Diagnóstico de sarcopenia em pacientes com doença renal em hemodiálise.

Abstract

INTRODUCTION: Chronic kidney disease is a progressive condition that results in a gradual deterioration of kidney function, often leading to the need for hemodialysis. Among the various associated complications, muscle dysfunction is one of the most prevalent and underestimated, significantly impacting the prognosis of patients. OBJECTIVE: To evaluate and diagnose sarcopenia in individuals with chronic kidney disease undergoing hemodialysis in a regional center, and to seek associations with clinical and laboratory parameters. ABSTRACT OF MANUSCRIPT I: UNRAVELING SARCOPENIA: THE IMPACT OF MUSCLE LOSS ON HEALTH. This narrative review updates information about sarcopenia through a review of both classic and recent studies. A condition characterized by progressive loss of muscle mass and strength, commonly associated with aging, but also present in individuals with sedentary lifestyles, chronic diseases or malnutrition. Sarcopenia affects approximately 30% of people over 60 years of age and up to 50% of individuals over 80 years of age. Pathophysiological factors include hormonal changes, chronic inflammation, oxidative stress, and mitochondrial dysfunction, which together contribute to muscle deterioration. Sarcopenia is classified as primary, related exclusively to aging, and secondary, associated with other conditions, such as chronic diseases or physical inactivity. The diagnosis of sarcopenia involves screening through questionnaires, muscle strength measurements with a dynamometer, and assessment of muscle mass by imaging techniques such as DXA and BIA. In addition, the article addresses prevention strategies, emphasizing the importance of physical activity and adequate nutrition from a Young age to mitigate the risks of sarcopenia in old age. The study highlights the need for early and personalized interventions to improve clinical outcomes and patients' quality of life, integrating technological advances and a more holistic and integrated approach to the management of this debilitating condition. ABSTRACT OF MANUSCRIPT II: ASSOCIATIONS BETWEEN SARCOPENIA AND CLINICAL PARAMETERS IN INDIVIDUALS ON HEMODIALYSIS: A STUDY IN A REGIONAL CENTER IN SOUTHERN BRAZIL. This analytical cross-sectional study, carried out between March 2023 and March 2024, aimed to identify the associations between rectus femoris muscle thickness, handgrip strength and biochemical parameters, in order to better understand the risk factors and clinical indicators of sarcopenia in patients with kidney failure on hemodialysis. The sample consisted of 67 patients, with a predominance of males (56.7%) and a mean age of 53.46 years. The study focused on variables such as handgrip strength, rectus femoris muscle thickness, and routine biochemical parameters. A significant correlation was observed between handgrip strength and sérum albumin levels, suggesting that albumin may be an important marker of the nutritional and muscular status of these patients. Although sarcopenia is prevalent in hemodialysis patients, no significant associations were found between other outcomes such as muscle thickness and biochemical parameters. ARTICLE ABSTRACT: DIAGNOSIS OF SARCOPENIA IN PATIENTS AT A HEMODIALYSIS SERVICE. Sarcopenia, characterized by age-related loss of muscle mass and strength, is common among patients with end-stage chronic kidney disease (CKD) undergoing hemodialysis. The aim of this study was to evaluate the prevalence of sarcopenia in patients with CKD undergoing dialysis in a hemodialysis service in the interior of Rio Grande do Sul. Sixty-six patients with clinical suspicion of sarcopenia were investigated using handgrip strength and bioimpedance measurements. The prevalence of low handgrip strength was significant (59.1%), indicating a high risk of sarcopenia. However, bioimpedance data did not confirm the diagnosis in any patient, suggesting limitations in the sensitivity of this technique in patients with chronic kidney disease. The lack of diagnostic confirmation by bioimpedance should not disregard the importance of early intervention to preserve muscle mass and improve the quality of life of these patients. Handgrip strength emerges as na accessible and effective tool to identify probable cases of sarcopenia, allowing timely clinical and nutritional interventions. This study highlights the need for multifaceted approaches to the assessment and treatment of sarcopenia in patients with CKD on hemodialysis, aiming to improve clinical outcomes and quality of life of these individuals. GENERAL CONCLUSIONS: Sarcopenia is a prevalent and underdiagnosed condition. It is related not only to aging, but also to factors such as chronic inflammation, hormonal changes and mitochondrial dysfunction, which highlights the need for preventive approaches and early diagnosis to improve the quality of life of the population. Especially in patients with chronic kidney disease on hemodialysis, a more careful look is essential, aiming at early diagnosis for appropriate interventions generating a positive impact on the health. There is a significant correlation between handgrip strength and serum albumin levels, allowing us to see that, even with simple measurements, it is already possible to observe probable cases of sarcopenia. The thickness of the rectus femoris muscle, measured by ultrasound, serves as an indicator of the preservation of muscle mass. The use of bioimpedance to estimate muscle mass, despite limitations in terms of accuracy compared to more advanced imaging techniques, can be applied in a wide range of clinical scenarios, especially in regions where access to cutting-edge technologies is limited.