Chronic kidney disease: considerations for monitoring skeletal muscle health and prescribing resistance exercise

Abstract

Skeletal muscle wasting has gained interest as a primary consequence of chronic kidney disease (CKD) due to the relationship between skeletal muscle mass, mortality and major adverse cardiovascular events in this population. The combination of reductions in physical function, skeletal muscle performance and skeletal muscle mass places individuals with CKD at greater risk of sarcopenia. Therefore the monitoring of skeletal muscle composition and function may provide clinical insight into disease progression. Dual-energy X-ray absorptiometry and bioelectrical impedance analysis are frequently used to estimate body composition in people with CKD within clinical research environments, however, their translation into clinical practice has been limited. Proxy measures of skeletal muscle quality can be obtained using diagnostic ultrasound, providing a cost-effective and accessible imaging modality to aid further clinical research regarding changes in muscle composition. Clinicians and practitioners should evaluate the strengths and limitations of the available technology to determine which devices are most appropriate given their respective circumstances. Progressive resistance exercise has been shown to improve skeletal muscle hypertrophy of the lower extremities, muscular strength and health-related quality of life in end-stage renal disease, with limited evidence available in CKD predialysis. Fundamental principles (i.e. specificity, overload, variation, reversibility, individuality) can be used in the development of more advanced programs focused on improving specific neuromuscular and functional outcomes. Future research is needed to determine the applicability of skeletal muscle monitoring in clinical settings and the feasibility and efficacy of more advanced resistance exercise approaches in those with CKD predialysis.

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

“…149 Exercise recommendations for patients with CKD do not differ from those for cardiac patients 149 and integration into a cardiac rehabilitation programme is usually feasible (Table 14). 150 Patients receiving haemodialysis may require adapted programmes. 151 The stage-based treatment of CKD should be performed in close cooperation with the nephrologist.…”

“…The programme should include a combination of endurance and resistance exercise (especially lower body exercise) and activities to develop flexibility, coordination and body awareness. See Gollie et al 150 for other programme details For a given patient, ET should depend on the baseline level of physical capacity and the CKD severity.…”

Decreased Bioimpedance Phase Angle in Patients with Diabetic Chronic Kidney Disease Stage 5

“…The loss of muscle mass was also significantly related to the glomerular filtration rate decline [18]. Skeletal muscle wasting is associated with mortality and major adverse cardiovascular events in patients with ESRD [21]. Furthermore, undernutrition is a key contributor to the development of sarcopenia and frailty in those with CKD.…”

Sarcopenia in CKD: a roadmap from basic pathogenetic mechanisms to clinical trials

“…Sarcopenia may be associated with bone disease (osteosarcopenia). In recent issues of Clinical Kidney Journal ( ckj ), several manuscripts address the issue of sarcopenia in CKD from the point of view of pathogenesis [6], monitoring and its clinical significance [7, 8], implementation and impact of exercise programmes [7, 9] and specific potential benefits of exercise programmes in dialysis and non-dialysis CKD patients, as assessed by clinical trials [10, 11].…”

“…Gollie et al . [7] review the available tools to monitor skeletal muscle composition and function in the CKD context. Specifically, they review the strengths and limitations of dual-energy X-ray absorptiometry and bioelectrical impedance to estimate body composition and of proxy measures of skeletal muscle quality using ultrasound.…”