Malnutrition and Sarcopenia Combined Increases the Risk for Mortality in Older Adults on Hemodialysis

Macedo, Catarina; Amaral, Teresa; Rodrigues, Juliana; Santin, Fernanda; Avesani, Carla María

doi:10.3389/fnut.2021.721941

Cited by 22 publications

(20 citation statements)

References 40 publications

(58 reference statements)

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“…Our findings showed that a low BMI was strongly associated with sarcopenia in patients on MHD ( P =0.010), consistent with the findings of Macedo et al [ 26 ]. A low BMI often indicates the presence of malnutrition, inadequate energy and protein intake in malnourished patients, gastrointestinal dysfunction, poor digestion and absorption, decreased plasma amino acid concentration, and decreased muscle protein synthesis rate, which, in turn, lead to impaired skeletal muscle quality, strength, and function [ 27 ].…”

Section: Discussionsupporting

confidence: 93%

Development of a Practical Screening Tool to Predict Sarcopenia in Patients on Maintenance Hemodialysis

Chen

Zhang

et al. 2022

Med Sci Monit

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Background Sarcopenia is a common complication in maintenance hemodialysis (MHD) and can increase patient hospitalization and mortality. No simple and reliable tools to identify sarcopenia exist. We aimed to develop a screening tool to predict MHD patients at high risk for sarcopenia. Material/Methods This cross-sectional study included 589 and 216 MHD patients for training and validation sets, respectively. We used diagnostic criteria developed by the Asian Working Group on Sarcopenia to screen for sarcopenia. The risk prediction model was established by univariate and multivariate logistic regression analyses. We used the area under the receiver operating characteristic curve (AUROC), calibration curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) to evaluate the model’s discrimination ability, calibration ability, and clinical utility. Results The incidence of sarcopenia was 17.1% in the training set and 18.1% in the validation set. We constructed prediction models applying age, body mass index, calf circumference, and serum creatinine and plotted a nomogram. The training set model had an AUROC of 0.922, sensitivity of 85.1%, specificity of 85.9%, and chi-square value (Hosmer-Lemeshow test) of 5.603 ( P >0.05); the DCA diagram showed that when the threshold probability was 0 to 0.95, the model predicted a net benefit for sarcopenia in MHD patients. The validation set model had an AUROC of 0.913, sensitivity of 94.3%, specificity of 82.9%, and chi-square value (Hosmer-Lemeshow test) of 9.822 ( P >0.05). Conclusions The screening tool has good discrimination ability, calibration ability, and clinical utility. It could help to identify MHD patients at a high risk for sarcopenia.

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Section: Discussionsupporting

confidence: 93%

Development of a Practical Screening Tool to Predict Sarcopenia in Patients on Maintenance Hemodialysis

Chen

Zhang

et al. 2022

Med Sci Monit

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“…The studies were published between 2014 and 2022 and varied in sample size (33 to 645 patients). Among the included studies, twenty-one studies were conducted in Asian countries (China, Iran, Japan, Korea, Taiwan, Thailand, and Turkey) [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ], nine in European countries (France, Sweden, Spain, and United Kingdom) [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ], eight in South American countries (Brazil and Argentina) [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ], two in the USA [ 57 , 58 ], and the remaining one in Australia [ 59 ]. These studies yielded a total sample of five continents (Asia: 45.6%, Europe: 25.9%, North America: 14.3%, South America: 13.7%, and Australia: 0.5%).…”

Section: Resultsmentioning

confidence: 99%

“…These studies yielded a total sample of five continents (Asia: 45.6%, Europe: 25.9%, North America: 14.3%, South America: 13.7%, and Australia: 0.5%). Thirty-one studies [ 19 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 43 , 44 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ] were conducted in HD population, seven studies [ 20 , 21 , 28 , 31 , 32 , 42 , 47 ] were performed in PD population, and three studies [ 24 , 33 , 59 ] were carried out in mixed populations (both HD and PD). Of the included patients, the mean age was 62.3 years, 61.4% were male, and 38.6% had diabetes mellitus as a comorbidity with a mean dialysis vintage of 52.4 months.…”

Section: Resultsmentioning

confidence: 99%

“… Forest plot visualizing the varying sarcopenic prevalence in dialysis patients reported as event rate for each study included publication in the meta-analysis [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ]. …”

Section: Figurementioning

confidence: 99%

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Prevalence of Sarcopenia and Its Impact on Cardiovascular Events and Mortality among Dialysis Patients: A Systematic Review and Meta-Analysis

et al. 2022

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Sarcopenia in end-stage kidney disease patients requiring dialysis is a frequent complication but remains an under-recognized problem. This meta-analysis was conducted to determine the prevalence of sarcopenia and explored its impacts on clinical outcomes, especially cardiovascular events, and mortality in dialysis patients. The eligible studies were searched from PubMed, Scopus, and Cochrane Central Register of Controlled trials up to 31 March 2022. We included studies that reported the interested outcomes, and the random-effects model was used for analysis. Forty-one studies with 7576 patients were included. The pooled prevalence of sarcopenia in dialysis patients was 25.6% (95% CI 22.1 to 29.4%). Sarcopenia was significantly associated with higher mortality risk (adjusted OR 1.83 (95% CI 1.40 to 2.39)) and cardiovascular events (adjusted OR 3.80 (95% CI 1.79 to 8.09)). Additionally, both low muscle mass and low muscle strength were independently related to increased mortality risk in dialysis patients (OR 1.71; 95% CI (1.20 to 2.44), OR 2.15 (95% CI 1.51 to 3.07)), respectively. This meta-analysis revealed that sarcopenia was highly prevalent among dialysis patients and shown to be an important predictor of cardiovascular events and mortality. Future intervention research to alleviate this disease burden in dialysis patients is needed.

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“…This paper highlights some recent evidence in this regard. Macedo et al investigated the prevalence of malnutrition (7p-SGA), presarcopenia (low muscle strength or low muscle mass) and sarcopenia (low muscle strength and low muscle mass) in 170 older (> 60 years) haemodialysis (HD) patients in Brazil ( [18]. They found that in this group 35.3 were presarcopenic, 14.1 were sarcopenic, and 58.8% were malnourished.…”

Section: Prevalence and Screening/ Assessmentmentioning

confidence: 99%

Disease-related malnutrition in chronic kidney disease

Slee¹,

Reid

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewDisease-related malnutrition has complex and multifactorial pathophysiology. It is common in patients with chronic kidney disease (CKD) and has a devastating impact on morbidity and mortality. Given the rising numbers of patients diagnosed with CKD, disease-related malnutrition is an escalating clinical challenge. This review summarises current knowledge in relation to the development, screening and treatments for disease-related malnutrition in CKD Recent findingsNew research has identified other potential causes for the development of malnutrition in CKD, including changes in taste and smell, and effects of polypharmacy. Screening and assessment studies have investigated different tools in relation to the new Global Leadership Initiative on Malnutrition (GLIM) criteria. Different modalities of low protein diets and the potential use of pre and probiotics are being explored. Furthermore, the importance of nutritional support, and possibly exercise during dialysis is being examined in terms of reducing anabolic resistance and catabolism. SummaryFurther research is required to better understand the nuances of the pathophysiology of disease-related malnutrition in CKD. This work should inform not only consistent terminology and the application of assessment tools specific to disease-related malnutrition in CKD but also the development of novel interventions that reflect its multifaceted pathophysiology and impact.

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Malnutrition and Sarcopenia Combined Increases the Risk for Mortality in Older Adults on Hemodialysis

Cited by 22 publications

References 40 publications

Development of a Practical Screening Tool to Predict Sarcopenia in Patients on Maintenance Hemodialysis

Development of a Practical Screening Tool to Predict Sarcopenia in Patients on Maintenance Hemodialysis

Prevalence of Sarcopenia and Its Impact on Cardiovascular Events and Mortality among Dialysis Patients: A Systematic Review and Meta-Analysis

Disease-related malnutrition in chronic kidney disease

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