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Dynapaenia and sarcopaenia in chronic haemodialysis patients: do muscle weakness and atrophy similarly influence poor outcome?
- Source :
- Nephrology Dialysis Transplantation, Nephrology Dialysis Transplantation, Oxford University Press (OUP), In press, ⟨10.1093/ndt/gfaa353⟩, Nephrology Dialysis Transplantation, In press, ⟨10.1093/ndt/gfaa353⟩
- Publication Year :
- 2020
-
Abstract
- Background Sarcopaenia, defined as a decline in both muscle mass and function, has been recognized as a major determinant of poor outcome in haemodialysis (HD) patients. It is generally assumed that sarcopaenia is driven by muscle atrophy related to protein-energy wasting. However, dynapaenia, defined as weakness without atrophy, has been characterized by a different disease phenotype from sarcopaenia. The aim of this study was to compare the characteristics and prognosis of sarcopaenic and dynapaenic patients among a prospective cohort of chronic HD (CHD) patients. Methods Two hundred and thirty-two CHD patients were enrolled from January to July 2016 and then followed prospectively until December 2018. At inclusion, weakness and atrophy were, respectively, evaluated by maximal voluntary force (MVF) and creatinine index (CI). Sarcopaenia was defined as the association of weakness and atrophy (MVF and CI below the median) while dynapaenia was defined as weakness not related to atrophy (MVF below the median, and CI above the median). Results From a total of 187 prevalent CHD patients [65% of men, age 65.3 (49.7–82.0) years], 44 died during the follow-up period of 23.7 (12.4–34.9) months. Sarcopaenia and dynapaenia were observed in 33.7 and 16% of the patients, respectively. Compared with patients with sarcopaenia, patients with dynapaenia were younger and with a lower Charlson score. In contrast, mortality rate was similar in both groups (38 and 27%, respectively). After adjustment for age, sex, lean tissue index, serum albumin, high-sensitivity C-reactive protein (hs-CRP), haemoglobin (Hb), normalized protein catabolic rate (nPCR), dialysis vintage and Charlson score, only patients with dynapaenia were at increased risk of death [hazard ratio (HR) = 2.99, confidence interval 1.18–7.61; P = 0.02]. Conclusions Screening for muscle functionality is highly warranted to identify patients with muscle functional impairment without muscle atrophy. In contrast to sarcopaenia, dynapaenia should appear as a phenotype induced by uraemic milieu, characterized by young patients with low Charlson score and poor prognosis outcome independently of serum albumin, hs-CRP, Hb, nPCR and dialysis vintage.
- Subjects :
- Male
medicine.medical_specialty
Weakness
Sarcopenia
[SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO]
medicine.medical_treatment
030232 urology & nephrology
030204 cardiovascular system & hematology
sarcopenia
[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology
03 medical and health sciences
0302 clinical medicine
Atrophy
Renal Dialysis
Internal medicine
medicine
[SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO]
Humans
Prospective Studies
10. No inequality
Prospective cohort study
Dialysis
Aged
Transplantation
Muscle Weakness
business.industry
chronic haemodialysis
Muscle weakness
dynapenia
medicine.disease
[SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology
Muscle atrophy
Muscular Atrophy
muscle mass
Nephrology
Creatinine
muscle strength
Kidney Failure, Chronic
Hemodialysis
medicine.symptom
business
Subjects
Details
- ISSN :
- 14602385 and 09310509
- Volume :
- 36
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
- Accession number :
- edsair.doi.dedup.....dd8230f34768d8a9309207a7a550beb0