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Sarcopenia diagnosed by ultrasound-assessed quadriceps muscle thickness and handgrip strength predicts mortality in patients on hemodialysis

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Abstract

Background

Estimation of muscle mass is a pivotal component in the diagnosis of protein-energy wasting and sarcopenia. While bioimpedance spectroscopy is a widely  accepted technique for the assessment of lean tissue related to the diagnosis of sarcopenia, to date skeletal muscle ultrasound (US) has not gained full acceptance for this purpose. The aim of this study was to assess the predictive value for mortality of the indexed thickness of the quadriceps vastus intermedius, as measured by US, compared to lean tissue index as estimated by bioimpedance spectroscopy, both combined with handgrip strength in a group of patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (HD).

Methods

The cut-off values for low handgrip strength were < 27 kg for males and < 16 kg for females. The cut-off value for low lean tissue index was obtained from an age-matched healthy control group, with low lean tissue index being defined as values below the 10th percentile of the distribution of healthy subjects. The cut-off values for low quadriceps vastus intermedius thickness index were < 3.44 mm/m2 for males and < 3.52 mm/m2 for females.

Results

Ultrasound and bioimpedance spectroscopy were performed in 99 patients, and handgrip strength was assessed in 64 patients, all on maintenance HD. After a median follow-up of 28 months (interquartile range 19–41 months) 38 patients died. Lean tissue index was not associated with mortality, while low quadriceps vastus intermedius thickness index and low handgrip strength were associated with an increased hazard of death. In the fully adjusted model, only the combination of low handgrip strength and low quadriceps vastus intermedius thickness index was significantly associated with higher mortality.

Conclusion

When combined with low handgrip strength, low quadriceps muscle US outperformed low lean tissue index as assessed by bioimpedance spectroscopy in predicting mortality in a cohort of patients on maintenance HD. Ultrasound may be a useful and convenient technique for the assessment of sarcopenia and protein-energy wasting in this patient population.

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Acknowledgements

This is a secondary analysis of a larger observational, longitudinal and prospective study for which Alice Sabatino was the recipient of a young investigator research fellowship by the Italian Society of Parenteral and Enteral Nutrition (SINPE, Società Italiana di Nutrizione Parenterale ed Enterale) for the project: “Valutazione nutrizionale nell'insufficienza renale mediante ecografia del muscolo quadricipite femorale” (“Nutritional assessment of patients with chronic kidney disease and acute kidney injury through ultrasound of the quadriceps femoris muscle”).

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Authors and Affiliations

  1. UO Nefrologia, Azienda Ospedaliera Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy

    Alice Sabatino & Enrico Fiaccadori

  2. Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy

    Alice Sabatino, Giuseppe Regolisti & Enrico Fiaccadori

  3. University Hospital Maastricht, Maastricht, The Netherlands

    Jeroen Kooman

  4. Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden

    Carla Maria Avesani

  5. UOC Nefrologia e Dialisi AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy

    Mariacristina Gregorini

  6. Nephrology and Dialysis Unit, Livorno Sud, Tuscany, Italy

    Stefano Bianchi

  7. UO Clinica e Immunologia Medica, Azienda Ospedaliera-Universitaria Parma, Parma, Italy

    Giuseppe Regolisti

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  1. Alice Sabatino
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Correspondence to Alice Sabatino.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was approved by the local Institutional Review Board (AVEN, ref. n° 45737, December 12th, 2015). The procedures were performed in agreement with the Declaration of Helsinki, and written informed consent was obtained from all participants.

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The study was approved by the institutional ethics committee. This article does not contain any studies performed with animals by any of the authors.

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Informed consent was obtained from all the patients.

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Sabatino, A., Kooman, J., Avesani, C.M. et al. Sarcopenia diagnosed by ultrasound-assessed quadriceps muscle thickness and handgrip strength predicts mortality in patients on hemodialysis. J Nephrol (2024). https://doi.org/10.1007/s40620-023-01867-7

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