Sarcopenia na doença renal crônica

Abstract

Background: Sarcopenia has emerged as a significant complication in Chronic Kidney Disease (CKD), particularly among younger age groups, where it is associated with worse clinical and functional prognoses. However, studies focusing on this pediatric population remain scarce. Objective: To evaluate sarcopenia in adolescents with CKD and its relationship with clinical and laboratory variables. Additionally, to analyze the agreement between diagnostic methods for sarcopenia in this population. Methods: A cross sectional and analytical study was conducted with 20 patients aged 10 to 19 years, undergoing conservative treatment (CT group) in stages G3a-G5, or hemodialysis (HD group), attended at the Pediatric Nephrology Service of the University Hospital of UFMA. Sarcopenia was defined by assessing lean mass and muscle strength using the gold standard method (ALMI, Appendicular Lean Mass Index, and Saehan dynamometer) and an alternative screening method (AMBc - Corrected Arm Muscle Area and DM-90 dynamometer). The 30-second chair stand test was used to evaluate the patients’ physical performance. ALMI was measured using dual-energy X-ray absorptiometry (DXA). Clinical and laboratory variables were collected through electronic medical records and questionnaires. Results: Among the included patients, eight belonged to the CT group and twelve to the HD group. The median age was 12 years, with a female predominance (65%). The HD group presented a higher percentage of height deficit compared to the CT group. The prevalence of sarcopenia was 78.9% (gold standard) and 73.6% (alternative method). When assessed using the DM-90 dynamometer, the HD group showed significantly lower strength compared to the CT group (p=0.035). Similarly, the values for AMB, AMBc, ALM, and ALMI were lower in the HD group (p=0.021; p=0.011; p=0.003; p<0.001, respectively). ALMI and the strength tests using DM-90 and Saehan demonstrated a significant correlation with height, weight, and hemoglobin levels. All muscle mass tests showed significant correlations with one another and with the strength tests. The strongest correlation was found between ALMI and AMBc (r=0.839; p<0.001). Strong agreement was reported between the DM-90 and Saehan devices (Kappa=0.857), with a difference of 1.3 kgf between the two. Conclusion: The study highlighted the relevance of sarcopenia in the growth, nutritional status, and development of adolescents with CKD, particularly in those undergoing dialysis. Additionally, it emphasized the feasibility of assessing sarcopenia using simple and accessible screening tools, as well as the necessity of early strategies to control modifiable factors such as anemia and uremia.