Document Detail


Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients.
MedLine Citation:
PMID:  18538898     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Muscle wasting is considered the best marker of protein-energy wasting in end-stage renal disease (ESRD). We tested the usefulness of a simple observer subjective muscle atrophy (MA) grading in relation to morbidity and mortality in ESRD patients. METHODS: In two different ESRD cohorts (265 incident patients starting dialysis and 221 prevalent hemodialysis patients), each patient's degree of MA was visually graded by a trained nurse on a scale from 1 to 4 as part of the subjective global assessment. This score was confronted with inflammatory and nutritional indexes as well as objective measurements of muscle atrophy. Patients were then prospectively followed for up to four or six years, depending on the cohort. RESULTS: Thirty percent of the incident and 39% of the prevalent patients presented signs of MA. Across worsening MA scale, nutritional and anthropometric markers of muscle loss were incrementally poorer. Inflammation markers as well as the proportion of women became progressively higher. Female sex, presence of cardiovascular disease, inflammation and low insulin-like growth factor-1 levels were associated with increased significant odd ratios of MA in each cohort. After adjustment for age, sex, inflammation, diabetes, cardiovascular disease, glomerular filtration rate and/or time on hemodialysis, the hazard ratio of death for moderate/severe MA was 2.62 (95% CI: 1.34, 5.13; p=0.001) and 3.04 (95% CI: 1.61, 5.71; p=0.0001) in the incident and prevalent cohorts respectively. CONCLUSION: Increased MA is more common in female dialysis patients and associated with inflammation, poor nutritional and anthropometric status, as well as a 3-fold increased 4-6 year mortality. Our data support the use of frequent MA and/or nutritional assessments in the clinical practice.
Authors:
Juan Jesús Carrero; Michal Chmielewski; Jonas Axelsson; Sunna Snaedal; Olof Heimbürger; Peter Bárány; Mohamed E Suliman; Bengt Lindholm; Peter Stenvinkel; Abdul Rashid Qureshi
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-06-06
Journal Detail:
Title:  Clinical nutrition (Edinburgh, Scotland)     Volume:  27     ISSN:  1532-1983     ISO Abbreviation:  Clin Nutr     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-09-01     Completed Date:  2008-12-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309603     Medline TA:  Clin Nutr     Country:  England    
Other Details:
Languages:  eng     Pagination:  557-64     Citation Subset:  IM    
Affiliation:
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. juan.jesus.carrero@ki.se
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Biological Markers / blood
Cohort Studies
Female
Humans
Incidence
Inflammation / epidemiology*,  mortality,  pathology
Kidney Failure, Chronic / mortality,  pathology,  therapy*
Male
Middle Aged
Muscular Atrophy / epidemiology*,  mortality,  pathology
Nutrition Assessment
Nutritional Status
Prevalence
Renal Dialysis / adverse effects*,  methods,  mortality*
Risk Factors
Severity of Illness Index
Sex Factors
Survival Analysis
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers

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