Photo Credit: Giorgiomtb1
Sarcopenia screening and early interventions (nutrition, exercise) are recommended for patients with CKD to maintain muscle mass, strength, and performance.
Because sarcopenia can adversely affect the outcomes experienced by patients with chronic kidney disease (CKD), an accurate assessment of prevalence could be helpful to healthcare practitioners. Determining sarcopenia’s prevalence has its challenges due to varying definitions and conflicting cut-off values.
To address this information gap, Thomas J. Wilkinson, PhD, and colleagues developed a systemic review and meta-analysis of observational studies to provide a clear understanding of the prevalence of sarcopenia worldwide. They published the results of their analysis in the Journal of Cachexia, Sarcopenia and Muscle.
“The frequency of sarcopenia-related traits and severe sarcopenia in patients with CKD would be valuable in clinical and research settings, but these data have yet to emerge, the authors wrote. “This is of particular interest given the impact of sarcopenia on adverse clinical outcomes in patients with CKD to provide vital information for future research and clinical practice guidelines and to set priorities regarding public health and research.”
Global Data
The research team drew from MEDLINE/PubMed, Embase, Web of Science, CINAHL, and LILACS databases to identify pertinent articles. From the 8359 articles retrieved, the study team selected 140 studies that collectively included 42,041 patients across 25 countries, with five continents represented. Most of these studies (114) were gathered in the collective meta-analysis for sarcopenia and/or severe sarcopenia, and 26 of the studies were identified for inclusion in the meta-analysis for sarcopenia traits.
Analysis of the data showed that the prevalence of sarcopenia worldwide in patients with CKD was 24.5% (95% CI, 20.9–28.3). Researchers noted that this finding did not vary when CKD stages and kidney replacement therapies were considered (P=0.33).
Consensus Definitions
The researchers drew from the European Working Group on Sarcopenia in Older People (EWGSOP), the Asian Working Group for Sarcopenia, the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project, and the International Working Group on Sarcopenia to identify different consensus definitions of sarcopenia. EWGSOP (29.7%; 95% CI, 24.3–35.4) showed the highest prevalence, and FNIH showed the lowest prevalence (10.6%; 95% CI, 1.4–26.5). However, the authors noted no significant difference in prevalence among the consensus definitions.
Severe sarcopenia includes low muscle strength, low muscle mass, and low physical performance (ie, the presence of all traits associated with sarcopenia). The prevalence of this iteration of the disease ranged from 0.524 to 75%, according to analysis. The overall prevalence of severe sarcopenia was 21.0% (95% CI, 11.7–32.0; I2, 98.7%). In patients undergoing dialysis, the prevalence of severe sarcopenia was 26.2% (95% CI: 16.6–37.1). The prevalence in patients not undergoing dialysis was 3.0% (95% CI: 0–11.1; P < 0.01).
Sarcopenia Traits
In addition to the overall presence of sarcopenia in the worldwide population, the researchers also sought to identify the traits embedded in the definition of sarcopenia. For example, the prevalence of low muscle strength was found to be 43.4% prevalent (95% CI, 35.0–51.9). Patients undergoing kidney replacement therapies showed low muscle strength, especially those on hemodialysis (51.5%; 95% CI, 42.5–60.6). The authors noted a significant difference when patients undergoing dialysis (50.0%; 95% CI, 41.7–57.4; I2, 97.4%) were compared with patients who were not undergoing dialysis (19.6%, 95% CI, 12.8-27.3; I2: 94.7%; P<0.01).
In terms of low muscle mass, results showed the overall prevalence was 29.1% (95% CI, 23.9-34.5). Participation in dialysis was found to be insignificant in this trait group. Low physical performance had a prevalence of 38.6 (95% CI, 30.9-46.6). Patients undergoing hemodialysis (46.8%, 95% CI, 39.4-54.2) and peritoneal dialysis (47.5%, 95% CI, 41.4-53.5) were noted as having a higher occurrence of low physical performance. Participation in dialysis was also found to be insignificant in this trait group.
Dr. Wilkinson and colleagues expressed hope that their results will be applied to clinical practice, “The results presented in this systematic review provide support for the inclusion of sarcopenia screening in clinical settings and early implementation of targeted interventions (eg, nutrition and exercise) to counteract the decline in muscle mass, strength, and performance in people with CKD, especially those dialysis-dependent.”
