Adults undergoing peritoneal dialysis for chronic kidney disease lose more muscle mas when they also have diabetes or obesity, according to findings published in Nutrition, Metabolism and Cardiovascular Diseases.
“A significant decrease in skeletal muscle mass (muscle wasting) may occur in chronic kidney disease and be complicated by dynapenia (ie, the loss of muscle strength) till a full-blown condition of sarcopenia,” Bruna Guida, MD, of the department of clinical medicine and surgery of the physiology nutrition unit at University of Naples Federico II in Italy, and colleagues wrote. “Patients on peritoneal dialysis could be even at higher risk of developing muscle wasting than other CKD patients because of the high glucose load from dialyzing solutions and of the loss of plasma proteins, mainly albumin, in the dialysate.”
Guida and colleagues conducted a cross-sectional observational study in which 88 adults (mean age, 53.4 years; 33% women) on an average dialysis duration of 15.9 months were recruited from University of Naples Federico II.
The researchers used bioelectrical impedance analysis to measure fat mass, skeletal muscle mass and body weight in the cohort. Fat mass was used to calculate fat mass index (FMI) and define obesity levels. FMI calculations of at least 8.3 kg/m2 and 11.8 kg/m2 defined obesity for men and women, respectively. In addition, by dividing skeletal muscle mass by body weight, the researchers established definitions for muscle mass status. Marks of less than 37% and less than 28% in men and women, respectively, equated to moderate to severe muscle loss.
More than one-third (37.5%) of the total cohort had moderate muscle mass loss, and 6.8% had severe muscle loss, which was defined by a skeletal muscle mass divided by body weight of less than 31% in men and less than 22% in women. Two-thirds (66.7%) of those with severe muscle mass loss also had diabetes compared with 15.2% of those with moderate muscle mass loss and those with normal muscle mass (P < .05). Most participants with reduced muscle mass also had obesity (86.4%), including all six participants with severe muscle mass loss. In comparison, only 6.1% of those without muscle mass loss had obesity (P < .01). Participants with both obesity and diabetes were more likely to have lower muscle mass than those without either condition (OR = 46.37; 95% CI, 7.26-296.13).
“The strong association that we found between muscle wasting and obesity in [peritoneal dialysis] suggests a possible causal link between these two conditions. An obvious, simplistic hypothesis to explain this association is that glucose overload caused by its absorption from the [peritoneal dialysis] dialysate could cause obesity, insulin resistance and, consequently, muscle mass loss,” the researchers wrote. “These characteristics may contribute to development of physical disability and mortality and pave the way to specific nutritional intervention to reduce fat and increase muscle mass in [peritoneal dialysis] patients.” – by Phil Neuffer
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