Department of Nephrology, Osaka City University Graduate School of Medicine 1-4-3, Asahi-Machi, Abeno-ku, Osaka 545-8585, Japan.
Nutrients. 2021 May 2;13(5):1538. doi: 10.3390/nu13051538.
Life extension in modern society has introduced new concepts regarding such disorders as frailty and sarcopenia, which has been recognized in various studies. At the same time, cutting-edge technology methods, e.g., renal replacement therapy for conditions such as hemodialysis (HD), have made it possible to protect patients from advanced lethal chronic kidney disease (CKD). Loss of muscle and fat mass, termed protein energy wasting (PEW), has been recognized as prognostic factor and, along with the increasing rate of HD introduction in elderly individuals in Japan, appropriate countermeasures are necessary. Although their origins differ, frailty, sarcopenia, and PEW share common components, among which skeletal muscle plays a central role in their etiologies. The nearest concept may be sarcopenia, for which diagnosis techniques have recently been reported. The focus of this review is on maintenance of skeletal muscle against aging and CKD/HD, based on muscle physiology and pathology. Clinically relevant and topical factors related to muscle wasting including sarcopenia, such as vitamin D, myostatin, insulin (related to diabetes), insulin-like growth factor I, mitochondria, and physical inactivity, are discussed. Findings presented thus far indicate that in addition to modulation of the aforementioned factors, exercise combined with nutritional supplementation may be a useful approach to overcome muscle wasting and sarcopenia in elderly patients undergoing HD treatments.
在现代社会，寿命的延长带来了有关衰弱和肌少症等疾病的新概念，这些疾病在各种研究中已经得到了认识。与此同时，尖端的技术方法，例如血液透析（HD）等情况下的肾脏替代疗法，使得人们能够保护患者免受晚期致命性慢性肾脏病（CKD）的侵害。肌肉和脂肪量的减少，即蛋白质能量消耗（PEW），已被认为是预后因素，并且随着日本老年人群中 HD 引入率的增加，需要采取适当的对策。尽管衰弱、肌少症和 PEW 的起源不同，但它们具有共同的组成部分，其中骨骼肌在其发病机制中起着核心作用。最近报道了诊断技术，最近报道了诊断技术，最接近的概念可能是肌少症。本综述的重点是基于肌肉生理学和病理学来维持骨骼肌对抗衰老和 CKD/HD。讨论了与肌肉减少症（包括肌少症）相关的临床相关和热门因素，如维生素 D、肌肉生长抑制素、胰岛素（与糖尿病有关）、胰岛素样生长因子 I、线粒体和身体活动不足。迄今为止的研究结果表明，除了调节上述因素外，运动结合营养补充可能是一种有用的方法，可以克服接受 HD 治疗的老年患者的肌肉消耗和肌少症。
