The creatinine approach to estimate skeletal muscle mass in patients with cirrhosis

Abstract

1 muscle mass.2-4 The 24-hour urinary creatinine approach and The creatinine-method to estimate muscle mass is frethe anthropometric estimation of whole body skeletal muscle quently used in clinical studies, although the validity of mass are the most common methods, and the creatininethis approach is uncertain in patients with cirrhosis. In method has been proposed for the use in clinical studies. 5-11this study 102 patients with cirrhosis differing in cause, The validity of the creatinine approach is uncertain in circlinical state, liver, and renal function were investigated rhosis, because creatine is synthesized in the liver by transto determine whether reduced liver or renal function methylation of guanidinoacetic acid (Fig. 1). 12 It has been may explain in part the low levels of urinary creatinine suggested that reduced liver function rather than reduced excretion frequently observed in these patients. Muscle muscle mass may explain the low levels of urinary creatinine mass assessed by 24-hour urinary creatinine excretion excretion frequently observed in these patients. 3,4 However, was compared with anthropometrically obtained muscle because the rate-limiting biosynthetic step of the creatine mass calculated from arm muscle area (AMA), and with precursor, guanidinoacetic acid, is predominantly located in body cell mass (BCM) estimated by bioelectrical impedthe kidney, 13 reduced liver function may not affect the validance analysis and total body potassium counting. In cirity of the creatinine approach in patients with cirrhosis. rhosis, the 24-hour urinary creatinine excretion wasTo determine the validity of the creatinine-muscle mass 10.4% and AMA was 19% lower than predicted values.method in cirrhosis we used anthropometry as a second comThe differences between the results obtained by differparative method. Anthropometrically obtained muscle mass ent methods did not show any relation to parameters of is based on a pars pro toto approach extrapolating from midliver function (ICG-t 1 2 , caffeine-t 1 2 , MEGX-test, cholinesarm circumference and triceps skinfold thickness. The preciterase) or the severity of liver disease (i.e., Child-Pugh sion and accuracy of skinfold measurements are good if perscore). In contrast, renal function was strongly correformed by skilled investigators. 14 In addition, the results of lated with the differences between creatinine-and anmuscle mass estimation were compared with body cell mass thropometric-muscle mass (r Å .64, P õ .001). At the same (BCM) assessed by total body potassium counting and biotime, patients with normal renal function (62% of the electrical impedance analysis (BIA) considering the fact that whole population) had significantly higher creatinine skeletal muscle mass represents about 80% of BCM. 15 BIA is (29.1 { 8.5 vs. 15.8 { 6 kg, P õ .001) and anthropometricwidely applied in clinical practice, and has a high precision muscle mass (22.4 { 6 vs. 17.9 { 5.3 kg; P õ .01) than (coefficient of variation õ 5%). 16,17 The value of the BIA appatients with reduc...

Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis

“…Average values of two measurements were calculated and used for statistical analysis. Urinary creatinine was measured using a modified kinetic Jaffe procedure (Merckotest Creatinin, Merck, Darmstadt, Germany) and used as a nutritional estimate of muscle mass (Pirlich et al 1996).…”

Bioelectrical Impedance Analysis Is A Useful Bedside Technique to Assess Malnutrition in Cirrhotic Patients With and Without Ascites

“…[1][2][3] The diagnosis and precise assessment of malnutrition in chronic liver disease is hampered by changes in body water. [4][5][6] In the absence of more accurate methods to be used bedside and because of the limited availability of sophisticated and expensive techniques 7,8 anthropometry and urinary creatinine excretion have been recommended as widely available bedside methods to obtain an estimate of muscle mass or fat-free mass in patients with cirrhosis. 3 In cirrhosis, however, even a precise measurement of fat-free mass might be inadequate for the detection of protein depletion because of an increase of the extracellular fluid compartment.…”

Liver Disease

“…Alcohol and viral infection can infl uence immune function, and edema and ascites can infl uence anthropometry and bioelectric impedance (O ' Keefe et al , 1980 ;Shronts et al , 1987 ;Shronts, 1988;Guglielmi et al , 1991 ;McCullough et al , 1991 ). Impaired renal function frequently occurs in more severe liver disease and infl uences indicators such as creatinine -height index (Pirlich et al , 1996 ). Thus, no ideal single indicator of malnutrition in liver disease exists and, often, subjective global assessment in conjunction with a combination of tests most appropriate for the particular patient will provide the best possible evaluation (Baker et al , 1982 ;Campillo, 2010 ).…”