Avaliação da massa muscular e sarcopenia em pacientes com doença renal crônica

• Autor(a) principal: Barreto, Juliana Giglio Paes
• Data de Publicação: 2017
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/7220
• topic: Chronic kidney disease; Computed tomography; Muscle mass; Sarcopenia; Doença renal crônica; Massa muscular; Sarcopenia; Tomografia computadorizada; Nutrição; Insuficiência renal crônica; Músculos; CNPQ::CIENCIAS DA SAUDE::NUTRICAO::ANALISE NUTRICIONAL DE POPULACAO

Chronic kidney disease (CKD) can lead to muscle mass wasting and sarcopenia. The inflammatory status inherent to the disease, the dialysis, especially the hemodialysis (HD) and the changes in muscle mass related to aging can partially explain the increased protein catabolism present in CKD. Several studies demonstrated the usefulness of computed tomography (CT) images for the assessment of muscle mass as a reference method. However, in the CKD patients, few studies applied CT aiming the assessment of muscle mass. The present study aims to evaluate the muscle mass by reference methods and to describe the prevalence of sarcopenia in two cohorts of patients with CKD, one comprised by patients on CKD stages 3 to 5 (non-dialysis dependent) and another comprised by elderly patients on HD. Considering CT as a reference method, the aim of the first paper was to evaluate the muscle mass in patients with CKD stage 3 to 5 (non-dialysis dependent) at the third lumbar vertebra region. Other objectives included to assess 1) the agreement between the CT and methods used in clinical practice to evaluate muscle mass; 2) the prevalence of sarcopenia; 3) to identify which substitute method shows better agreement with CT for the diagnosis of sarcopenia. The main findings of the first study showed that midarm muscle circumference (MAMC) and Baumgartner's equation were the methods with higher agreement with CT to assess muscle mass. In addition, the prevalence of sarcopenia varied from 3 to 7%, depending on the method applied to evaluate muscle mass. The second paper of this thesis aimed to evaluate the association between low muscle mass, low muscle strength and sarcopenia with worsening nutritional status and clinical condition, poor quality of life, higher hospitalization risk and mortality in elderly patients on HD. This second study showed that low muscle strength was associated with poorer quality of life and higher hospitalization risk and, sarcopenia, on the other hand, was associated with poorer nutritional status and clinical condition and higher mortality rates. These studies confirm the importance of the assessment of muscle mass in CKD patients, considering their usefulness for the diagnosis of sarcopenia, the prevention of nutritional disturbances and the possibility to apply early therapeutic interventions. In addition, accessible methods in clinical practice, such as anthropometry and predictive equation, showed a good agreement with the gold standard method for the evaluation of muscle mass in CKD patients