Introduction:
Sarcopenia is characterized by progressive decrease in the skeletal muscle mass, strength, and or function. Chronic Kidney Disease (CKD) progression can have an impact on the nutrition and lifestyle due to decrease in protein consumption and lack of physical activity, thereby affecting the skeletal muscle mass.Limited literature is available on the prevalence of the different stages of sarcopenia across the various stages of diabetic kidney disease. The aim of this study is to determine the prevalence of Sarcopenia among people with type 2 diabetes and CKD based on KDIGO.
Methods:
A total of 184 (M:F-111:73) participants were recruited for this cross sectional study from November 2023 to August 2024 at a tertiary care center, Chennai. The participants were screened according to KDIGO into: CKD stages 1- Low risk (n=61), 2-Moderate risk (n=64), 3-High risk (n=59).Participants with artificial electrical implants such as a defibrillator or pacemaker and with diabetic foot ulcers were excluded.Skeletal muscle mass (SMM) was measured using Body Impedence Analysis (In Body 570) and Skeletal Muscle index (SMI) was calculated by dividing the SMM by square of the participants’ height(in m2).Hand Grip strength (HGS) was estimated using Jamar hydraulic dynamometer in the dominant hand and a 6-minute walk test was used to assess the physical performance. The Asian Working Group criteria (2019) was used to diagnose Sarcopenia. Participants with only SMI <7 kg/m2 for males and <5.7 kg/ m2 for females but with normal hang grip strength and physical performance were diagnosed with Presarcopenia. Those with decreased SMI (with the above mentioned cut off) with either decreased muscle strength (M:<28 kg,F:<18 kg) or function (6 metre walk;<1 m/s) were diagnosed with Sarcopenia. Severe sarcopenia was associated with low SMI, low muscle strength as well as low physical performance.
Results:
Participants in CKD stage 3 were older than the other stages (57vs 55,52;p=0.034).SMM ,SMI and HGS were significantly lower in stage 3 than stage 1[(22.4 vs 24.9), (6.7 vs 7.2), (24 vs 31)];p<0.001 for all. The median duration of diabetes and HbA1c were significantly higher in stage 3 than stage 1(18 vs 10) years, (8.7 vs 7.2) %whereas the eGFR and the amount of protein estimated were significantly lower in stage 3 when compared to stage 1[(39 vs 78), (7.9 vs 9)];p<0.001 for all. The prevalence of presarcopenia across the stages were 32.8%,18.8%,10.2% respectively (p=0.008). The prevalence of sarcopenia and severe sarcopenia in stages 2 and 3 were 10.9%,4.7% and 18.6%,10.2% respectively. The BMI and eGFR of participants with sarcopenia and severe sarcopenia were significantly lower than participants without sarcopenia.(25.8,23.1vs28.8)and (46,32vs60);p<0.001.SMI was positively correlated with BMI and eGFR but negatively correlated with age, duration of diabetes and HbA1c.
Conclusions:
Our study findings showed that the prevalence and severity of sarcopenia was higher among people with advancing stages of CKD and type 2 diabetes. Thus, it is essential to diagnose this condition early to prevent muscle loss and its associated potential complications.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.