dialysis treatment Sarcopenia in the terminal hememic in dialytic treatment

Sarcopenia in the terminal hememic in dialytic treatment





Yuri Battaglia1, Dario Galeano2, Elena Cojocaru1, Fulvio Fiorini3, Silvia Forcellini1, Luca Zanoli4, Alda Storari1, Antonio Granata2

(1) UOC of Nephrology and Dialysis, AOU "Sant'Anna", Ferrara, Italy
(2) UOC Nephrology and Dialysis, P.O. "San Giovanni di Dio", Agrigento, Italy
(3) UOC Nephrology - Dialysis and Dietology, P.O. "S.M. della Misericordia ", Rovigo, Italy
(4) Dept. of Internal Medicine, University of Catania, AOU "Policlinico-Vittorio Emanuele", Catania, Italy


Correspondence to: Dr. Antonio Granata; Complex Operative Unit of Nephrology and Dialysis, P.O. "San Giovanni di Dio" of Agrigento Contrada Consolida, 92100 Agrigento, Italy .; Tel: +39 0922442292; Fax: +39 0922442238; E-mail: antonio.granata4@tin.it



Abstract

The progressive and generalized loss of muscle mass and strength (sarcopenia) represents an increasingly frequent complication in the dialysis patient. The alterations described in the uremia such as insulin resistance, increased glucocorticoid activity, metabolic acidosis, malnutrition, inflammation and dialysis per se contribute to the development of sarcopenia, through the modulation of control mechanisms intracellular proteolytic (ubiquitin-proteasome system, caspase-3, IGF-1 / PI3K / Akt pathway). Since sarcopenia correlates with the increase in mortality, the risk of fractures and the worsening of the quality of life of the uremic patient, a timely and personalized diagnostic-therapeutic approach is central. Currently nuclear magnetic resonance (MR), computed tomography (CT), X-ray absorption double-beam densitometry (DXA), bio-impedancemetry, electrical bio-impedancemetry (BIA) and anthropometric measurements are the main methods of evaluation of skeletal muscle mass. On the therapeutic side, aerobic and anaerobic exercise programs in association with the correction of alterations linked to uremia, have proved effective in reducing sarcopenia and increasing muscle strength and power. In the present review the most recent data on the pathophysiology, diagnosis, therapy and future prospects of treatment of sarcopenia in the dialysis patient were analyzed.
Key words: hemodialysis, chronic renal failure, malnutrition, sarcopenia