Xanthine Oxidoreductase Inhibitor Use Associated With Reduced Risk of Sarcopenia and Severe Sarcopenia in Patients Undergoing Hemodialysis

Abstract

BackgroundXanthine oxidoreductase (XOR) inhibition reduces reactive oxygen species (ROS) production and enhances adenosine triphosphate (ATP) synthesis. We investigated the protective effects of XOR inhibitor treatment on sarcopenia, frequently observed in patients undergoing hemodialysis (HD), in which increased ROS and ATP shortage are known to be involved.MethodsThis retrospective cross-sectional study included 296 HD patient (203 males, 93 females). Muscle mass, physical performance, and muscle strength were assessed using dual-energy X-ray absorptiometry, five-time chair stand testing, and handgrip strength, respectively. The Asian Working Group for Sarcopenia 2019 criteria were used to define low muscle mass, low physical performance, and low muscle strength, as well as sarcopenia and severe sarcopenia.ResultsSarcopenia and severe sarcopenia prevalence rates were 42.2 and 20.9%, respectively. XOR inhibitor users (n = 119) showed a significantly (p < 0.05) lower prevalence of sarcopenia and severe sarcopenia, as well as reduced muscle mass, physical performance, and muscle strength than non-users (n = 177). Multivariate logistic regression analyses also revealed XOR inhibitor use to be significantly associated with low muscle mass [odds ratio (OR), 0.384; 95% confidence interval (CI), 0.183–0.806; p = 0.011] and low physical performance (OR, 0.286; 95% CI, 0.142–0.578; p < 0.001), while significance with low muscle strength was borderline. Furthermore, XOR inhibitor use was significantly associated with sarcopenia (OR, 0.462; 95% CI, 0.226–0.947; p = 0.035) and severe sarcopenia (OR, 0.236; 95% CI, 0.091–0.614; p = 0.003).ConclusionsXOR inhibitor use was significantly associated with reduced risk of sarcopenia/severe sarcopenia in HD patients, suggesting that XOR inhibitor treatment has protective effects on sarcopenia in HD patients.

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

“…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%).…”

“…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.…”

“… 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 ]. …”

Nutritional Status Association With Sarcopenia in Patients Undergoing Maintenance Hemodialysis Assessed by Nutritional Risk Index

“…As a part of routine clinical care for MHD patients at Inoue Hospital, muscle mass, muscle strength, and physical performance are generally measured after the end of MHD treatment at the beginning of the week of their birthday (21). The participants were informed that they were scheduled to be evaluated in regard to muscle mass, muscle strength, and physical performance on a day when undergoing treatment prior to the scheduled test date.…”

“…This cross-sectional retrospective study was conducted at Inoue Hospital (Osaka, Japan) (21). Among 334 MHD patients who underwent measurements of muscle mass, muscle strength, and physical performance from January 2019 to December 2019, those who had been receiving therapy for <6 months (n = 3) or with missing data regarding nutritional status (n = 12) were excluded.…”