Alice Sabatino1, Giuseppe Regolisti1, Marco Delsante1, Tommaso Di Motta2, Chiara Cantarelli2, Sarah Pioli3, Giulia Grassi4, Valentina Batini5, Mariacristina Gregorini6, Enrico Fiaccadori7. 1. Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy. 2. Postgraduate School of Nephrology, Parma University, Parma, Italy. 3. Dialysis ASL Parma, Italy. 4. Nephrology and Dialysis South, Cecina-Piombino, Livorno, Italy. 5. Nephrology and Dialysis North, Livorno, Italy. 6. Nephrology and Dialysis, Reggio Emilia, Italy. 7. Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; Postgraduate School of Nephrology, Parma University, Parma, Italy. Electronic address: enrico.fiaccadori@unipr.it.
Abstract
BACKGROUND & AIMS: Protein-Energy Wasting (PEW) is a pathological condition of renal patients with advanced Chronic Kidney Disease characterized by a progressive reduction of energy and protein assets. Nutritional status assessment, especially for what concerns muscle mass, is essential for both the identification of patients at risk for the development of PEW, as well as monitoring the effects of nutritional interventions. Ultrasound methods are easily applicable at the bedside for quantitative assessment of skeletal muscle. The present study was aimed at evaluating quadriceps rectus femoris thickness (QRFT) and quadriceps vastus intermedius thickness (QVIT) in patients on chronic hemodialysis. METHODS: This was a prospective observational study. Three groups of adult patients were studied: young healthy subjects, well-nourished hospitalized patients with normal renal function, and End-Stage Renal Disease patients on hemodialysis (ESRD-HD). QRFT and QVIT were measured at two sites bilaterally (8 measures/patient) and were compared between groups, and also between subgroups of ESRD-HD patients stratified on the basis of conventional nutritional status parameters. RESULTS: We enrolled 35 healthy subjects, 30 hospitalized patients, and 121 ESRD-HD patients on hemodialysis. QRFT and QVIT of ESRD patients on hemodialysis were lower than those of both control groups (P < 0.001). After stratifying ESRD patients into subgroups based on nutritional variable cut-offs commonly used to define PEW in this clinical setting (BMI [≥ 23 vs <23 kg/m2], albumin [≥3.8 vs <3.8 g/dL]) and malnutrition inflammation score (MIS) status (<6 vs ≥6), QRFT and QVIT of patients with worse nutritional status were significantly lower than those of well-nourished ESRD-HD patients (P value range: <0.001 to <0.05). CONCLUSION: Skeletal muscle ultrasound is a simple and easily applicable bedside technique in the dialysis units, and could represent an adequate tool for the identification of patients with reduced muscle mass.
BACKGROUND & AIMS: Protein-Energy Wasting (PEW) is a pathological condition of renal patients with advanced Chronic Kidney Disease characterized by a progressive reduction of energy and protein assets. Nutritional status assessment, especially for what concerns muscle mass, is essential for both the identification of patients at risk for the development of PEW, as well as monitoring the effects of nutritional interventions. Ultrasound methods are easily applicable at the bedside for quantitative assessment of skeletal muscle. The present study was aimed at evaluating quadriceps rectus femoris thickness (QRFT) and quadriceps vastus intermedius thickness (QVIT) in patients on chronic hemodialysis. METHODS: This was a prospective observational study. Three groups of adult patients were studied: young healthy subjects, well-nourished hospitalized patients with normal renal function, and End-Stage Renal Diseasepatients on hemodialysis (ESRD-HD). QRFT and QVIT were measured at two sites bilaterally (8 measures/patient) and were compared between groups, and also between subgroups of ESRD-HDpatients stratified on the basis of conventional nutritional status parameters. RESULTS: We enrolled 35 healthy subjects, 30 hospitalized patients, and 121 ESRD-HDpatients on hemodialysis. QRFT and QVIT of ESRDpatients on hemodialysis were lower than those of both control groups (P < 0.001). After stratifying ESRDpatients into subgroups based on nutritional variable cut-offs commonly used to define PEW in this clinical setting (BMI [≥ 23 vs <23 kg/m2], albumin [≥3.8 vs <3.8 g/dL]) and malnutrition inflammation score (MIS) status (<6 vs ≥6), QRFT and QVIT of patients with worse nutritional status were significantly lower than those of well-nourished ESRD-HDpatients (P value range: <0.001 to <0.05). CONCLUSION: Skeletal muscle ultrasound is a simple and easily applicable bedside technique in the dialysis units, and could represent an adequate tool for the identification of patients with reduced muscle mass.
Authors: Alice Sabatino; Giuseppe Regolisti; Giuseppe Benigno; Francesca Di Mario; Carla Maria Avesani; Enrico Fiaccadori Journal: J Nephrol Date: 2021-10-07 Impact factor: 3.902
Authors: Douglas W Gould; Emma L Watson; Thomas J Wilkinson; Joanne Wormleighton; Soteris Xenophontos; Joao L Viana; Alice C Smith Journal: J Cachexia Sarcopenia Muscle Date: 2019-05-03 Impact factor: 12.910
Authors: Ilaria Gandolfini; Giuseppe Regolisti; Alberto Bazzocchi; Umberto Maggiore; Alessandra Palmisano; Giovanni Piotti; Enrico Fiaccadori; Alice Sabatino Journal: Front Nutr Date: 2019-11-12