Physiological abnormalities of skeletal muscle in dialysis patients

Fahal, I. H.; Bell, G. M.; Bone, J. M.; Edwards, R. H. T.

doi:10.1093/ndt/12.1.119

Cited by 132 publications

(116 citation statements)

References 16 publications

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“…The diagnosis of uremic myopathy is based on clinical features, including weakness (defined as a failure to generate force) and wasting (sarcopenia), which affect predominantly the proximal lower limbs 102. Whereas muscle enzymes levels and electromyographical studies are usually normal, muscle biopsies show atrophy of the fast‐twitch white (type 2) fibres 103, 104. These morphological features are similar from those found in patients with vitamin D deficiency 11, 48…”

Section: Bone and Musculoskeletal Abnormalities In Chronic Kidney Dismentioning

confidence: 61%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

102

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The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

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Section: Bone and Musculoskeletal Abnormalities In Chronic Kidney Dismentioning

confidence: 61%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

102

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“…Among them are decreased protein-calorie intake, muscle atrophy through disuse and muscle protein imbalance, which mostly affect type II muscle fibers; reduction of the vascular and capillary bed; presence of intravascular calcification and decreased local blood flow. These results are part of the pathogenesis of uremic myopathy and are commonly described in the literature in relation to skeletal muscles such as the deltoid, quadriceps and abdominal muscles [4][5][6][7][8][9] .…”

Section: Introductionmentioning

confidence: 72%

“…They include decreases in muscle mass (cross-sectional area, mainly of type II fibers) found in studies on mice and humans, decreases in oxidative metabolism, decreases in muscle protein synthesis and decreases in calcium plasmatic concentration [6][7][8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

Efeitos negativos da insuficiência renal crônica sobre a função pulmonar e a capacidade funcional

Cury¹,

Brunetto²,

Aydos

2010

Rev. bras. fisioter.

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Objective: To evaluate lung function and functional capacity in patients with chronic kidney failure (CKF) undergoing dialysis and in patients after kidney transplant. Methods: Seventy-two participants were evaluated: 32 patients with CKF on dialysis (DG) for at least six months, ten patients who had kidney transplants (TG) at least six months earlier, and 30 healthy subjects as a control group (CG). all groups were evaluated using spirometry, with maximum inspiratory pressure (mIP) and maximum expiratory pressure (mEP), and using the six-minute walking test (6mWT). The SPSS 12.0 software was used for statistical analysis, with a minimum significance level of α<0.05. Results: There was a decreased lung function in the DG for FVC, FEV1, mVV, VC, mIP and mEP, and decreased FEV1 and mVV in the TG compared to the CG (one-way aNOVa/Fisher's post-hoc; p<0.01). There was also an association (chi-square) between decreased mIP and belonging to the DG ‫,5.0=ג(‬ p<0.001), between lower performance in the 6mWT for the DG and TG (p<0.01) compared to the CG (one-way aNOVa/Fisher's post-hoc), and between mIP and mEP (Pearson's coefficient; r=0.752; p<0.01). Conclusions:Patients with CKF undergoing dialysis showed impaired functional capacity and lung function that were not completely reverted in the kidney transplant patients.Key words: dialysis; kidney transplant; spirometry; respiratory muscles; functional capacity. ResumoObjetivo: avaliar a função pulmonar e a capacidade funcional em pacientes com insuficiência renal crônica (IRC) em hemodiálise e em pacientes após transplante renal. Métodos: Foram avaliados 72 indivíduos, sendo 32 pacientes com IRC em hemodiálise (GD) há mais de 6 meses, 10 pacientes transplantados renais (GT) há, pelo menos, 6 meses e 30 sujeitos saudáveis para grupo controle (GC). Todos os grupos foram avaliados utilizando espirometria, pressões inspiratória (PImax) e expiratória (PEmax) máximas e teste da caminhada em seis minutos (TC6min). Para análise estatística, foi utilizado o programa SPSS 12.0, com nível mínimo de significância α<0,05. Resultados: Foram encontrados resultados estatisticamente significativos (p<0,01) para: diminuição da função pulmonar no GD para Capacidade vital forçada (CVF), Volume expirado forçado (VEF1), Ventilação voluntária máxima (VVm), Capacidade vital (CV), PImax, PEmax e, para o GT, diminuição do VEF1 e VVm, quando comparados ao GC (aNOVa uma via/post hoc Fischer); associação (qui-quadrado) entre diminuição da PImax e pertencer ao GD ‫,5,0=ג(‬ p<0,001); menor desempenho no TC6min no GD e GT (p<0,01) quando comparados ao GC (aNOVa uma via/post hoc Fischer). Encontrou-se correlação significativa (coeficiente de Pearson) entre PImax e PEmax (r=0,752, P<0,01). Conclusões: Pode-se concluir que existem alterações na capacidade funcional e na função pulmonar do paciente com IRC em hemodiálise, as quais são indicativas de prejuízos funcionais que não se apresentam completamente revertidos no paciente transplantado renal.

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“…Of the remaining case-control studies, seven 15,[36][37][38][39][40][41] included participants with chronic renal disease not on HD and with comorbidities (clinical evidence of polyneuropathy, varying degrees of paresis, myopathy, renal bone disease, cerebrovascular accident, diabetes mellitus, peripheral vascular disease, etc. ); four included male participants only; [42][43][44][45] and five [46][47][48][49][50] did not provide adequate description of the participants included in the study.…”

Section: Methodological Qualitymentioning

confidence: 99%

Morphological, Electrophysiological, and Metabolic Characteristics of Skeletal Muscle in People with End-Stage Renal Disease: A Critical Review

Sawant¹,

Garland²,

House³

et al. 2011

Physiotherapy Canada

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Purpose: Fatigue is one of the most frequent debilitating symptoms reported by people with end-stage renal disease (ESRD) on haemodialysis (HD) therapy. A wide range of underlying abnormalities, including skeletal muscle weakness, have been implicated as causes of this fatigue. Skeletal muscle weakness is well established in this population, and such muscle weakness is amenable to physical therapy treatment. The purpose of this review was to identify morphological, electrophysiological, and metabolic characteristics of skeletal muscles in people with ESRD/HD that may cause skeletal muscle weakness. Method: Electronic databases were searched for relevant literature from inception to March 2010. Inclusion criteria were English language; adult subjects with ESRD/HD; and the use of muscle biopsy, electromyography, and nuclear magnetic spectroscopy ( 31 P-NMRS) techniques to evaluate muscle characteristics. Results: In total, 38 studies were included. All studies of morphological characteristics reported type II fibre atrophy. Electrophysiological characteristics included both neuropathic and myopathic skeletal muscle changes. Studies of metabolic characteristics revealed higher cytosolic inorganic phosphate levels and reduced effective muscle mass. Conclusion:The results indicate an array of changes in the morphological, electrophysiological, and metabolic characteristics of skeletal muscle structure in people with ESRD/HD that may lead to muscle weakness. RÉ SUMÉObjectif : La fatigue est l'un des symptô mes dé bilitants signalé s chez les personnes aux prises avec une insuffisance ré nale chronique au stade ultime avec l'hé modialyse (IRSU/HD). Un large é ventail d'anomalies sous-jacentes, y compris de la faiblesse du muscle squelettique, ont é té mises en cause dans cette fatigue. La faiblesse du muscle squelettique est courante au sein de cette population; une telle faiblesse musculaire peut faire l'objet de traitements en physiothé rapie. L'objectif de cette analyse é tait d'identifier les caracté ristiques morphologiques, é lectrophysiologiques et mé taboliques des muscles squelettiques qui pourraient susciter une faiblesse du muscle squelettique chez les personnes avec IRSU/HD. Mé thode : Une recherche a é té ré alisé e dans les bases de donné es é lectroniques de leur cré ation à mars 2010 afin de ré pertorier la documentation pertinente. Les critè res d'inclusion é taient que ces documents soient en anglais, qu'ils concernent des adultes avec IRSU/HD et que des techniques de biopsie musculaire, d'é lectromyographie et de spectroscopie magné tique nuclé aire ( 31 P-NMRS) avaient é té utilisé es pour é valuer les caracté ristiques des muscles concerné s. Ré sultats : Au total, 38 documents ont é té ré pertorié s et utilisé s. Toutes les é tudes des caracté ristiques morphologiques faisaient é tat d'atrophie des fibres de type II. Les caracté ristiques é lectrophysiologiques incluaient à la fois les changements né vropathiques et myopathiques. Les é tudes des caracté ristiques mé taboliques ont ré vé l...

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Physiological abnormalities of skeletal muscle in dialysis patients

Abstract: The only significant predictor of loss of muscle strength and abnormality of relaxation in this study was the nutritional state. A regular assessment of the nutritional state is required to ensure adequate nutrition to prevent the observed abnormalities of the skeletal muscles.

Cited by 132 publications

References 16 publications

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Efeitos negativos da insuficiência renal crônica sobre a função pulmonar e a capacidade funcional

Morphological, Electrophysiological, and Metabolic Characteristics of Skeletal Muscle in People with End-Stage Renal Disease: A Critical Review

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