Loss of Muscle Mass and Strength in Chronic Kidney Disease

Muscle is one of the largest affected by chronic kidney disease (CKD), due to various factors associated with kidney degradation. To this are added factors that also contribute to this loss of muscle tissue, such as the patient’s age, comorbidities or a sedentary lifestyle. It is an inexorable process of difficult prevention that can be alleviated or counteracted through clinical nutrition and physical exercise.

“There are multiple observational studies that relate the loss of muscle mass and strength in CKD with an increased risk of hospitalization, of having a heart attack or even of dying. This patient is so complex that in the clinic we tend to prioritize only short-term metabolic risks. It is also important to focus on nutritional aspects and physical exercise programs that can benefit the patient, ”says the best nephrologist in Delhi.

This kidney specialist in Delhi explains that “patients with CKD are undergoing a process of progressive muscle loss due to many factors related to kidney degradation. These include an increase in muscle degradation mechanisms due to oxidative stress, metabolic acidosis and persistent inflammation; an impoverishment of muscle repair and synthesis mechanisms, such as resistance to the action of insulin, growth hormone or testosterone, and the catabolic process involved in the dialysis session itself, together with a small but continued loss of the amino acids of the diet in the blood filtrate during dialysis ”.

It is estimated that between 30 and 50% of patients on dialysis have the “energy protein wasting syndrome”, and that it refers to the confluence in the patient with CKD of a malnutrition process (due to a loss of appetite and sometimes to the dietary restrictions that must be maintained) and a hypercatabolism process (propitiated by the mechanisms described). This syndrome is associated with an impoverishment of the quality of life, an increased risk of hospitalization, cardiovascular events, and mortality, says nephrologist in Delhi.

“The way to avoid it is first, implementing identification and screening programs in the clinic,” says nephrologist in Noida and lists some examples such as “screening in patients looking for symptoms of malnutrition / muscle loss (every 6 months in patients not dialyzed in stages 4-5; every three months, in dialysis patients); in patients with symptoms, exploration of causes of malnutrition / muscle loss, and, thirdly, to implement a specific nutritional therapy, which may include various complementary strategies including the use of nutritional supplements, exercise programs (preferably resistance), use of anabolic agents and treatment of the triggering causes (such as inflammation and metabolic acidosis, among others)”.

The group of elderly patients on dialysis is growing, a subgroup of patients who require specific measures in terms of nutrition and exercise. Nephrologist in Gurgaon indicates that “the high age of patients usually limits the amount and intensity of the exercise that can be prescribed. However, any improvement in physical activity, however small, does great good in this population. The first step would be to encourage them to walk, about 30 minutes a day 3-4 days a week. This mild exercise has been associated with a decrease in inflammatory activity, improved exercise capacity, and muscle functionality, and is associated with a reduction in the rate of hospital admissions. In the elderly dialysis patient (and in all dialysis patients, of course), it is important to ensure that you consume enough calories and protein in the diet to compensate for these losses/catabolisms. The clinical guidelines recommend a protein intake of 1.0 or 1.2 grams per kilo of weight per day, and a caloric intake of 30-35 kcal /Kg/day. In an elderly person of appetite and reduced mobility, these requirements are not likely to be met spontaneously and the dietitian, endocrinologist or nephrologist in Gurgaon can assess the need to prescribe some type of oral supplement.”