Nephrology Dialysis Transplantation, Vol 12, Issue 1 119-127, Copyright © 1997 by Oxford University Press
I Fahal, G Bell, J Bone and R Edwards
Background. Muscle weakness is a common but
unexplained feature of dialysis patients. This study investigated the
prevalence and causes of muscle weakness in dialysis patients by examining
the quadriceps muscle force and contractile properties.
Methods. The quadriceps femoris was studied in terms
of force, force-frequency curve, and speed of muscle relaxation in 49
dialysis patients and 27 healthy subjects. In addition nutritional,
haematological, biochemical, and histological assessments were performed,
and steps of force generation were analysed to reach the possible
mechanisms leading to the observed weakness. Results.
Muscle weakness, though invariable as a symptom, was subtle or absent on
clinical examination. Quadriceps force measurements, however, revealed
unequivocal weakness in most of the patients (71%). The quadriceps muscle
was weaker (317±115 versus
460±159 N, P <0.01) compared to healthy individuals, but
there was no evidence of impaired excitation-contraction coupling
(0.79±0.05 versus 0.76±0.07,
P=0.1). Among dialysis patients the older and the malnourished (n=23) were
the weaker but there was no relationship to the type or duration of
dialysis. The serum albumin was the only biochemical parameter related to
the muscle force (r=0.6, P=0.01). The other most prominent abnormality of
quadriceps muscle function observed in this study was slowing of relaxation
(patients versus controls; 8.7±1.8%
versus 10.8±1.1% force loss/10 ms, P
<0.0001) particularly in the malnourished group (malnourished
versus well nourished; 8.3±2.1
versus 9.4±0.95, P=0.03). Muscle histology
was investigated (n=12) and revealed that type II fibres were mildly
atrophic in 40% of the biopsies in most areas, but predominantly type IIB.
Although type IIB fibre areas are slightly smaller in the dialysis patients
compared to controls, this was not statistically significant
(3025±578 versus 4406±1582,
P=0.1) except in the malnourished group compared to the well-nourished
dialysis patients (2092±304 versus
4346±1496, P=0.04), and in the malnourished dialysis patients
type IIB fibre area was significantly correlated to the strength (r=0.6,
P=0.02). Conclusion. The only significant predictor of
loss of muscle strength and abnormality of relaxation in this study was the
nutritional state. A regular assessment of the nutritional state is
required to insure adequate nutrition to prevent the observed abnormalities
of the skeletal muscles. Key words: dalysis patients;
nutrition; skeletal muscle; weakness
ORIGINAL ARTICLES
Physiological abnormalities of skeletal muscle in dialysis patients
Muscle Research Centre and Department of Nephrology, University of Liverpool, Liverpool, UK; Corresponding author at: Link Unit 6Z, Royal Liverpool University Hospital, Prescot Street, Liverpoo L7 8XP, UK
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