Natural History of Skeletal Muscle Mass Changes in Chronic Kidney Disease Stage 4 and 5 Patients: An Observational Study

Cross-sectional studies in dialysis demonstrate muscle wasting associated with loss of function, increased morbidity and mortality. The relative drivers are poorly understood. There is a paucity of data regarding interval change in muscle in pre-dialysis and dialysis-dependant patients. This study aimed to examine muscle and fat mass change and elucidate associations with muscle wasting in advanced CKD. 134 patients were studied (60 HD, 28 PD, 46 CKD 4–5) and followed up for two years. Groups were similar in age, sex and diabetes prevalence. Soft tissue cross-sectional area (CSA) was measured annually on 3 occasions by a standardised multi-slice CT thigh. Potential determinants of muscle and fat CSA were assessed. Functional ability was assessed by sit-to-stand testing. 88 patients completed follow-up (40 HD, 16 PD, 32 CKD). There was a significant difference in percentage change in muscle CSA (MCSA) over year 1, dependant on treatment modality (χ2 = 6.46; p = 0.039). Muscle loss was most pronounced in pre-dialysis patients. Muscle loss during year 1 was partially reversed in year 2 in 39%. Incident dialysis patients significantly lost MCSA during the year which they commenced dialysis, but not the subsequent year. Baseline MCSA, change in MCSA during year 1 and dialysis modality predicted year 2 change in MCSA (adjusted R2 = 0.77, p<0.001). There was no correlation between muscle or fat CSA change and any other factors. MCSA correlated with functional testing, although MCSA change correlated poorly with change in functional ability. These data demonstrate marked variability in MCSA over 2 years. Loss of MCSA in both pre-dialysis and established dialysis patients is reversible. Factors previously cross-sectionally shown to correlate with MCSA did not correlate with wasting progression. The higher rate of muscle loss in undialysed CKD patients, and its reversal after dialysis commencement, suggests that conventional indicators may not result in optimal timing of dialysis initiation.

[1]  P. Chauveau,et al.  Nutrition and chronic kidney disease. , 2011, Kidney international.

[2]  W. Mitch,et al.  Proteolysis by the ubiquitin-proteasome system and kidney disease. , 2011, Journal of the American Society of Nephrology : JASN.

[3]  K. Kalantar-Zadeh,et al.  Mid-arm muscle circumference and quality of life and survival in maintenance hemodialysis patients. , 2010, Clinical journal of the American Society of Nephrology : CJASN.

[4]  G. Beck,et al.  Both low muscle mass and low fat are associated with higher all-cause mortality in hemodialysis patients. , 2010, Kidney international.

[5]  W. Mitch,et al.  Review of muscle wasting associated with chronic kidney disease. , 2010, The American journal of clinical nutrition.

[6]  Seoung Woo Lee,et al.  Insulin resistance and muscle wasting in non-diabetic end-stage renal disease patients. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[7]  A. O’Sullivan,et al.  Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. , 2007, Journal of the American Society of Nephrology : JASN.

[8]  N. Selby,et al.  The haemodynamic and metabolic effects of hypertonic-glucose and amino-acid-based peritoneal dialysis fluids. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[9]  P. Flakoll,et al.  Insulin resistance is associated with skeletal muscle protein breakdown in non-diabetic chronic hemodialysis patients. , 2007, Kidney international.

[10]  P. Stenvinkel,et al.  Adipose tissue and inflammation in chronic kidney disease. , 2006, Contributions to nephrology.

[11]  N. Selby,et al.  Patients receiving maintenance dialysis have more severe functionally significant skeletal muscle wasting than patients with dialysis-independent chronic kidney disease. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[12]  P. Painter,et al.  Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: A randomized, controlled trial. , 2006, Journal of the American Society of Nephrology : JASN.

[13]  S. Hedayati.  HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Dialysis‐Related Carnitine Disorder , 2006, Seminars in dialysis.

[14]  J. Kent‐Braun,et al.  Effect of diabetes mellitus on muscle size and strength in patients receiving dialysis therapy. , 2006, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[15]  M. McKenna,et al.  Exercise performance falls over time in patients with chronic kidney disease despite maintenance of hemoglobin concentration. , 2006, Clinical journal of the American Society of Nephrology : CJASN.

[16]  W. Mitch,et al.  Chronic kidney disease causes defects in signaling through the insulin receptor substrate/phosphatidylinositol 3-kinase/Akt pathway: implications for muscle atrophy. , 2006, Journal of the American Society of Nephrology : JASN.

[17]  E. Bartels,et al.  The Uremic Environment and Muscle Dysfunction in Man and Rat , 2006, Nephron Physiology.

[18]  S. Anker,et al.  Associations of body fat and its changes over time with quality of life and prospective mortality in hemodialysis patients. , 2006, The American journal of clinical nutrition.

[19]  T. Ikizler,et al.  Accelerated lean body mass loss in incident chronic dialysis patients with diabetes mellitus. , 2005, Kidney international.

[20]  P. Flakoll,et al.  Increased muscle protein breakdown in chronic hemodialysis patients with type 2 diabetes mellitus. , 2005, Kidney international.

[21]  Richard Casaburi,et al.  Endurance exercise training during haemodialysis improves strength, power, fatigability and physical performance in maintenance haemodialysis patients. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[22]  M. Odamaki,et al.  Association of age with muscle mass, fat mass and fat distribution in non-diabetic haemodialysis patients. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[23]  W. Mitch,et al.  Molecular mechanisms activating muscle protein degradation in chronic kidney disease and other catabolic conditions , 2005, European journal of clinical investigation.

[24]  C. Blake,et al.  Subjective and objective physical limitations in high-functioning renal dialysis patients. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[25]  S. Frostick,et al.  Abnormal mitochondrial function and muscle wasting, but normal contractile efficiency, in haemodialysed patients studied non-invasively in vivo. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[26]  I. Jaussent,et al.  Creatinine index and lean body mass are excellent predictors of long-term survival in haemodiafiltration patients. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[27]  R. Wolfe,et al.  Protein turnover and amino acid transport kinetics in end-stage renal disease. , 2004, American journal of physiology. Endocrinology and metabolism.

[28]  J. Eiserich,et al.  RENAL RESEARCH INSTITUTE SYMPOSITUM: Characteristics and Effects of Inflammation in End‐Stage Renal Disease , 2003, Seminars in dialysis.

[29]  J. Kent‐Braun,et al.  Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function. , 2003, Kidney international.

[30]  J. Campistol.  Uremic myopathy. , 2002, Kidney international.

[31]  T. Mercer,et al.  Effects of exercise training on aerobic and functional capacity of end‐stage renal disease patients , 2002, Clinical physiology and functional imaging.

[32]  J. Campistol.  Uremic myopathy. , 2002, Kidney international.

[33]  A. Levey,et al.  Resistance Training To Counteract the Catabolism of a Low-Protein Diet in Patients with Chronic Renal Insufficiency , 2001, Annals of Internal Medicine.

[34]  P. Painter,et al.  Determinants of physical performance in ambulatory patients on hemodialysis. , 2001, Kidney international.

[35]  Suzanne G. Leveille,et al.  Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[36]  Suzanne G. Leveille,et al.  Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[37]  M. Odamaki,et al.  Standardized thigh muscle area measured by computed axial tomography as an alternate muscle mass index for nutritional assessment of hemodialysis patients. , 2000, The American journal of clinical nutrition.

[38]  E. Kouidi,et al.  The effects of exercise training on muscle atrophy in haemodialysis patients. , 1998, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[39]  B. Goodpaster,et al.  Subcutaneous Abdominal Fat and Thigh Muscle Composition Predict Insulin Sensitivity Independently of Visceral Fat , 1997, Diabetes.