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physiology > Sarcopenia and Kidney disease > Flashcards

Sarcopenia and Kidney disease Flashcards

1
Q

How has the definition of Sarcopenia developed over the years?

A
  • 2010 - age related disease of skeletal muscle function
  • 2016 - international classification of diseases-10 code
  • 2019 - change to muscle function as key criteria in defining probable sarcopenia
  • 2024 - revert back to sarcopenia being about mass and function
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2
Q

What factors can accelerate sarcopenia?

A

Sarcopenia is intrinsic to the ageing process but can be accelerated by various factors, including
- increased inflammation
- increased ammonia levels
- decreased testosterone
- increased myostatin levels
- decreased IGF-1

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3
Q

What is the most widely used criteria for defining sarcopenia?

Explain the process of diagnosis?

A

European Working Group on Sarcopenia in Older People

F- find people with sarcopenia - clinical susption of sacropenia of SarcF form
A - assess its presence - grip strength
C - confirm its presence - echo testing
S - severity of the case - gait speed, or up & go test

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4
Q

What are the primary and secondary causes of sarcopenia?

A

primary - age-related - when no other specific cause is evident
secondary - when casual factors other than (or in addition to) aging are evident

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5
Q

What are the 2 biggest risk factors for sarcopenia?

A
  • 2 biggest risk factors are physical inactivity(can be changed with specialist help) and multimorbidity
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6
Q

Describe chronic kidney disease:

What is it characterised by?

A
  • CKD is the progressive loss of kidney function over time affecting ~1 in 10 people
  • Kidney disease can be divided into three approximate cohorts: non-dialysis, dialysis, and transplant (RRT)
  • Patients characterised by increased CVD, muscle wasting, poor physical and exercise capacity
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7
Q

What are the stages of CKD?

A
  • Stage 1: kidney damage but normal function 90-100%
    most people display this as they age
  • Stage 2: damage & mild loss of function 89-60%
  • Stage 3a: mild-moderate loss of function 59-45%
  • Stage 3b: moderate-severe loss of function 44-30%
  • Stage 4: severe loss of function 29-15%
  • Stage 5: kidney failure <15%, need for transplant otherwise will die in 6 months
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8
Q

What happens to the recognition of sarcopenia in CKD patients?

A
  • CKD prevalence almost doubles in dialysis patients
  • CKD is described as a model of ‘accelerated aging’
  • sarcopenia is underrecognised in those with CKD
  • discrepancies in definitions/criteria used
  • no formal assessment
  • confused with malnutrition and protein-energy wasting
  • Depending on the definition used, can change the prevalence of sarcopenia, aswell as types of participants used
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9
Q

what are the 3 statuses in defining sarcopenia?

A
  • probable sarcopenia: low hand grip strength
  • confirmed sarcopenia: plus low muscle mass from BIA
  • severe sarcopenia: plus poor walking speed
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10
Q

How can the prevalence of sarcopenia vary in studies?

A

Low prevalence of sarcopenia could be due to the way biobank advertised the study
- Generally the healthier population were interested in taking part

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11
Q

How does physical inactivity and multi morbidity affect sarcopenia prevalence?

A

physical inactivity - participants in highest quartile of METs per week were 43% less likely to have sarcopenia
mulitmorbidity - participants with 3 or more comorbidities were 2.3 times more likely to be sarcopenic.

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12
Q

How did the prevalence of CKD effect sarcopenia?

A
  • those without CKD and probable sarcopenia had a much better survival that those with CKD and without sarcopenia.
  • if you have CKD = increased death risk
  • In participants with CKD, probable sarcopenia was associated with an increased risk of developing end-stage renal disease (ESRD). Adjustment for age, comorbidities, inflammation
  • People with CKD are at higher risk of developing sarcopenia
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13
Q

What is low grip strength associated with in CKD patients?

A

Low grip strength is correlated with clinical outcomes such as increased functional limitations, longer hospital stays, poor health-related quality of life and mortality. This is easily measured and doesn’t need a specialist

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14
Q

How do sarcopenia and CKD affect mortality?

A
  • 10 yr survival in sarcopenia and CKD patients is 4% lower compared to non-sarcopenic CKD patients
  • Having CKD has a far greater impact on survival than sarcopenia i.e. those without CKD and probable sarcopenia had a much better survival than those with CKD and without sarcopenia
  • Overall CKD and sarcopenia = death
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15
Q

How did sarcopenia affect the prevalence of Covid-19?

A

Impacted on risk of severe Covid-19
- Effect on immune function
- Individuals with probable sarcopenia were 64% more likely to have severe Covid infections.
- Those with sarcopenic obesity were 2.6 times more likely to have severe covid.

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16
Q

What happens following a kidney transplant?

A
  • muscle mass decreases (sarcopenia)
  • fat mass increases (obesity)
  • BMI increases (sarcopenic obesity)
    Peoples muscle mass reduces after surgery transplant
    But body weight remains the same
    This is why BMI is important as it masks this transition
17
Q

Describe muscle quality post-transplant:

A
  • increased muscle size = increased physical performance and strength
  • lack of evidence showing this in CKD patients
  • however, loss in function is observed independently of muscle mass in HD patients and older adults
18
Q

What factors influence muscle quality?

A
  • composition
  • metabolism
  • fibrosis
  • neuro-muscular activation
    influence muscle quality
19
Q

Define Myosteatosis:

A
  • Myosteatosis, the intramuscular infiltration of fat, has emerged as an important factor underpinning muscle quality. Fat infiltration into the muscle, can reduce quality of the muscle
20
Q

How can muscle quality be determined?

A
  • MRI can give a clear indication of muscle quality including infiltration of fat and fibrosis
  • costly and requires expertise and resources
  • also evaluated by non-invasive, low cost ultrasounds
  • echo testing can represent increased intramuscular adipose tissue and intramuscular fibrosis (white is fat, darkness is muscle)
21
Q

What is more important? quality or quantity?

A

linear relationship between RF-CSA(mass) & echo intensity(quality), both important
- but increased size of muscle can override quality of muscle & increase performance

22
Q

How is higher echo intensity(lower muscle quality) negatively correlated with physical performance?

A
  • fat infiltration alter fibre orientation and decrease elasticity & impairs mitochondrial metabolism(decreasing oxidative capacity)
  • non-contractile fibrotic tissue = decrease fibre direction (type II) = increased stiffness and decreased contractile ability
  • Reduces generation of ATP when fat gets into muscle can change the structure of the muscle
23
Q

Why CKD?

A
  • Myosteatosis has been associated with overall body fat and obesity (and diabetes) and physical inactivity and inflammation
    • Skeletal muscle fibrosis common in CKD1
    • Increase myostatin = increase fibro/adopogenic progenitor cells
    • Metabolic abnormalities from CKD uremic milieu
24
Q

How can patients overcome sarcopenia?

A
  • The first treatment for sarcopenia is PA
    • 150 min per week of moderate to vigorous aerobic physical activity, muscle-strengthening activities at least twice a week, and activities that challenge balance, in addition to several hours of light physical activity (i.e., standing)
    • However, resistance training is recommended as the primary mode of treatment for age-related muscle-wasting diseases as it can improve muscle mass and function in the elderly
    • Protein intervention to help sarcopenia: older adults should consume high-quality animal-derived protein sources, such as dairy, eggs, and meat, as it results in greater muscle hypertrophy when combined with resistance training
25
Q

What is the overall consensus for overcoming sarcopenia in older adults?

A

Overall: Encouraging older adults to participate in resistance training at least twice a week and consume ~1.6 g/kg/day of high-quality protein will reduce risks for many of the negative consequences of sarcopenia

physiology (10 decks)

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