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Sarcopenia is characterized by reduced muscle strength and muscle mass, related with decline in functionality, reduced quality of life, risk of hospitalizations, falls and mortality in individuals on hemodialysis (HD). The muscle respiratory, such as appendicular skeletal muscles, also show functional declines resulting from aging and the presence of chronic diseases. In chronic kidney disease (CKD), fluid overload can lead to hyperventilation due to compromised lung compliance, electrolyte imbalance, reduced oxygen diffusion with increased demand on respiratory muscles and weak respiratory. This study aimed to evaluate the association of sarcopenia traits with static and dynamic respiratory muscle strength in individuals undergoing HD.
Cross-sectional study, including individuals with CKD undergoing HD, in a nephrology unit of a public hospital in the Federal District, Brazil, including participants ≥ 18 years of age, both gender, between April and October 2023. The present study was approved by the Research Ethics Committee of the University of Brasília. Variables such as gender, age, dialysis vintage, presence of comorbidities, using the Charlson Comorbidity Index, body mass index (BMI) and albumin were collected. The Malnutrition Inflammation Score (MIS) and sarcopenia screening questionnaires, using the SARC-F and SARC-CalF, were applied. Sarcopenia traits were assessed by the presence of reduced handgrip strength measured in the dominant or contralateral limb and the presence of an arteriovenous fistula using a Jamar® hydraulic dynamometer and/or reduced muscle mass assessed using X-ray absorptiometry dual energy (DEXA). The cutoff points considered for reduced muscle strength were < 27 kgf for men and < 16 kgf for women, and for reduced muscle mass the appendicular muscle mass index < 7.0 kg/m2 for men and < 5.5 kg/m2 for women, according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP 2019). Static respiratory muscle strength was tested according to maximal inspiratory pressure (MIP) using a respiratory pressure meter, and dynamic inspiratory muscle strength was measured based on the S-Index obtained using the POWERbreathe K5. The Shapiro-Wilk test used to analyse data normality, the T Student, Chi-square and Mann Whitney tests were performed for differences between groups. Statistical analyses were performed using the SPPS program, V26, with statistical significance p<0.05.
The sample consisted of 33 participants, 54.50% (n=18) men; 60.60% (n=20) adults; age 55.78±13.23 years; dialysis vintage 20 [3-219] months; Charlson Comorbidity Index 4 [2-9]; BMI 26.20±4.82 kg/m2; albumin 3.95±0.36 g/dL; MIS 4 [1-14] and risk of sarcopenia using SARC-F and SARC-CalF was 18.18% (n=6) and 39.39% (n=13), respectively. The MIP (p=0.027) and S-Index (p=0.016) variables showed a significant difference between the groups of individuals with and without sarcopenia traits.
Possible sarcopenia was associated with reduced respiratory strength. Therefore, screening for sarcopenia and lung assessment in individuals with CKD provides useful information to direct early interventions and minimize negative outcomes.