Adrian Slee1, Clare McKeaveney2, Gary Adamson3, Andrew Davenport4, Ken Farrington5, Denis Fouque6, Kamyar Kalantar-Zadeh7, John Mallett3, A Peter Maxwell8, Robert Mullan9, Helen Noble2, Donal O'Donoghue10, Sam Porter11, David S Seres12, Joanne Shields13, Miles Witham14, Joanne Reid15. 1. Division of Medicine, Faculty of Medical Sciences, University College London, London, UK. 2. School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK. 3. School of Psychology, Ulster University Magee Campus, Londonderry, UK. 4. UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK. 5. East and North Hertfordshire University NHS Trust, Stevenage, UK. 6. Department of Nephrology, Centre Hospitalier Lyon Sud, University Lyon, CARMEN, Pierre-Benite, France. 7. Division of Nephrology and Hypertension, Medicine, Pediatrics and Public Health, University of California, California. 8. School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast & Regional Nephrology Unit, Belfast City Hospital, Belfast HSC Trust, Belfast, UK. 9. Department of Nephrology, Antrim Area Hospital, Northern HSC Trust, Co., Antrim, UK. 10. School of Medicine, University of Manchester, Manchester, UK. 11. Department of Social Sciences and Social Work, Bournemouth University, UK. 12. Columbia University Medical Centre / New York Presbyterian Hospital, New York. 13. Regional Nephrology Unit, Belfast City Hospital, Belfast HSC Trust, Belfast, UK. 14. NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK. 15. School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK. Electronic address: j.reid@qub.ac.uk.
Abstract
OBJECTIVES: Haemodialysis (HD) patients suffer from nutritional problems, which include muscle wasting, weakness, and cachexia, and are associated with poor clinical outcomes. The European Working Group for Sarcopenia in Older People (EWGSOP) and Foundations for the National Institute of Health (FNIH) have developed criteria for the assessment of sarcopenia, including the use of non-invasive techniques such as bioelectrical impedance assessment (BIA), anthropometry, and hand grip strength (HGS) dynamometry. This study investigated the prevalence of muscle wasting, weakness, and sarcopenia using the EWGSOP and FNIH criteria. METHODS: BIA was performed in 24 females (f) and 63 males (m) in the post-dialysis period. Total skeletal muscle mass and appendicular skeletal muscle mass were estimated and index values (i.e., muscle mass divided by height2 [kg/m2]) were calculated (Total Skeletal Muscle Index (TSMI) and Appendicular Skeletal Muscle Index (ASMI)). Mid-arm circumference and triceps skin-fold thickness were measured and mid-upper arm muscle circumference (MUAMC) calculated. HGS was measured using a standard protocol and Jamar dynamometer. Suggested cut-points for low muscle mass and grip strength were utilized using the EWGSOP and FNIH criteria with prevalence estimated, including sarcopenia. RESULTS: The prevalence varied depending on methodology: low TSMI (moderate and severe sarcopenia combined) was 55% for whole group: 21% (f) and 68% (m). Low ASMI was 32% for whole group: 25% (f) and 35% (m). Low MUAMC was 25% for whole group: 0% (f) and 30% (m). ASMI highly correlated with Body Mass Index (r = 0.78, P < .001) and MUAMC (r = 0.68, P < .001). Muscle weakness was high regardless of cut-points used (50-71% (f); 60-79% (m)). CONCLUSIONS: Internationally, this is the first study comparing measures of muscle mass (TSMM and ASMM by BIA and MUAMC) and muscle strength (HGS) using this specific methodology in a hemodialysis population. Future work is required to confirm findings.
OBJECTIVES: Haemodialysis (HD) patients suffer from nutritional problems, which include muscle wasting, weakness, and cachexia, and are associated with poor clinical outcomes. The European Working Group for Sarcopenia in Older People (EWGSOP) and Foundations for the National Institute of Health (FNIH) have developed criteria for the assessment of sarcopenia, including the use of non-invasive techniques such as bioelectrical impedance assessment (BIA), anthropometry, and hand grip strength (HGS) dynamometry. This study investigated the prevalence of muscle wasting, weakness, and sarcopenia using the EWGSOP and FNIH criteria. METHODS: BIA was performed in 24 females (f) and 63 males (m) in the post-dialysis period. Total skeletal muscle mass and appendicular skeletal muscle mass were estimated and index values (i.e., muscle mass divided by height2 [kg/m2]) were calculated (Total Skeletal Muscle Index (TSMI) and Appendicular Skeletal Muscle Index (ASMI)). Mid-arm circumference and triceps skin-fold thickness were measured and mid-upper arm muscle circumference (MUAMC) calculated. HGS was measured using a standard protocol and Jamar dynamometer. Suggested cut-points for low muscle mass and grip strength were utilized using the EWGSOP and FNIH criteria with prevalence estimated, including sarcopenia. RESULTS: The prevalence varied depending on methodology: low TSMI (moderate and severe sarcopenia combined) was 55% for whole group: 21% (f) and 68% (m). Low ASMI was 32% for whole group: 25% (f) and 35% (m). Low MUAMC was 25% for whole group: 0% (f) and 30% (m). ASMI highly correlated with Body Mass Index (r = 0.78, P < .001) and MUAMC (r = 0.68, P < .001). Muscle weakness was high regardless of cut-points used (50-71% (f); 60-79% (m)). CONCLUSIONS: Internationally, this is the first study comparing measures of muscle mass (TSMM and ASMM by BIA and MUAMC) and muscle strength (HGS) using this specific methodology in a hemodialysis population. Future work is required to confirm findings.