Avaliação da massa muscular esquelética por ultrassonografia e correlação com força e funcionalidade em idosos com doença renal crônica submetidos à hemodiafiltração online

Abstract

Introduction: skeletal muscle mass (SMM) and muscle function are negatively affected by conditions inherent to chronic kidney disease (CKD) and dialysis, a process accelerated by aging. The measurement of muscle mass and the assessment of strength and functionality are indicators and predictors of the clinical and nutritional status of elderly patients with CKD on dialysis. A method of assessment of these parameters would be ideal for an early diagnosis. Objective: to evaluate older patients submitted to online-hemodiafiltration (OL-HDF), by using quadriceps muscle ultrasound (US) to monitor the SMM and quality and to correlate with measures of muscle strength and functionality in male and female. Methods: a prospective observational study of incident older patients on OL-HDF, evaluated at admission (T0), 6 months (T1), and 12 months (T2) by anthropometric data, nutritional assessment, calf circumference (CC), muscle strength and functionality, assessment of body composition (bioelectrical impedance analyses - BIA, dual-energy-X-ray absorptiometry - DXA), general lab tests, inflammatory cytokines, and SMM assessment of the quadriceps by US. Results: thirty subjects were included (76 ± 8 years, 76.7% men). There was a significant reduction in CC (p<0.01) in both genders in the 12-month follow-up and gait speed reduced only in men (p=0.01). In men and women, there was a reduction in total testosterone and insulin-like growth factor binding protein - IGF-1BP3 (p<0.01) and an increase in tumor necrosis factor alpha - TNF- (p=0.04) in one year. Men had a reduction in muscle mass by BIA, DXA, and US (p<0.01), which in women was observed only by US (p<0.01). The percentage of SMM loss assessed by US of the cross-sectional area (CSA) of the rectus femoris muscle (RFM) in 12 months was -19.3 ± 6.9% (95% CI 15.2 -23.2; p<0.01) in men and -23.0 ± 8.2% (95% CI 12.8-31.1; p<0.01) in women. There was a correlation between quadriceps muscle thickness (QMT) and CSA of RFM (r=0.54; p=0.04) in men and between gait speed and pennation angle assessed by US (r=0.90; p=0.04) in women. Conclusion: Muscle US can be useful for the assessment of SMM in elderly patients with CKD on OL-HDF, being a bedside, non-invasive, accessible, and less costly option, in addition to having a good correlation with muscle strength and functionality.