Universidade Nove de Julho (UNINOVE), São Paulo, Brazil; Nutrology and Clinical Nutrition, Sancta Maggiore Hospital, Prevent Senior Institute, São Paulo, Brazil.
Universidade Nove de Julho (UNINOVE), São Paulo, Brazil; Nutrology and Clinical Nutrition, Sancta Maggiore Hospital, Prevent Senior Institute, São Paulo, Brazil.
Clin Nutr ESPEN. 2023 Jun;55:200-207. doi: 10.1016/j.clnesp.2023.03.017. Epub 2023 Mar 28.
BACKGROUND & AIMS: Skeletal muscle mass (SMM) and function are negatively affected in chronic kidney disease (CKD). SMM and the assessment of muscle strength and functionality are indicators of clinical and nutritional status. We aimed to evaluate older patients undergoing online hemodiafiltration (OL-HDF), using muscle ultrasound (US) to monitor the SMM, correlating findings with strength and physical performance.
This is a prospective cohort that included patients on OL-HDF, evaluated at admission (T0), 6 months (T1), and 12 months (T2) by anthropometric data, calf circumference (CC) measurement, muscle strength measured by handgrip (HGS) and functionality by gait speed. Muscle US was used for serial assessment of the quantity and quality of SMM during the 12-month follow-up. The main outcome was change in the following muscle parameters: quadriceps muscle thickness (QT), rectus femoris cross-sectional area (RF-CSA), pennation angle (PA) and muscle echogenicity, evaluated by the US.
Thirty subjects were included (75.9 ± 7.8 years, 76.7% men). Over time, there was a significant reduction in CC (p < 0.01) in both sexes and gait speed only in men (p < 0.01). The reduction of SMM was observed in both sexes by the assessment of QT and RF-CSA (p < 0.01). There was an increased muscle echogenicity in both men (p < 0.01) and women (p = 0.01). The percentage of SMM loss of the RF-CSA in 12 months was -19.3 ± 6.9% (95% CI: 15.2-23.2; p < 0.01) in men and -23.0 ± 8.2% (95% CI: 12.8-31.1; p < 0.01) in women.
Muscle US, a bedside, non-invasive, accessible, and inexpensive tool, can be applied for assessment of the accelerated loss of SMM in older patients with CKD on dialysis.
慢性肾脏病（CKD）会导致骨骼肌质量（SMM）和功能下降。SMM 以及肌肉力量和功能评估是临床和营养状况的指标。我们旨在评估接受在线血液透析滤过（OL-HDF）的老年患者，使用肌肉超声（US）监测 SMM，并将结果与力量和身体表现相关联。
这是一项前瞻性队列研究，纳入了接受 OL-HDF 的患者，在入院时（T0）、6 个月（T1）和 12 个月（T2）进行了人体测量数据、小腿围（CC）测量、手握力（HGS）测量的肌肉力量以及步态速度评估的功能性评估。肌肉 US 用于在 12 个月的随访期间连续评估 SMM 的数量和质量。主要结果是以下肌肉参数的变化：股四头肌厚度（QT）、股直肌横截面积（RF-CSA）、肌腹角度（PA）和肌肉超声回声，通过 US 评估。
共纳入 30 名受试者（75.9±7.8 岁，76.7%为男性）。随着时间的推移，男女 CC 均显著减少（均 p<0.01），男性仅步态速度显著减少（p<0.01）。QT 和 RF-CSA 评估显示，两性的 SMM 均减少（均 p<0.01）。男女肌肉回声均增加（均 p<0.01）。男性 12 个月时 RF-CSA 中 SMM 的损失百分比为-19.3±6.9%（95%CI：15.2-23.2；p<0.01），女性为-23.0±8.2%（95%CI：12.8-31.1；p<0.01）。
肌肉 US 是一种床边、非侵入性、易于获得且廉价的工具，可用于评估透析治疗的 CKD 老年患者 SMM 的加速丢失。
