Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.

Cross-sectional studies in dialysis demonstrate muscle wasting associated with loss of function, increased morbidity and mortality. The relative drivers are poorly understood. There is a paucity of data regarding interval change in muscle in pre-dialysis and dialysis-dependant patients. This study a...

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Autores principales:	Stephen G John, Mhairi K Sigrist, Maarten W Taal, Christopher W McIntyre
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5b980a3d2f4e4d689d4f3342e5a9e264
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spelling	oai:doaj.org-article:5b980a3d2f4e4d689d4f3342e5a9e2642021-11-18T07:43:24ZNatural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.1932-620310.1371/journal.pone.0065372https://doaj.org/article/5b980a3d2f4e4d689d4f3342e5a9e2642013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23741490/?tool=EBIhttps://doaj.org/toc/1932-6203Cross-sectional studies in dialysis demonstrate muscle wasting associated with loss of function, increased morbidity and mortality. The relative drivers are poorly understood. There is a paucity of data regarding interval change in muscle in pre-dialysis and dialysis-dependant patients. This study aimed to examine muscle and fat mass change and elucidate associations with muscle wasting in advanced CKD. 134 patients were studied (60 HD, 28 PD, 46 CKD 4-5) and followed up for two years. Groups were similar in age, sex and diabetes prevalence. Soft tissue cross-sectional area (CSA) was measured annually on 3 occasions by a standardised multi-slice CT thigh. Potential determinants of muscle and fat CSA were assessed. Functional ability was assessed by sit-to-stand testing. 88 patients completed follow-up (40 HD, 16 PD, 32 CKD). There was a significant difference in percentage change in muscle CSA (MCSA) over year 1, dependant on treatment modality (χ(2) = 6.46; p = 0.039). Muscle loss was most pronounced in pre-dialysis patients. Muscle loss during year 1 was partially reversed in year 2 in 39%. Incident dialysis patients significantly lost MCSA during the year which they commenced dialysis, but not the subsequent year. Baseline MCSA, change in MCSA during year 1 and dialysis modality predicted year 2 change in MCSA (adjusted R(2) = 0.77, p<0.001). There was no correlation between muscle or fat CSA change and any other factors. MCSA correlated with functional testing, although MCSA change correlated poorly with change in functional ability. These data demonstrate marked variability in MCSA over 2 years. Loss of MCSA in both pre-dialysis and established dialysis patients is reversible. Factors previously cross-sectionally shown to correlate with MCSA did not correlate with wasting progression. The higher rate of muscle loss in undialysed CKD patients, and its reversal after dialysis commencement, suggests that conventional indicators may not result in optimal timing of dialysis initiation.Stephen G JohnMhairi K SigristMaarten W TaalChristopher W McIntyrePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 5, p e65372 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Stephen G John Mhairi K Sigrist Maarten W Taal Christopher W McIntyre Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.
description	Cross-sectional studies in dialysis demonstrate muscle wasting associated with loss of function, increased morbidity and mortality. The relative drivers are poorly understood. There is a paucity of data regarding interval change in muscle in pre-dialysis and dialysis-dependant patients. This study aimed to examine muscle and fat mass change and elucidate associations with muscle wasting in advanced CKD. 134 patients were studied (60 HD, 28 PD, 46 CKD 4-5) and followed up for two years. Groups were similar in age, sex and diabetes prevalence. Soft tissue cross-sectional area (CSA) was measured annually on 3 occasions by a standardised multi-slice CT thigh. Potential determinants of muscle and fat CSA were assessed. Functional ability was assessed by sit-to-stand testing. 88 patients completed follow-up (40 HD, 16 PD, 32 CKD). There was a significant difference in percentage change in muscle CSA (MCSA) over year 1, dependant on treatment modality (χ(2) = 6.46; p = 0.039). Muscle loss was most pronounced in pre-dialysis patients. Muscle loss during year 1 was partially reversed in year 2 in 39%. Incident dialysis patients significantly lost MCSA during the year which they commenced dialysis, but not the subsequent year. Baseline MCSA, change in MCSA during year 1 and dialysis modality predicted year 2 change in MCSA (adjusted R(2) = 0.77, p<0.001). There was no correlation between muscle or fat CSA change and any other factors. MCSA correlated with functional testing, although MCSA change correlated poorly with change in functional ability. These data demonstrate marked variability in MCSA over 2 years. Loss of MCSA in both pre-dialysis and established dialysis patients is reversible. Factors previously cross-sectionally shown to correlate with MCSA did not correlate with wasting progression. The higher rate of muscle loss in undialysed CKD patients, and its reversal after dialysis commencement, suggests that conventional indicators may not result in optimal timing of dialysis initiation.
format	article
author	Stephen G John Mhairi K Sigrist Maarten W Taal Christopher W McIntyre
author_facet	Stephen G John Mhairi K Sigrist Maarten W Taal Christopher W McIntyre
author_sort	Stephen G John
title	Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.
title_short	Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.
title_full	Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.
title_fullStr	Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.
title_full_unstemmed	Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.
title_sort	natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/5b980a3d2f4e4d689d4f3342e5a9e264
work_keys_str_mv	AT stephengjohn naturalhistoryofskeletalmusclemasschangesinchronickidneydiseasestage4and5patientsanobservationalstudy AT mhairiksigrist naturalhistoryofskeletalmusclemasschangesinchronickidneydiseasestage4and5patientsanobservationalstudy AT maartenwtaal naturalhistoryofskeletalmusclemasschangesinchronickidneydiseasestage4and5patientsanobservationalstudy AT christopherwmcintyre naturalhistoryofskeletalmusclemasschangesinchronickidneydiseasestage4and5patientsanobservationalstudy
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Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study.

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