SARCOPENIA E DENSIDADE MINERAL ÓSSEA EM PORTADORES DE DOENÇA RENAL CRÔNICA EM HEMODIÁLISE.

Abstract

Patients with Chronic Kidney Disease (CKD) have complex abnormalities in mineral and bone metabolism, since the reduction of renal function leads to disorders in bone and muscle metabolism. Sarcopenia is an important risk factor for decreased bone mineral density and other changes in CKD patients undergoing hemodialysis. In this context, the main objective of this study was to analyze the association between sarcopenia and Bone Mineral Density (MOD) in patients with chronic kidney disease on hemodialysis. This is a case-control study nested in a prospective cohort of CKD patients undergoing hemodialysis in the city of São Luís - MA. In this study, cases were considered to have been considered in the patients who at the beginning of the cohort study had sarcopenia (n=68). For the control group, those who did not present sarcopenia (n=141) were considered. The study participants were followed for one year. The criterion of sarcopenia adopted was that proposed by the Consensus European Working Group on Sarcopenia in Older People (EWGSOP). The participants of each group were evaluated in two moments. Clinical, laboratory, sociodemographic, nutritional status and bone densiometry characteristics were evaluated. Nutritional status was assessed by body mass index (BMI), and body composition measurements (%lean mass, relative skeletal muscle index) by Dual Energy X-ray Absorption (DEXA). Bone Mineral Density (MOD) was measured in different regions of the body (upper limbs, lower limbs, spine and total) through DEXA. The basal characteristics of the groups, after one year, were compared by means of t-student for paired samples or Wilcoxon. To evaluate how changes in clinical and body composition variables between the two moments of the study influence osteoporosis, the logistic model of mixed effects was adjusted. There was a predominance of males (48% case group and 52% control) and mean age in the case group was 53.1±16.3 years and in the control of 46.9±11.9 years (p=0.009). At the beginning of the study of sarcopenic patients, 65% had osteoporosis, while in the control group this prevalence was 36%, and this difference was statistically significant (p=0.0005). At the end of the study, there was a prevalence of osteoporosis of 57% in the case group and 30% in the control group (p=0.0010). In both groups, when comparing the prevalence of osteoporosis at the beginning and end of the study, there was a reduction in prevalence, but without statistical significance. When the influence of changes in clinical and body composition variables was evaluated, only age (years) (OR: 1.88; CI95%: 1.07-1.31) and increased lean mass (OR: 0.80; CI95%: 0.66-0.97) were related to the presence of osteoporosis. The results of this study showed that the decrease in lean mass increases the chance of osteoporosis in patients with chronic kidney disease on hemodialysis. It was also observed that the chance of developing osteoporosis increases as the renal patient was older and that body fat increased in both sexes, regardless of the group.