NDT Advance Access published online on March 5, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh189
© 2004 by European Renal Association - European Dialysis and Transplant Association
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1 Department of Musculoskeletal Science, University of Liverpool, Liverpool, UK
* To whom correspondence should be addressed. E-mail: gkemp{at}liv.ac.uk.
Background. Muscle dysfunction, which contributes to morbidity in patients on haemodialysis, has several manifestations and a number of possible causes. We applied the non-invasive techniques of 31P-magnetic resonance spectroscopy (31P-MRS), magnetic resonance imaging (MRI) and near-infrared spectroscopy (NIRS) to calf muscle of dialysed patients to define the abnormalities in muscle cross-sectional area (CSA), contractile efficiency, mitochondrial function and vascular O2 supply. Methods. We performed 31P-MRS/NIRS/MRI studies on the lateral gastrocnemius during isometric plantarflexion and recovery in 23 male patients on haemodialysis (age 24-71 years; haemoglobin 9.9-14.2 g/dl; bicarbonate 17-30 mmol/l; urea reduction ratio 53-77%; parathyroid hormone 1-95 U/l) and 15 male controls (age 29-71 years). To understand the relationships between calf CSA and body mass we also performed MRI only in a further six male patients and 18 male controls. Results. In patients, exercise duration was 30±11% lower than in controls. Muscle CSA was lower by 26±5%, but contractile efficiency (force/CSA/ATP turnover) was normal. Slowing of post-exercise phosphocreatine (PCr) recovery implied a 22±5% defect in effective ‘mitochondrial capacity’. That PCr recovery was slow relative to NIRS recovery suggests that this is largely an intrinsic mitochondrial problem (not the result of impaired O2 supply), one which, furthermore, correlated with CSA. Urea reduction ratio showed a negative correlation with body mass and CSA, but none with PCr rate constant.
Accepted February 4, 2004
Original Article
Abnormal mitochondrial function and muscle wasting, but normal contractile efficiency, in haemodialysed patients studied non-invasively in vivo
2 Renal Unit, Royal Liverpool University Hospital, Liverpool, UK; Countess of Chester Hospital NHS Trust, Chester, UK
3 Department of Musculoskeletal Science, University of Liverpool, Liverpool, UK; Renal Unit, Royal Liverpool University Hospital, Liverpool, UK
4 Magnetic Resonance and Image Analysis Research Centre, University of Liverpool, Liverpool, UK; Department of Medical Imaging, University of Liverpool, Liverpool, UK
5 Magnetic Resonance and Image Analysis Research Centre, University of Liverpool, Liverpool, UK
6 Renal Unit, Royal Liverpool University Hospital, Liverpool, UK
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