Distinguishing Between Cachexia, Sarcopenia and Protein Energy Wasting in End-Stage Renal Disease Patients on Dialysis

Reid, Joanne; Noble, Helen; Slee, Adrian; Davenport, Andrew; Farrington, Ken; Fouque, Denis; Kalantar‐Zadeh, Kamyar; Porter, Sam; Seres, David S.; Witham, Miles; Maxwell, Alexander

doi:10.17140/pmhcoj-2-e004

Cited by 7 publications

(9 citation statements)

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“…Diagnosing wasting in CKD by estimating measurements of non-oedematous tissue and muscle mass is challenging (8). Advanced CKD is associated with multiple symptoms, particularly those managed by haemodialysis (HD) (9), experience significant and complex changes to their nutritional status and body composition. These alterations to body composition can further confound identifying and diagnosing cachexia (10).…”

Section: Introductionmentioning

confidence: 99%

Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study

McKeaveney

Slee

Adamson

et al. 2020

Nephrology Dialysis Transplantation

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Background Research indicates that cachexia is common among persons with chronic illnesses and is associated with increased morbidity and mortality. However, there continues to be an absence of a uniformed disease-specific definition for cachexia in chronic kidney disease (CKD) patient populations. Objective The primary objective was to identify cachexia in patients receiving haemodialysis (HD) using a generic definition and then follow up on these patients for 12 months. Method This was a longitudinal study of adult chronic HD patients attending two hospital HD units in the UK. Multiple measures relevant to cachexia, including body mass index (BMI), muscle mass [mid-upper arm muscle circumference (MUAMC)], handgrip strength (HGS), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], appetite [Functional Assessment of Anorexia/Cachexia Therapy (FAACT)] and biomarkers [C-reactive protein (CRP), serum albumin, haemoglobin and erythropoietin resistance index (ERI)] were recorded. Baseline analysis included group differences analysed using an independent t-test, dichotomized values using the χ2 test and prevalence were reported using the Statistical Package for the Social Sciences 24 (IBM, Armonk, NY, USA). Longitudinal analysis was conducted using repeated measures analysis. Results A total of 106 patients (30 females and 76 males) were recruited with a mean age of 67.2 years [standard deviation (SD) 13.18] and dialysis vintage of 4.92 years (SD 6.12). At baseline, 17 patients were identified as cachectic, having had reported weight loss (e.g. >5% for >6 months) or BMI <20 kg/m2 and three or more clinical characteristics of cachexia. Seventy patients were available for analysis at 12 months (11 cachectic versus 59 not cachectic). The FAACT and urea reduction ratio statistically distinguished cachectic patients (P = 0.001). However, measures of weight, BMI, MUAMC, HGS, CRP, ERI and FACIT tended to worsen in cachectic patients. Conclusion Globally, cachexia is a severe but frequently underrecognized problem. This is the first study to apply the defined characteristics of cachexia to a representative sample of patients receiving HD. Further, more extensive studies are required to establish a phenotype of cachexia in advanced CKD.

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Section: Introductionmentioning

confidence: 99%

Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study

McKeaveney

Slee

Adamson

et al. 2020

Nephrology Dialysis Transplantation

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“…It is acknowledged that research with palliative populations faces particular challenges as the patient’s condition deteriorates. The research team has extensive experience working with such populations [ 18 , 19 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the clinical management of cachexia in persons with ESKD is challenging [ 14 ]. In part, this is due to the difficulty discriminating cachexia from other causes of malnutrition and weight loss [ 23 ]. For persons with ESKD there is now greater emphasis on defining clinical markers for Protein Energy Wasting (PEW) which precedes cachexia and specialised diagnostic tools are being developed and tested [ 5 , 16 ] Cachexia is seen as a severe form of PEW [ 11 , 13 ], however it is important to be able to clinically differentiate between cachexia and PEW as each may require distinct management strategies; such discrimination may also be important when defining target groups for future trials of novel pharmacological or nutritional interventions [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Establishing a clinical phenotype for cachexia in end stage kidney disease – study protocol

et al. 2018

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BackgroundSurveys using traditional measures of nutritional status indicate that muscle wasting is common among persons with end-stage kidney disease (ESKD). Up to 75% of adults undergoing maintenance dialysis show some evidence of muscle wasting. ESKD is associated with an increase in inflammatory cytokines and can result in cachexia, with the loss of muscle and fat stores. At present, only limited data are available on the classification of wasting experienced by persons with ESKD. Individuals with ESKD often exhibit symptoms of anorexia, loss of lean muscle mass and altered energy expenditure. These symptoms are consistent with the syndrome of cachexia observed in other chronic diseases, such as cancer, heart failure, and acquired immune deficiency syndrome. While definitions of cachexia have been developed for some diseases, such as cardiac failure and cancer, no specific cachexia definition has been established for chronic kidney disease. The importance of developing a definition of cachexia in a population with ESKD is underscored by the negative impact that symptoms of cachexia have on quality of life and the association of cachexia with a substantially increased risk of premature mortality. The aim of this study is to determine the clinical phenotype of cachexia specific to individuals with ESKD.MethodsA longitudinal study which will recruit adult patients with ESKD receiving haemodialysis attending a Regional Nephrology Unit within the United Kingdom. Patients will be followed 2 monthly over 12 months and measurements of weight; lean muscle mass (bioelectrical impedance, mid upper arm muscle circumference and tricep skin fold thickness); muscle strength (hand held dynamometer), fatigue, anorexia and quality of life collected. We will determine if they experience (and to what degree) the known characteristics associated with cachexia.DiscussionCachexia is a debilitating condition associated with an extremely poor outcome. Definitions of cachexia in chronic illnesses are required to reflect specific nuances associated with each disease. These discrete cachexia definitions help with the precision of research and the subsequent clinical interventions to improve outcomes for patients suffering from cachexia. The absence of a definition for cachexia in an ESKD population makes it particularly difficult to study the incidence of cachexia or potential treatments, as there are no standardised inclusion criteria for patients with ESKD who have cachexia. Outcomes from this study will provide much needed data to inform development and testing of potential treatment modalities, aimed at enhancing current clinical practice, policy and education.

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“…high proinflammatory cytokines), insulin resistance and nutritional deficiencies (e.g. energy, protein and micronutrients) (19).…”

Section: Sarcopeniamentioning

confidence: 99%

“…To progress this science forward, there is a need for large, well‐controlled studies to determine the most appropriate approaches to managing cachexia in this population. Furthermore, prior to such studies it is essential that a disease specific definition for cachexia in renal disease is established to ensure continuity across future research activity (18, 19). Reid et al, 2016 discusses this issue in some detail distinguishing the differences between cachexia, PEW and sarcopenia in the ESRD population on dialysis (19).…”

Section: Introductionmentioning

confidence: 99%

Wasting in Chronic Kidney Disease – a Complex Issue

Slee

Reid²

2018

JCSM Clinical Reports

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Chronic kidney disease (CKD) has become a global health burden and is associated with increased morbidity and mortality. In particular, wasting is highly prevalent in later stages of the illness with muscle loss being a common problem. The aetiology and progression of this wasting is complex and multiple states have been identified linked to wasting in CKD. These include: 'malnutrition', 'disease-related malnutrition', 'protein-energy wasting', 'cachexia', 'sarcopenia', 'frailty' and 'muscle wasting'. The purpose of this paper is to review these terms in the context of CKD. Common features include weight loss, loss of muscle mass and muscle function principally driven by CKD disease specific factors and inflammatory mediators. Disease-related malnutrition would appear to be a more appropriate term for CKD than malnutrition as it take in to consideration disease specific factors such as inflammation for example. Frailty is commonly associated with age-related decline in physiological function. Development of novel screening tools measuring across multiple domains of nutritional status, muscle and physical function may be useful in CKD. Research into potential treatments are currently underway with focus on multi-modal therapies including nutrition, resistance training and anabolic drugs such as myostatin blockade and selective androgen receptor modulators. A better understanding of different states and terms may help guide assessment and treatment opportunities for patients.

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Distinguishing Between Cachexia, Sarcopenia and Protein Energy Wasting in End-Stage Renal Disease Patients on Dialysis

Abstract: CitationReid J, Noble HR, Slee A, et al. Distinguishing between cachexia, sarcopenia and protein energy wasting in end-stage renal disease patients on dialysis. Palliat Med Hosp Care Open J. 2016; 2(2): e11-e13.

Cited by 7 publications

References 15 publications

Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study

Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study

Establishing a clinical phenotype for cachexia in end stage kidney disease – study protocol

Wasting in Chronic Kidney Disease – a Complex Issue

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