NDT Advance Access originally published online on February 27, 2006
Nephrology Dialysis Transplantation 2006 21(8):2210-2216; doi:10.1093/ndt/gfl064
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Patients receiving maintenance dialysis have more severe functionally significant skeletal muscle wasting than patients with dialysis-independent chronic kidney disease
1 Department of Renal Medicine, Derby City General Hospital, Derby, 2 Centre for Integrated Systems Biology and Medicine, University of Nottingham, 3 School of Sport, Health and Exercise Sciences, University of Wales, Bangor and 4 Department of Nephrology, North Staffordshire Hospital Trust, Stoke-on-Trent, UK
Correspondence and offprint requests to: Dr C McIntyre, Department of Renal Medicine, Derby City General Hospital, Uttoxeter Rd, Derby, DE22 3NE, UK. Email: Chris.McIntyre{at}derbyhospitals.nhs.uk
Background. Chronic renal replacement therapy patients exhibit reduction in skeletal muscle function as a result of a combination of metabolic effects and muscle fibre size reduction. The aim of this study was to compare muscle mass with function in patients with chronic kidney disease (CKD) at stages 4 and 5 on haemodialysis (HD) and peritoneal dialysis (PD), and investigate the associations of muscle wasting in a cross-sectional cohort.
Methods. We studied 134 patients (60 HD, 28 PD and 46 CKD 4). The three groups were well matched for age, sex, diabetes and dialysis vintage. Cross-sectional area (CSA) of muscle and fat was measured from a standardized multi-slice CT scan of a 6 cm long section of thigh. CSA of soft tissue was taken from appropriate fat and muscle densities. Functional assessment was by the sit-to-stand 60 test, assessing both the number of sit-to-stands possible under controlled conditions in 60 s (STS 60), and the time taken to perform five sit-to-stand movements (STS 5). Data were collected on a wide range of potential determinants of muscle CSA.
Results. There were no significant differences in haemoglobin between males or females or between any of the groups studied. Serum phosphate and calcium-phosphate product were higher in HD patients as compared to CKD4 patients, but there were no differences in these variables when comparing PD patients with either CKD4 or HD patients. Muscle CSA correlated well with objective functional assessments in males (STS 60 R = 0.52, P<0.0001) and females (R = 0.41, P = 0.004), and STS performance was reduced in dialysed patients as compared with CKD 4. Univariate analysis demonstrated that muscle CSA was associated with serum albumin concentration (R = 0.49, P<0.0001), age (R = –0.35, P = 0.005) and C-reactive protein (R = –0.34, P = 0.004). Creatinine clearance, dialysis adequacy, dialysis vintage and time-averaged serum bicarbonate, calcium and phosphate concentrations were not correlated with muscle CSA.
Conclusion. In conclusion, patients with dialysis-treated CKD 5 exhibited more functionally significant muscle wasting than patients with CKD 4. This may be amenable to modification with targeted exercise or amelioration of factors associated with observed differences in muscle mass.
Keywords: chronic kidney disease; computed tomography; haemodialysis; peritoneal dialysis; skeletal muscle; wasting
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