r = - 0.701, p < 0.001) were most strongly associated with the visceral fat, followed by renal CT values (r = - 0.525, p < 0.001) and hepatic CT values (r = - 0.510, p < 0.001). Fully automated 3D volumetric CT measurement using a deep learning algorithm has the potential to detect the structural changes in the abdominal organs, especially the pancreas, such as an increase in the volumes and a decrease in CT attenuation values, probably due to increased ectopic fat accumulation in patients with VFO. This technique may provide valuable imaging support for the early detection and intervention of metabolic-related diseases.
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Affiliation(s)
- Haruka Kiyoyama
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Mayumi Higashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Naohiko Kamamura
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yosuke Kawano
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kenichiro Ihara
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Keiko Hideura
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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Zicarelli M, Greco M, Roumeliotis S, Lo Vasco ME, Dragone F, Kourtidou C, Alekos I, Misiti R, Foti DP, Coppolino G, Liakopoulos V, Dounousi E, Bolignano D. MOTS-c Levels and Sarcopenia Risk in Chronic Peritoneal Dialysis Patients: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:322. [PMID: 40005438 PMCID: PMC11857303 DOI: 10.3390/medicina61020322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Revised: 02/09/2025] [Accepted: 02/11/2025] [Indexed: 02/27/2025]
Abstract
Background and Objectives: Sarcopenia is exceedingly frequent in end-stage kidney disease (ESKD) patients on dialysis, including those undergoing peritoneal dialysis (PD), and is of multifactorial origin. MOTS-c is a mitochondrial-derived peptide that promotes muscle growth whose levels are unbalanced in ESKD. In this study, we evaluated MOTS-c balance and its relationship with sarcopenia risk in an ESKD-PD cohort. Materials and Methods: MOTS-c was measured in serum, urine, and dialysate samples of 32 chronic PD patients. Patients were thus screened for sarcopenia risk by the SARC-F tool, anthropometric measurements, and physical performance tests. Results: PD patients with a very high sarcopenia risk (SARC-F ≥ 2) had significantly lower serum (sMOTS-c) and higher dialysate (dMOTS-c) levels, suggesting an increased peritoneal clearance of this substance (d/s MOTS-c). sMOTS-c levels were directly correlated with muscle performance in physical tests, while an opposite relationship was found with dMOTS-c and d/sMOTS-c. ROC analyses demonstrated the diagnostic potential of MOTS-c, particularly in combination with physical and anthropometric assessments, to identify PD patients at very high risk of sarcopenia. Conclusions: Chronic PD may negatively affect MOTS-c balance, which, in turn, may contribute to enhanced sarcopenia risk. Larger studies are needed to confirm these observations and to validate the potential utility of this substance as a biomarker for improving sarcopenia risk stratification in PD patients.
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Affiliation(s)
| | - Marta Greco
- Department of Health Sciences, Magna-Graecia University, 88100 Catanzaro, Italy
- Clinical Pathology Lab, Magna-Graecia University Hospital, 88100 Catanzaro, Italy
| | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | | | - Francesco Dragone
- Clinical Pathology Lab, Magna-Graecia University Hospital, 88100 Catanzaro, Italy
| | - Christodoula Kourtidou
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Alekos
- Department of Nephrology, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Roberta Misiti
- Clinical Pathology Lab, Magna-Graecia University Hospital, 88100 Catanzaro, Italy
| | - Daniela Patrizia Foti
- Clinical Pathology Lab, Magna-Graecia University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna-Graecia University, 88100 Catanzaro, Italy
| | - Giuseppe Coppolino
- Department of Health Sciences, Magna-Graecia University, 88100 Catanzaro, Italy
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Evangelia Dounousi
- Department of Nephrology, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Davide Bolignano
- Department of Medical and Surgical Sciences, Magna-Graecia University, 88100 Catanzaro, Italy
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Yang TW, Kang Y, Kim DH, Kim YS, Kwon OY, Lee TW, Park DJ, Bae E. The prevalence of frailty according to kidney function and its association with cognitive impairment, nutritional status, and clinical outcome. BMC Nephrol 2025; 26:65. [PMID: 39930363 PMCID: PMC11808967 DOI: 10.1186/s12882-025-04006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 02/05/2025] [Indexed: 02/14/2025] Open
Abstract
BACKGROUND Frailty is a state of vulnerability to poor homeostatic resolution of after a stressful event. The prevalence of frailty in patients with chronic kidney disease (CKD) is more common than in the general population. Frailty is associated with a poor clinical prognosis, malnutrition, and cognitive impairment; however, studies on these factors in patients with CKD are lacking. Therefore, we aimed to evaluate the relationship between CKD and frailty, nutritional status, and cognitive impairment and their influence on clinical outcomes. METHODS We prospectively enrolled participants from June 2019 to December 2020 and divided them into three CKD groups according to kidney function (CKD G1-2, CKD G3-4, and CKD G5D). Clinical outcomes were defined as the composite outcomes of all-cause death, hospitalization, and cardiovascular outcomes, including nonfatal myocardial infarction, revascularization, or stroke. To calculate the relative risk of frailty, cognitive impairment, nutritional status, and clinical outcome, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression analysis. RESULT A total of 83 patients were included, of whom 31.3% had frailty and 18.1% had cognitive impairment. In the CKD G5D group, the prevalence of frailty (56.7%, n = 17) was significantly higher, and the nutritional quotient score was lower in the other groups. The Korean-Montreal Cognitive Assessment score was significantly lower in the CKD G5D group; however, cognitive impairment did not differ among the three groups. Frailty was significantly associated with cognitive impairment and CKD G5D group. Cognitive impairment was significantly associated with older age and higher BMI. Well-nourished status was significantly associated with BMI and CKD G5D group. Patients in the CKD G5D group were significantly more likely to have adverse clinical outcomes. CONCLUSIONS The prevalence of frailty increased significantly as the CKD stage progressed. Particularly, CKD G5D group correlated with frailty and nutritional status, leading to poor clinical outcomes.
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Affiliation(s)
- Tae-Won Yang
- Department of Neurology, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - YooMee Kang
- Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Do-Hyung Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young-Soo Kim
- Department of Neurology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Oh-Young Kwon
- Department of Neurology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Medical Science, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Tae Won Lee
- Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Dong Jun Park
- Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
- Institute of Medical Science, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Eunjin Bae
- Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea.
- Institute of Medical Science, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea.
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Sun Y, Liu H, Li X, Zhang L, Xu W, Liu H, Yuan T. Association of social frailty, sarcopenia, and oral frailty with depressive symptoms in Chinese older adults: a cross-sectional study. BMC Public Health 2025; 25:464. [PMID: 39910522 PMCID: PMC11796157 DOI: 10.1186/s12889-025-21662-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 01/28/2025] [Indexed: 02/07/2025] Open
Abstract
BACKGROUND Depressive symptoms are a serious health issue that can cause profound, lifelong suffering for people who are affected by it. This study aimed to evaluate the effect of sarcopenia, oral frailty, and social frailty on depressive symptoms among Chinese participants aged ≥ 60 years old in China. METHODS This research utilized a cross-sectional design and used convenience sampling to select participants from Anhui Province, China. Demographic questionnaire, SARC-F (Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls), OFI-8 (Oral Frailty Index-8), the HALFT (Help, Participation, Loneliness, Financial, Talk) scale, and PHQ-9 (Patient Health Questionnaire-9) were used to conduct the survey. A chi-square test was performed to evaluate the differences between categorical variables, spearman correlation analysis was used to find the correlation between depressive symptoms and factors. Four regression models were set up to evaluate the effect of factors on depressive symptoms and select the appropriate adjustment variables. RESULTS Of 1453 participants, 33.5% had sarcopenia, 51.4% had oral frailty, 31.5% had pre-social frailty, 14.5% had social frailty, and 32.2% had depressive symptoms. Spearman correlation analysis indicated that depressive symptoms significantly correlated with sarcopenia (r = 0.415), oral frailty (r = 0.282), and social frailty (r = 0.410). In crude analysis, sarcopenia (OR = 0.179, 95%CI 0.141-0.227), oral frailty (OR = 3.946, 95%CI 3.101-5.021), pre-social frailty (OR = 4.449, 95%CI 3.401-5.818), and social frailty (OR = 12.552, 95%CI 8.833-17.837) were significantly associated with depressive symptoms in older adults. After adjusting for the covariates, sarcopenia (OR = 4.301, 95%CI 3.322-5.569), oral frailty (OR = 3.136, 95%CI 2.430-4.046), pre-social frailty (OR = 3.664, 95%CI 2.775-4.836) and social frailty (OR = 9.488, 95%CI 6.560-13.723) were significantly associated with depressive symptoms. (P <0.05). CONCLUSION This research indicated that sarcopenia, oral frailty, pre-social frailty, and social frailty, were significant and positively associated with depressive symptoms. These results provide clinicians with a reference for identifying high-risk older adults and give public health policymakers a scientific approach to taking targeted interventions. Future research should further explore the two-way relationship between these factors and depressive symptoms and assess the effectiveness of different interventions. This will help to improve the quality of life and mental health.
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Affiliation(s)
- Yuanhao Sun
- Department of Graduate School, Wannan Medical College, Wuhu, Anhui, China
| | - Huan Liu
- Department of Hemodialysis, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Zheshan West Road, Yijishan District, Wuhu City, Anhui Province, P. R. China
| | - Xiangdong Li
- Department of Gerontology, Yijishan Hospital, the First Affiliated Hospital of Wannan Medical College, Zheshan West Road, Yijishan District, Wuhu City, Anhui Province, P. R. China
| | - Lin Zhang
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, P. R. China
| | - Wenwen Xu
- Department of Graduate School, Wannan Medical College, Wuhu, Anhui, China
| | - Hairong Liu
- School of Humanities and Management Science, Wannan Medical College, Wuhu City, Anhui Province, P. R. China.
- Anhui Key Laboratory of Philosophy and Social Sciences for Public Health Crisis Management, Wuhu City, Anhui Province, P. R. China.
| | - Ting Yuan
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, P. R. China.
- Anhui Key Laboratory of Philosophy and Social Sciences for Public Health Crisis Management, Wuhu City, Anhui Province, P. R. China.
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Tsai CC, Wang PC, Hsiung T, Fan YH, Wu JT, Kan WC, Shiao CC. Sarcopenia in Chronic Kidney Disease: A Narrative Review from Pathophysiology to Therapeutic Approaches. Biomedicines 2025; 13:352. [PMID: 40002765 PMCID: PMC11852367 DOI: 10.3390/biomedicines13020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 01/22/2025] [Accepted: 01/24/2025] [Indexed: 02/27/2025] Open
Abstract
Chronic kidney disease (CKD) is a progressive condition linked to sarcopenia, a syndrome characterized by loss of skeletal muscle mass and strength, affecting a quarter of CKD patients globally. Sarcopenia has multiple paths through which it can worsen morbidity and mortality as well as decrease the quality of life in CKD, including systemic inflammation, hormonal imbalances, metabolic changes, and dysbiosis of gut microbiota. There is a regional variation in the criteria set for diagnosis, with two main groups being the European Working Group on Sarcopenia in Older People and the Asian Working Group for Sarcopenia. Management regimes such as nutritional optimization, vitamin D, exercise, correction of metabolic acidosis, and modulation of gut microbiota constitute effective intervention strategies. Emerging therapeutic options include anabolic agents, myostatin inhibitors, and anti-inflammatory treatment options. Future advances such as genomics, proteomics, and personalized medicine will open up new avenues for addressing the complex pathophysiology of sarcopenia. Hence, a comprehensive multidisciplinary approach focused on the specific needs of each patient will be vital in reducing the effects of sarcopenia and improving the situation of people with CKD.
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Affiliation(s)
- Chung-Ching Tsai
- Division of Orthopaedics, Department of Surgery, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 26546, Taiwan;
| | - Ping-Chen Wang
- Department of Medical Research and Education, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 26546, Taiwan;
| | - Ted Hsiung
- Division of General Surgery, Department of Surgery, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 26546, Taiwan; (T.H.); (Y.-H.F.); (J.-T.W.)
| | - Yang-Hsin Fan
- Division of General Surgery, Department of Surgery, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 26546, Taiwan; (T.H.); (Y.-H.F.); (J.-T.W.)
| | - Jui-Teng Wu
- Division of General Surgery, Department of Surgery, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 26546, Taiwan; (T.H.); (Y.-H.F.); (J.-T.W.)
| | - Wei-Chih Kan
- Department of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City 71004, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, No. 89, Wenhua 1st St., Rende Dist., Tainan City 71703, Taiwan
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 26546, Taiwan
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Dilaver RG, Demirci M, Crescenzi R, Pridmore M, Ertuglu LA, Guide A, Greevy R, Roshanravan B, Ikizler TA, Gamboa JL. INTERMUSCULAR ADIPOSE TISSUE AND MUSCLE FUNCTION IN PATIENTS ON MAINTENANCE HEMODIALYSIS. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.01.31.25321429. [PMID: 39974089 PMCID: PMC11838629 DOI: 10.1101/2025.01.31.25321429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
Background and Aims Sarcopenia, defined as a loss in muscle mass and strength, is common in patients with advanced chronic kidney disease (CKD), leading to poor outcomes. Intermuscular adipose tissue (IMAT) accumulation is associated with metabolic and functional abnormalities in chronic disease conditions. This study assesses IMAT in maintenance hemodialysis (MHD) patients and its association with metabolic markers and physical performance. Methods and Results We performed a cross-sectional study comparing MHD patients with controls. IMAT accumulation was measured by analyzing the fat-to-muscle ratio of the calf muscles through Magnetic Resonance Imaging (MRI) scans. Body composition and metabolic markers were assessed (hs-CRP, TNF-α, IL-6, and insulin resistance). Circulating cell-free mitochondrial DNA (ccf-mtDNA) was quantified using qRT-PCR. Muscle function was evaluated with handgrip strength. Inverse propensity weighted (IPW) method was used to test the difference between IMAT levels of the groups. Twenty-five MHD patients and 23 controls were analyzed. The MHD group had higher IMAT accumulation than controls (p < 0.01). IMAT was positively correlated with Body Mass Index (BMI) and fat mass index (FMI) in controls. MHD patients exhibited elevated TNF-α, IL-6, and hs-CRP levels (p < 0.01). Positive correlations were found between IMAT and IL-6 in MHD patients and between IMAT and TNF-α in controls. Handgrip strength was negatively correlated with IMAT in the entire cohort (p <0.01). Conclusion Our findings highlight the potential role of IMAT in muscle catabolism and functional decline in advanced CKD. Targeting IMAT could be a valuable strategy for improving health outcomes in this population.
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Affiliation(s)
- R. Gulsah Dilaver
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mert Demirci
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rachelle Crescenzi
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Pridmore
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lale A. Ertuglu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew Guide
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Baback Roshanravan
- Department of Medicine, Division of Nephrology University of California, Davis, Sacramento, CA, USA
| | - T. Alp Ikizler
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Jorge L. Gamboa
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
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Wang M, You L, He X, Peng Y, Wang R, Zhang Z, Shu J, Zhang P, Sun X, Jia L, Xia Z, Ji C, Gao C. Multiomics Analysis Reveals Therapeutic Targets for Chronic Kidney Disease With Sarcopenia. J Cachexia Sarcopenia Muscle 2025; 16:e13696. [PMID: 39911133 PMCID: PMC11799769 DOI: 10.1002/jcsm.13696] [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: 10/05/2023] [Revised: 10/11/2024] [Accepted: 01/02/2025] [Indexed: 02/07/2025] Open
Abstract
BACKGROUND The presence of sarcopenia in patients with chronic kidney disease (CKD) is associated with poor prognosis. The mechanism underlying CKD-induced muscle wasting has not yet been fully explored. This study investigates the influence of renal secretions on muscles using multiomics sequencing. METHODS The kidney transcriptome analysis by RNA-seq and protein profiling by tandem mass tag (TMT), serum TMT and muscle TMT were performed in CKD established using 0.2% adenine and control mice. Spp1 recombinant protein was used to study its effect on myotube atrophy in vitro. In animal experiments on CKD, pharmacological inhibition of Spp1 was used to explore the role of Spp1 in skeletal muscle wasting. Transcriptome analysis was performed to identify differentially expressed genes (DEGs) in the gastrocnemius muscle following Spp1 pharmacological inhibition. RESULTS In the renal transcriptome and TMT, 503 and 377 proteins/genes respectively were co-upregulated and co-downregulated. In the serum TMT of CKD and normal control (NC) mice, 22 upregulated and 7 downregulated differentially expressed proteins (DEPs) showed the same expression patterns as those in the kidney transcriptome and TMT analysis. Based on bioinformatics analysis and reported studies, we selected Spp1 for further validation. Spp1 recombinant protein was added to C2C12 myotubes in vitro, and the results indicated that Spp1 significantly increased the protein levels of the muscle atrophy marker (Murf-1) and promoted the smaller myotubes (all p < 0.05). Compared with NC mice, Spp1 mRNA and protein levels were significantly upregulated in the kidneys of CKD mice, and the serum concentration of Spp1 was also markedly increased (all p < 0.05). In animal experiments, pharmacological inhibition of Spp1 increased the weights of gastrocnemius and tibialis anterior muscles (p < 0.05) and improved muscle atrophy phenotype. Transcriptome analysis showed that DEGs in the gastrocnemius muscle following Spp1 pharmacological inhibition were enriched in protein digestion and absorption, glucagon signalling pathway, apelin signalling pathway and ECM-receptor interaction pathway. CONCLUSIONS Our study is the first to establish a regulatory network of kidney-muscle crosstalk to explore the potential mechanism of CKD-related sarcopenia. Employing multiomics analysis, cellular assessment and animal experiments, we have identified that Spp1 could potentialy serve as a promising therapeutic target for CKD patients with sarcopenia.
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Affiliation(s)
- Meiqiu Wang
- Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Lianghui You
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Women and Children's Healthcare InstituteWomen's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care HospitalNanjingChina
| | - Xu He
- Department of Pediatrics, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Yingchao Peng
- Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Ren Wang
- Department of PediatricsJinling Hospital, Nanjing Medical UniversityNanjingChina
| | - Zhiqiang Zhang
- Department of PediatricsJinling Hospital, Nanjing Medical UniversityNanjingChina
| | - Jiaping Shu
- Department of PediatricsMedical School of Southeast UniversityNanjingChina
| | - Pei Zhang
- Department of PediatricsJinling HospitalNanjingChina
| | - Xiaoyi Sun
- Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - LiLi Jia
- Department of PediatricsJinling HospitalNanjingChina
| | - Zhengkun Xia
- Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Chenbo Ji
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Women and Children's Healthcare InstituteWomen's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care HospitalNanjingChina
| | - Chunlin Gao
- Department of Pediatrics, Nanjing Jinling Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
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Acuña-Pardo C, Muñoz-Redondo E, Delcros-Forestier L, Curbelo YG, Rodríguez-Hernández C, Meza-Valderrama D, Sánchez-Rodríguez D, Pascual J, Pérez-Sáez MJ, Marco E. Association between muscle strength and echogenicity using greyscale ultrasound software: a diagnostic accuracy study in kidney transplant candidates. Eur J Phys Rehabil Med 2025; 61:119-129. [PMID: 39679795 PMCID: PMC11922199 DOI: 10.23736/s1973-9087.24.08496-x] [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: 03/07/2024] [Revised: 07/26/2024] [Accepted: 11/21/2024] [Indexed: 12/17/2024]
Abstract
BACKGROUND Advanced chronic kidney disease disrupts the delicate equilibrium between protein anabolism and catabolism, leading to alterations in muscle quantity, quality, and function. Musculoskeletal ultrasound emerges as a promising assessment tool due to its widespread availability and high reliability. AIM To evaluate the efficacy of rectus femoris (RF) echogenicity, measured using greyscale software, in identifying diminished muscle quality and strength in candidates for kidney transplant. DESIGN Post-hoc diagnostic accuracy study. SETTING Outpatients in a multimodal prehabilitation program pre kidney transplantation (KT). POPULATION Patients on the waiting list for KT. METHODS Sensitivity, specificity, likelihood ratios and area under the curve (AUC) for diagnostic efficacy of echogenicity (index test) assessed with the ImageJ software greyscale as a potential marker of quadriceps muscle weakness (reference test) were calculated. Muscle weakness was considered as maximal voluntary isometric contraction of the quadriceps (Q-MVIC) <40% of body weight. Other variables included body composition parameters derived from multifrequency electrical bioimpedance, upper limb muscle strength (handgrip), and RF thickness assessed by ultrasound. Statistical tests: Chi-square, t-Student, Pearson correlation coefficients (r), bivariate and multivariate logistic regression models. Statistical significance level ≤0.05. RESULTS Of 112 patients (mean age: 63.6, 76% male), 72 (63.7%) exhibited quadriceps weakness, while 80 (70.8%) had some degree of overhydration (extracellular water/total body water ratio >0.390). The echogenicity cut-off point of highest concordance with muscle weakness was 70, boasting a sensitivity of 83%, specificity of 57%, and AUC of 0.671 (CI 95% 0.570-0.772 [P=0.003]). Echogenicity >70 was associated with a 3.4-fold higher risk of muscle weakness (crude OR = 3.4 [CI95% 1.4 to 8.0]), which persisted after adjusting for age, height, weight and RF thickness. CONCLUSIONS The RF echogenicity exhibits fair validity in identifying muscle weakness among candidates for KT. However, it cannot be endorsed as a standalone diagnostic tool in this population. CLINICAL REHABILITATION IMPACT Early identification of muscle weakness would advance efforts to mitigate morbidity and mortality through targeted measures.
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Affiliation(s)
- Carolina Acuña-Pardo
- Department of Physical Medicine and Rehabilitation, Hospital del Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Elena Muñoz-Redondo
- Department of Physical Medicine and Rehabilitation, Hospital del Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Lou Delcros-Forestier
- Department of Physical Medicine and Rehabilitation, Hospital del Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Yulibeth G Curbelo
- Department of Physical Medicine and Rehabilitation, Hospital del Mar, Barcelona, Spain
| | | | - Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- National Institute of Physical Medicine and Rehabilitation (INMFRE), Panama City, Panama
- Department of Physical Medicine and Rehabilitation, Caja de Seguro Social (CSS), Panama City, Panama
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Geriatrics, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Julio Pascual
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria J Pérez-Sáez
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Ester Marco
- Department of Physical Medicine and Rehabilitation, Hospital del Mar, Barcelona, Spain -
- Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Kim JW, Yang SJ. Dietary Patterns, Kidney Function, and Sarcopenia in Chronic Kidney Disease. Nutrients 2025; 17:404. [PMID: 39940262 PMCID: PMC11821004 DOI: 10.3390/nu17030404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 01/14/2025] [Accepted: 01/21/2025] [Indexed: 02/14/2025] Open
Abstract
Sarcopenia is a condition characterized by the loss of muscle mass and function. It is a risk factor for adverse clinical outcomes, including falls, disability, and mortality in patients with chronic kidney disease (CKD). The progression of CKD leads to metabolic disturbances and pathophysiological changes. These alterations, such as metabolic acidosis, dysregulated muscle proteostasis, and excessive inflammation, contribute to accelerated muscle wasting, resulting in sarcopenia. Proper nutritional interventions are essential in the management of sarcopenia in patients with CKD. Appropriate dietary intake of protein and specific micronutrients, carefully considering the needs and restrictions of CKD, may help maintain muscle mass and function. Specific dietary patterns, such as an anti-inflammatory diet, Dietary Approaches to Stop Hypertension diet, and a plant-based diet, may be beneficial for attenuating muscle wasting in CKD patients. The underlying mechanisms of how these dietary patterns affect sarcopenia are multifaceted, including inflammation, oxidative stress, and defects in muscle protein homeostasis. This review summarizes the current evidence on the relationship between dietary patterns and sarcopenia, as well as the underlying mechanisms of how dietary patterns modulate sarcopenia in CKD patients.
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Affiliation(s)
| | - Soo Jin Yang
- Department of Food and Nutrition, Seoul Women’s University, Seoul 01797, Republic of Korea
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Hu X, Ye X, Chen H, Wu B, Guo Q, Yu C, Ding W, Niu J, Zhao J, Qi H, Zhang S, Xue C, Zhang L. Depression as a risk factor for osteoporosis independent of sarcopenia in hemodialysis patients: findings from a multicenter cross-sectional study. BMC Nephrol 2025; 26:35. [PMID: 39849392 PMCID: PMC11755883 DOI: 10.1186/s12882-025-03963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 01/14/2025] [Indexed: 01/25/2025] Open
Abstract
BACKGROUND Osteoporosis and sarcopenia frequently occur in patients with end-stage renal disease undergoing hemodialysis (HD), and depression is also a common mental health issue in this population. Despite the prevalence of these conditions, the interrelationships among them remain poorly understood in HD patients. METHODS In this multicenter cross-sectional study, 858 HD patients from 7 dialysis centers were recruited. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was calculated from body composition data obtained through multifrequency bioimpedance analysis (BIA), while handgrip strength (HGS) was measured with a dynamometer. Gait speed was evaluated with a 4-meter walk test, and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). RESULTS Among the 858 participants (524 men, 334 women), 39.2% had osteoporosis. The prevalence of sarcopenia and depression was 18.9% and 42.1%, respectively. Logistic regression analysis showed that SMI was significantly associated with a decreased risk of osteoporosis (OR = 0.638, 95% CI = 0.494-0.823, P = 0.001), while HGS was not(OR = 0.990, 95% CI = 0.963-1.017, P = 0.449). HD patients with sarcopenia were 1.92 times more likely to have osteoporosis than those without sarcopenia. Most notably, after adjusting for both sarcopenia and SMI, the risk of osteoporosis in HD patients with depression was 1.45 times higher than in those without depression (OR = 1.452, 95% CI = 1.060-1.989, P = 0.020). CONCLUSIONS In HD patients, increased muscle mass, rather than muscle strength, is linked to a lower risk of osteoporosis. Notably, depression emerges as a significant risk factor for osteoporosis in this population, highlighting the need for mental health considerations in managing bone health.
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Affiliation(s)
- Xiaohua Hu
- Department of Nephrology, Zhabei Central Hospital of Jing'an District, No. 619 Zhonghua New Road, Shanghai, 20070, China
| | - Xianwu Ye
- Department of Nephrology, Zhabei Central Hospital of Jing'an District, No. 619 Zhonghua New Road, Shanghai, 20070, China
| | - Haimin Chen
- Department of Hematology and Oncology, Zhabei Central Hospital of Jing'an District, Shanghai, China
| | - Bibo Wu
- Department of Nephrology, Zhabei Central Hospital of Jing'an District, No. 619 Zhonghua New Road, Shanghai, 20070, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital School of Medicine, Tongji University, Shanghai, China
| | - Wei Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianying Niu
- Department of Nephrology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Junli Zhao
- Department of Nephrology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Hualin Qi
- Department of Nephrology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Suhua Zhang
- Department of Nephrology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China
| | - Cheng Xue
- Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University (Naval Medical University), Shanghai, China.
| | - Liming Zhang
- Department of Nephrology, Zhabei Central Hospital of Jing'an District, No. 619 Zhonghua New Road, Shanghai, 20070, China.
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Zhao Q, Yang X, Bao M, Zhang M, Wang D. Knowledge, attitudes, and practice toward sarcopenia among maintenance dialysis patients in Anhui, China. BMC Public Health 2025; 25:292. [PMID: 39849393 PMCID: PMC11758721 DOI: 10.1186/s12889-024-21198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/24/2024] [Indexed: 01/25/2025] Open
Abstract
BACKGROUND To explore the knowledge, attitudes, and practice (KAP) toward sarcopenia among maintenance dialysis (MHD) patients in Anhui. METHODS This multicenter cross-sectional study was conducted in November 2022 among MHD patients in the Anhui Province, China. A self-administered questionnaire was used to collect their demographic characteristics and KAP toward sarcopenia. RESULTS A total of 1548 questionnaires were collected, with 909 (58.72%) being valid. The average knowledge, attitude, and practice scores were 4.45 ± 4.21 (possible range: 0-12), 28.21 ± 3.71 (possible range: 8-40), and 18.04 ± 4.28 (possible range: 7-35) points, respectively. The multivariable logistic regression showed that 5.1-10 years of dialysis (OR = 0.38, 95% CI: [0.15, 0.97]) and attitude scores (OR = 1.36, 95% CI: [1.25, 1.48]) were independently associated with practice. The structural equation model showed that knowledge had a direct effect on attitudes (β = 0.38, 95% CI: [0.33, 0.44]) and practice (β = 0.18, 95% CI: [0.11, 0.24]) and had an indirect effect on practice though attitudes (β = 0.42, 95% CI: [0.35, 0.50]). CONCLUSION The MHD patients in Anhui showed insufficient knowledge and moderate attitudes and practices toward sarcopenia. Proactive practice might be facilitated and achieved by improving knowledge and attitudes.
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Affiliation(s)
- Qianyun Zhao
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, 230601, China
| | - Xiyao Yang
- Nursing Department, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230061, China
| | - Manzhen Bao
- Nursing Department, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230061, China
| | - Miao Zhang
- Nursing Department, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230061, China
| | - Deguang Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, 230601, China.
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Morais DM, Trombim IC, de Góes CR, Vogt BP. The adductor pollicis muscle thickness is not associated with physical function, lean mass, and nutritional status in patients on maintenance hemodialysis. Front Nutr 2025; 11:1502309. [PMID: 39912060 PMCID: PMC11796473 DOI: 10.3389/fnut.2024.1502309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 12/30/2024] [Indexed: 02/07/2025] Open
Abstract
Background The adductor pollicis muscle thickness (APMT) may be associated with the muscle strength in patients on hemodialysis. However, the association of APMT with other physical function assessment tests has not yet been tested. Moreover, because it is considered a good nutritional indicator and not influenced by fluid overload, the APMT may be associated with the muscle mass and nutritional status of these patients. Therefore, the objective was to assess the association of APMT with physical function, muscle mass and nutritional status in patients on hemodialysis. Methods The APMT was measured using a skinfold caliper between pollicis finger and index finger. Physical function was evaluated by handgrip strength (HGS), Short Physical Performance Battery (SPPB), the sit-to-stand test, gait speed test, and timed up and go (TUG). Appendicular muscle mass index (AMMI) was estimated using bioelectrical impedance. The nutritional status was evaluated by the Malnutrition Inflammation Score (MIS). Results Fifty-one patients were included, 60.8% men, mean age 58.4 ± 12.6 years. There were no significant correlations of APMT with physical function, muscle mass and nutritional status. Values of APMT were not different between the groups according to adequate physical function or muscle mass. In the multiple linear regression analysis adjusted for sex, age and diabetes, APMT was not significantly associated with physical function tests, as HGS (β = 0.101; p = 0.778), gait speed (β = -0.014; p = 0.180), SPPB (β = -0.054; p = 0.590), TUG (β = 0.202; p = 0.109), lean mass AMMI (β = 0.058; p = 0.147). Conclusion There were no associations of APMT with physical function, muscle mass and nutritional status in patients on hemodialysis. We suggest APMT should not be used in physical function and nutritional assessments of these patients.
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Affiliation(s)
| | | | - Cassiana Regina de Góes
- Institute of Biological and Health Sciences, Federal University of Viçosa, Campus Rio Paranaíba, Rio Paranaíba, Brazil
| | - Barbara Perez Vogt
- Faculty of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Brazil
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Zhang Y, Zhang Z, Cao Z, Bai X, Zhang S, Zhang S, Tang J, Xi J, Xie Y, Wu Y, Liu Z, Liu W. Clinical and novel insights into risk factors for sarcopenia in dialysis patients: a systematic review and meta-analysis. BMC Musculoskelet Disord 2025; 26:58. [PMID: 39825310 PMCID: PMC11742487 DOI: 10.1186/s12891-025-08317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 01/09/2025] [Indexed: 01/20/2025] Open
Abstract
OBJECTIVE We employed a meta-analysis to investigate the risk factors associated with sarcopenia in patients undergoing dialysis. METHODS We conducted a search in PubMed, Embase, Cochrane Library, and Web of Science databases. Inclusion criteria included case-control and cohort studies on risk factors for sarcopenia in dialysis patients. The search period spanned from the inception of each database to September 20, 2024. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Data analysis was performed using Stata 15.0. RESULT A total of 625 articles were screened, with 610 articles excluded based on predefined eligibility criteria, resulting in 15 articles involving 2904 individuals were included in the final analysis, meta-analysis results indicate that older dialysis patients [SMD = 0.76, 95% CI (0.54, 0.99), I2 = 81%, P = 0.001], those with a lower BMI [SMD = -0.50, 95% CI (-0.80, -0.20), I2% = 87.4%, P = 0.02], a lower SMI [SMD = -2.67, 95% CI (-3.87, -1.47), I2% = 98.2%, P = 0.001], and those with diabetes [OR = 1.43, 95% CI (1.13, 1.82), I2% = 48.8%, P = 0.03] are more likely to develop sarcopenia. CONCLUSION Based on current research, our study found that elderly dialysis patients, those with a lower BMI, lower SMI, and diabetic patients are more likely to develop sarcopenia. These findings highlight the necessity of early intervention for these high-risk groups. However, the study has limitations. Future research should address these limitations and investigate the mechanisms linking these risk factors to sarcopenia to develop targeted prevention and treatment strategies.
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Affiliation(s)
- Yifei Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Zeyu Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | | | - Xuehui Bai
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Shujiao Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Shuaixing Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jingyi Tang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Junyu Xi
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yiran Xie
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yuqi Wu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Zhongjie Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
- Renal Research Institution of Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
| | - Weijing Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
- Renal Research Institution of Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
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Guo J, Liu Z, Wang P, Wu H, Fan K, Jin J, Zheng L, Liu Z, Xie R, Li C. Global, regional, and national burden inequality of chronic kidney disease, 1990-2021: a systematic analysis for the global burden of disease study 2021. Front Med (Lausanne) 2025; 11:1501175. [PMID: 39882527 PMCID: PMC11774877 DOI: 10.3389/fmed.2024.1501175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 12/30/2024] [Indexed: 01/31/2025] Open
Abstract
Background Chronic kidney disease (CKD) is a significant global health issue, often linked to diabetes, hypertension, and glomerulonephritis. However, aggregated statistics can obscure heterogeneity across subtypes, age, gender, and regions. This study aimed to analyze global CKD trends from 1990 to 2021, focusing on age, gender, socio-demographic index (SDI), and regional variations. Methods Data were extracted from the Global Burden of Disease (GBD) 2021 database, covering prevalence, incidence, mortality, and disability-adjusted life years (DALYs). These were presented as counts per 100,000 population and age-standardized rates, with uncertainty intervals (UIs) to highlight variability. Joinpoint regression was used to assess trends over the 30-year period. Results In 2021, global CKD prevalence was 359 million, with 11.13 million new cases, 1.53 million deaths, and 44.45 million DALYs-up 92, 156, 176, and 114% since 1990. While prevalence slightly declined, incidence, mortality, and DALYs increased significantly. CKD burden varied by region and age, with notable gender disparities. Conclusion The study highlights a dramatic rise in CKD burden linked to population growth and aging, emphasizing the need for targeted treatment and effective global healthcare policies.
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Affiliation(s)
- Jingxun Guo
- Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science and Ocular Surface and Corneal Diseases, Xiamen, Fujian, China
| | - Zhen Liu
- Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science and Ocular Surface and Corneal Diseases, Xiamen, Fujian, China
| | - Pengjun Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Heming Wu
- Department of Basic Medical Sciences, School of Medicine, Xiamen University, Xiamen, China
| | - Kai Fan
- Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science and Ocular Surface and Corneal Diseases, Xiamen, Fujian, China
| | - Jianbo Jin
- Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science and Ocular Surface and Corneal Diseases, Xiamen, Fujian, China
| | - Lan Zheng
- Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science and Ocular Surface and Corneal Diseases, Xiamen, Fujian, China
| | - Zeyu Liu
- Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science and Ocular Surface and Corneal Diseases, Xiamen, Fujian, China
| | - Renyi Xie
- Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Clinical Research Center for Eye Diseases, Xiamen, Fujian, China
| | - Cheng Li
- Eye Institute and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science and Ocular Surface and Corneal Diseases, Xiamen, Fujian, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Huaxia Eye Hospital of Quanzhou, Quanzhou, Fujian, China
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M Y, Parmar PA, Sharma S, Kakadiya JP, Lakkad D. Neutrophil-to-lymphocyte ratio as a novel predictor of sarcopenia in maintenance hemodialysis patients: a cross-sectional study exploring associations across body composition categories. BMC Musculoskelet Disord 2025; 26:39. [PMID: 39794771 PMCID: PMC11721321 DOI: 10.1186/s12891-025-08291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 01/06/2025] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND Sarcopenia is prevalent among hemodialysis patients and is associated with poor outcomes. The neutrophil-to-lymphocyte ratio (NLR), an easily obtainable marker of inflammation, may predict sarcopenia risk. This study aimed to investigate the association between NLR and sarcopenia risk in maintenance hemodialysis patients, examining this association in the context of obesity. METHODS This cross-sectional study included 411 maintenance hemodialysis patients. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria-2019 (AWGS 2019). Body composition was assessed using bioelectrical impedance analysis. Logistic regression models examined associations between NLR and sarcopenia risk, adjusting for potential confounders. Analyses were stratified by obesity status. RESULTS The prevalence of sarcopenia was 51% (95% CI: 45.1-54.9%), with 37.2% classified as sarcopenic non-obese and 13.6% as sarcopenic obese. In fully adjusted models, each unit increase in NLR was associated with 10% higher odds of sarcopenia overall (OR 1.10, 95% CI: 1.00-1.21, p = 0.048). This association remained significant in sarcopenic obese patients (OR 1.15, 95% CI: 1.00-1.32, p = 0.049). Patients in the highest NLR tertile had 1.95 times higher odds of sarcopenia compared to the lowest tertile (95% CI: 1.12-3.40, p = 0.018), with a significant trend across tertiles (p-trend = 0.015). CONCLUSIONS NLR is independently associated with sarcopenia risk in hemodialysis patients, including those with obesity. These findings suggest NLR could serve as a simple, cost-effective tool for identifying hemodialysis patients at high risk of sarcopenia, potentially facilitating early intervention strategies.
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Affiliation(s)
- Yogesh M
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
| | - Parth Anilbhai Parmar
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India.
| | - Soumya Sharma
- Shri M P Shah Government Medical College, Jamnagar, 361006, Gujarat, India
| | | | - Dhruv Lakkad
- Shri M P Shah Government Medical College, Jamnagar, 361006, Gujarat, India
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Hou Z, Li X, Yang L, Liu T, Lv H, Sun Q. Prediction models for sarcopenia risk in dialysis patients: a systematic review and critical appraisal. Aging Clin Exp Res 2025; 37:18. [PMID: 39752019 PMCID: PMC11698787 DOI: 10.1007/s40520-024-02911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 12/16/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND Many studies have developed or validated predictive models to estimate the risk of sarcopenia in dialysis patients, but the quality of model development and the applicability of the models remain unclear. OBJECTIVE To systematically review and critically evaluate currently available predictive models for sarcopenia in dialysis patients. METHODS We systematically searched five databases until March 2024. Observational studies that developed or validated predictive models or scoring systems for sarcopenia in dialysis patients were considered eligible. We included studies of adults (≥ 18 years of age) on dialysis and excluded studies that did not validate the predictive model. Data extraction was performed independently by two authors using a standardized data extraction table based on a checklist of key assessments and data extraction for systematic evaluation of predictive modeling research. The quality of the model was assessed using the Predictive Model Risk of Bias Assessment Tool. RESULTS Of the 104,454 studies screened, 13 studies described 13 predictive models. The incidence of sarcopenia in dialysis patients ranged from 6.6 to 34.4%. The most commonly used predictors were age and body mass index. In the derivation set, the reported area under the curve or C-statistic is between 0.81 and 0.95. The area under the curve reported by the external validation set is between 0.78 and 0.93. All studies had a high risk of bias, mainly due to poor reporting in the outcome and the analysis domains, and three studies had a high risk of bias in terms of applicability. CONCLUSION Future research should focus on validating and improving existing predictive models or developing new models using rigorous methods.
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Affiliation(s)
- Zhuoer Hou
- The College of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
- The Affiliated Shaoyifu Hospital of Zhejiang University, Hangzhou, China
| | - Xiaoyan Li
- The College of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lili Yang
- The College of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ting Liu
- The College of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hangpeng Lv
- Department of stomatology, Haining Traditional Chinese Medicine Hospital, Jiaxing, China
| | - Qiuhua Sun
- The College of Nursing, Zhejiang Chinese Medical University, Hangzhou, China.
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Ahmed FE, Hassen EZ, Mousa FME, Abdelfadeel KF. Ameliorating role of co-administration of granulocyte colony stimulating factor and sodium bicarbonate on the skeletal muscle of a rat model of chronic kidney disease (A histological and immunohistochemical study). Ultrastruct Pathol 2025; 49:67-92. [PMID: 39741386 DOI: 10.1080/01913123.2024.2446242] [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: 10/02/2024] [Revised: 11/22/2024] [Accepted: 12/20/2024] [Indexed: 01/03/2025]
Abstract
Over half million individuals suffer from chronic kidney disease (CKD) worldwide. In addition to raising the possibility of cardiovascular diseases, skeletal myopathy remains a challenging complication that is highly correlated with mortality and a lower quality of life. Granulocyte-colony stimulating factor (G-CSF) is an active cytokine for mobilization of immunological and hematopoietic stem cells that can replace exogenous stem cell infusions. So, it is seen as a less expensive and noninvasive tool for regenerative medicine. Sixty three rats were divided into 4 groups: I control, II CKD induced, IIIa, IIIb treated and IV recovery groups. After induction of CKD in all rats, group II were sacrificed after 4 weeks. Rats of group IIIa received NaHCO3. Group IIIb rats were injected subcutaneously by G-CSF as 100 µg/kg/day for 5 successive days in addition to NaHCO3 as group IIIa. Group IV rats were housed for 4 weeks without treatment. Serum urea, creatinine, tissue MDA& TNF-α were assessed. Renal and gastrocnemius muscle sections were evaluated for histological structure, CD34 and myogenin immune expression, morphometric and statistical analyses. The CKD group revealed a significant increase in MDA and TNF-α. Furthermore, features of renal injury, muscle degenerative changes, increased collagen and decreased CD34 and myogenin expression were observed. Alterations were partially attenuated by NaHCO3, while GCSF remarkably improved most parameters. The current results indicated that co-administration of GCSF and NaHCO3 could ameliorate CKD myopathy via attenuating oxidative stress, immunomodulation, pro-angiogenic ability, myocyte regeneration. In addition to the reduction of mitochondrial stress and maintenance of cellular homeostasis.
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Affiliation(s)
- Fayza E Ahmed
- Medical Histology and Cell Biology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ebtahal Z Hassen
- Medical Histology and Cell Biology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Fatma M E Mousa
- Medical Histology and Cell Biology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Karima F Abdelfadeel
- Medical Histology and Cell Biology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Leng YJ, Wang GR, Xie RN, Jiang X, Li CX, Nie ZM, Li T. Risk Prediction Models for Sarcopenia in Dialysis Patients: A Systematic Review. J Ren Nutr 2025; 35:146-155. [PMID: 38848803 DOI: 10.1053/j.jrn.2024.05.009] [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: 09/14/2023] [Revised: 04/04/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
Nowadays, numerous studies have developed risk prediction models for sarcopenia in dialysis patients. However, the quality and performance of these models have not been integrated. The purpose of our study is to provide a comprehensive overview of the current risk prediction models for sarcopenia in dialysis patients and to offer a reference for the development of high-quality prediction models. Ten electronic databases were searched from inception to March 8, 2024. Two researchers independently assessed the risk of bias and applicability of the studies, and used Revman, 5.4, software to conduct a meta-analysis of common predictors in the models. A total of 12 studies described 13 risk prediction models for dialysis patients with sarcopenia. In dialysis patients, the prevalence of sarcopenia ranged from 6.60% to 63.73%. The area under curve (AUC) of the 13 models ranged from 0.776 to 0.945. Only six models (AUC ranging from 0.73 to 0.832) were internally validated, while two were externally evaluated (AUC ranging from 0.913 to 0.955). Most studies had a high risk of bias. The most common effective predictors in the models were age, body mass index, muscle circumference, and C-reactive protein. Our study suggests that developing a prediction model for the onset of sarcopenia in dialysis patients requires a rigorous design scheme, and future verification methods will necessitate multicenter external validation.
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Affiliation(s)
- Ying-Jie Leng
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guo-Rong Wang
- West China School of Public Health and West China Fourth Hospital, West China Nursing School, Sichuan University, Chengdu, China.
| | - Ruo-Nan Xie
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Jiang
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Cheng-Xiang Li
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhuo-Miao Nie
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Li
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Visser WJ, de Geus M, van Ruijven IM, van Egmond-de Mik AME, Venrooij L, Minnee RC, Moeskops P, Oei EHG, Dam M, Severs D. Fat-Free Mass Derived From Bioimpedance Spectroscopy and Computed Tomography are in Good Agreement in Patients With Chronic Kidney Disease. J Ren Nutr 2025; 35:72-80. [PMID: 38848806 DOI: 10.1053/j.jrn.2024.05.011] [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: 08/15/2023] [Revised: 01/30/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE Malnutrition is highly prevalent in patients with kidney failure. Since body weight does not reflect body composition, other methods are needed to determine muscle mass, often estimated by fat-free mass (FFM). Bioimpedance spectroscopy (BIS) is frequently used for monitoring body composition in patients with kidney failure. Unfortunately, BIS-derived lean tissue mass (LTMBIS) is not suitable for comparison with FFM cutoff values for the diagnosis of malnutrition, or for calculating dietary protein requirements. Hypothetically, FFM could be derived from BIS (FFMBIS). This study aims to compare FFMBIS and LTMBIS with computed tomography (CT) derived FFM (FFMCT). Secondarily, we aimed to explore the impact of different methods on calculated protein requirements. METHODS CT scans of 60 patients with kidney failure stages 4-5 were analyzed at the L3 level for muscle cross-sectional area, which was converted to FFMCT. Spearman rank correlation coefficient and 95% limits of agreement were calculated to compare FFMBIS and LTMBIS with FFMCT. Protein requirements were determined based on FFMCT, FFMBIS, and adjusted body weight. Deviations over 10% were considered clinically relevant. RESULTS FFMCT correlated most strongly with FFMBIS (r = 0.78, P < .001), in males (r = 0.72, P < .001) and in females (r = 0.60, P < .001). A mean difference of -0.54 kg was found between FFMBIS and FFMCT (limits of agreement: -14.88 to 13.7 kg, P = .544). Between LTMBIS and FFMCT a mean difference of -12.2 kg was apparent (limits of agreement: -28.7 to 4.2 kg, P < .001). Using FFMCT as a reference, FFMBIS best predicted protein requirements. The mean difference between protein requirements according to FFMBIS and FFMCT was -0.7 ± 9.9 g in males and -0.9 ± 10.9 g in females. CONCLUSION FFMBIS correlates well with FFMCT at a group level, but shows large variation within individuals. As expected, large clinically relevant differences were observed in calculated protein requirements.
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Affiliation(s)
- Wesley J Visser
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, Rotterdam, The Netherlands.
| | - Manon de Geus
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, Rotterdam, The Netherlands; Faculty of Sports and Nutrition, Department of Nutrition and Dietetics, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Isabel M van Ruijven
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Anneke M E van Egmond-de Mik
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Lucie Venrooij
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Robbert C Minnee
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands; Division of HPB/Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Edwin H G Oei
- Deptartment of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Manouk Dam
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - David Severs
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands; Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Madrid-Gambin F, Pérez-Sáez MJ, Gómez-Gómez A, Haro N, Redondo-Pachón D, Dávalos-Yerovi V, Marco E, Crespo M, Pozo OJ, Pascual J. Frailty and sarcopenia metabolomic signatures in kidney transplant candidates: the FRAILMar study. Clin Kidney J 2025; 18:sfae366. [PMID: 40008357 PMCID: PMC11852263 DOI: 10.1093/ckj/sfae366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Indexed: 02/27/2025] Open
Abstract
Background Sarcopenia and frailty are often overlooked in assessing kidney transplant (KT) candidates with chronic kidney disease (CKD), potentially leading to poor post-transplant outcomes. This study aimed to identify metabolites associated with frailty and sarcopenia in KT candidates from the FRAILMar study. Methods Between June 2016 and June 2020, we evaluated frailty and sarcopenia in 173 KT candidates using the Physical Frailty Phenotype and EGWSOP-2 criteria, respectively. Seventy-five metabolic markers from targeted pathways, previously linked to CKD, sarcopenia or frailty, were measured in serum samples. These markers were analyzed using adjusted and weighted generalized linear models. Metabolomic data were integrated with multi-modal data, such as comorbidities, using a factor-based integration algorithm to identify metabolic phenotypes. Results Increased metabolites related to energy metabolism and essential amino acids were associated with frailty, mainly Krebs cycle intermediates. Sarcopenic KT candidates showed lower levels of aromatic amino acids, and lower protein/muscle metabolism, energy metabolism and neurotransmission compared with non-sarcopenic patients. Unsupervised multi-modal integration revealed a high-risk metabolic phenotype characterized by the presence of sarcopenia, diabetes mellitus and low body mass index, with alterations in branched-chain amino acids and high activity of lactate dehydrogenase enzyme. Conclusions Frailty and sarcopenia are common among KT candidates, and their metabolic status reveals notable disruptions in energy and amino acid metabolism. These findings highlight the value of a detailed metabolic assessment to more accurately evaluate patient health status prior to transplantation.
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Affiliation(s)
| | - María José Pérez-Sáez
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Alex Gómez-Gómez
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Noemí Haro
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Dolores Redondo-Pachón
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Vanessa Dávalos-Yerovi
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Rehabilitation Research Group, Hospital del Mar Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Rehabilitation Research Group, Hospital del Mar Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Oscar J Pozo
- Applied Metabolomics Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Nephrology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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Shaaker H, Davenport A. Assessment of Nutritional Intake in Patients With Kidney Failure Treated by Haemodialysis on Dialysis and Non-dialysis Days. J Ren Nutr 2025; 35:172-180.e1. [PMID: 38992516 DOI: 10.1053/j.jrn.2024.07.009] [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: 06/17/2023] [Revised: 05/24/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION/AIMS/OBJECTIVE Inadequate nutritional intake in haemodialysis (HD) patients increases the risk of muscle wasting, nutrient deficiencies, leading to an increased risk of additional morbidity and mortality. We aimed to assess nutritional intake on the dialysis day and nondialysis day (NDD) of patients established on HD. METHODS We employed a 2-day dietary record, one on the day of dialysis and one on the NDD, and then determined nutritional intake using the Nutritics software. Muscle strength was assessed by hand grip strength, and the body composition was determined using multifrequency bioelectrical impedance recorded postdialysis. RESULTS We recruited 51 established HD patients dialysing between May 2022 and July 2022, of mean age 60 ± 15 years, 52.9% male, and 51% diabetic. Only 25% achieved the calorie and protein intake recommended by Kidney Disease Outcomes Quality Initiative. Most patients had inadequate consumption of fiber (96%), calcium (86%), iron (80%), zinc (82%), selenium (92%), folate (82%), vitamin A (88%), and (100%) vitamin D. On the other hand, the great majority followed the restriction guidelines for potassium (96%), phosphorus (86%), and sodium (84%), respectively. However, consumption was greater for potassium (P = .007), phosphorus (P = .015), and zinc (P = .032) on NDDs versus dialysis days, but there was no difference in protein or calorie intake between days. CONCLUSION Our results suggest that many of our HD patients do not achieve the recommended nutritional targets. Patient compliance with restricting sodium, potassium, and phosphate limits protein and calorie intake. HD patients are at increased risk of sarcopenia, so failure to achieve dietary protein intake will further increase this risk.
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Affiliation(s)
- Haalah Shaaker
- Division of Medicine, University College London, London, United Kingdom; Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Andrew Davenport
- Department of Renal Medicine, Royal Free Hospital, University College London, London, United Kingdom
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Westenberg LB, van Londen M, Zorgdrager M, de Borst MH, Viddeleer AR, Bakker SJL, Pol RA. Higher skeletal muscle mass associates with higher measured glomerular filtration rate in healthy individuals. Nephrol Dial Transplant 2024; 40:212-214. [PMID: 39363226 DOI: 10.1093/ndt/gfae217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Indexed: 10/05/2024] Open
Affiliation(s)
- Lisa B Westenberg
- Department of Surgery, Division of Transplant Surgery
- Department of Internal Medicine, Division of Nephrology
| | | | - Marcel Zorgdrager
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Alain R Viddeleer
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Robert A Pol
- Department of Surgery, Division of Transplant Surgery
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