Prevalência da sarcopenia e a relação de seus componentes com a qualidade de vida de indivíduos em hemodiálise

Abstract

End-stage chronic kidney disease (CKD) requires renal replacement therapy such as hemodialysis (HD), and this accelerates the onset of sarcopenia and can negatively influence the quality of life (QoL) of these individuals. Little is investigated about the components of sarcopenia considering the context of QoL of this population. Objectives: i) to assess the prevalence of sarcopenia in individuals aged 50 years or older with CKD on hemodialysis; ii) verify the association of sarcopenia with sociodemographic, clinical, anthropometric factors, sarcopenia components (muscular strength, skeletal muscle mass and physical performance) and QoL; iii) to correlate the components of sarcopenia determination with QoL. Methods: This is a cross-sectional study, with a non-probabilistic design, carried out at the Nephrology Center of Dourados, state of Mato Grosso do Sul, central-west region of Brazil, from January 2021 to January 2022. Participated individuals with CKD, aged 50 years or over, of both sexes and undergoing HD. Sociodemographic, clinical, functional, anthropometric, capacity, QoL and sarcopenia characteristics were investigated. For the diagnosis of sarcopenia, the algorithm and criteria proposed by the European Working Group on Sarcopenia in Older People (EWGSOP2) were adopted. Low muscle strength was determined at cut-off points for handgrip strength (HGS) <32 kg for men and <21 kg for women. Muscle mass was assessed in two methods, by calf circumference (CC) and by appendicular skeletal muscle mass index (ASMMI). Low muscle mass by CC was obtained at cutoff points ≤34 cm for men and ≤33 cm for women. And by the ASMMI <9.1 kg/m² for men and <6.6 kg/m² for women, both determined at the 20th percentile of the sample distribution. Low physical performance was determined by gait speed (GS) ≤0.8 m/s. QoL was assessed using the instrument proposed by the World Health Organization, the WHOQOL-bref (World Health Organization Quality of Life Instrument-bref). Descriptive statistics were performed and data were expressed as mean and standard deviation for continuous variables and percentages for categorical variables. Pearson's chi-square (χ2) was used for associations. Analysis of variance for the comparison of means between sarcopenia groups. Multiple comparisons were performed using the Tukey test. Pearson's correlation coefficient (r) was used to establish correlations between sarcopenia components and QoL. A significance level of 5% was adopted. Results: Of the 83 patients, there was a predominance of individuals with probable sarcopenia, both using CC (34.9%) and ASMMI (49.4%). Sarcopenia (confirmed and severe) was higher using CC than ASMMI (32.6% vs 18.1%). The mean age was 61.8 ± 8.3 years, most of them had low muscle strength (67.5%), adequate muscle mass obtained by both CC (55.4%) and ASMMI (79.5%) and adequate GS (71.1%). In the investigation of QoL, the physical domain (PD) had the lowest score (61.1±16.5). The median time of HD treatment in the study population was 26 months. There was no association between sarcopenia and global QoL as well as the domains evaluated. Significant associations were observed with weight (p<0.001), height (p=0.004), body mass index (BMI) (p<0.001), ASMMI (<0.001), HGS (<0.001) and GS (p=0.002) when sarcopenia was determined by the measure of CC. And when determined by the ASMMI, there was an association between sarcopenia and the variables weight (p<0.001), height (p=0.006), BMI (p<0.001), CC (<0.001), HGS (<0.001) and GS (p =0.002). Both HGS (p<0.05, r=0.25) and GS (p<0.001, r=0.36) were correlated with PD of the WHOQOL-bref instrument. Still, the GS was correlated with the ambient domain of the same instrument. Conclusion: The probable sarcopenia status was predominant and the PD was the most affected in this population. Individuals with sarcopenia had lower weight, BMI, CC and ASMMI compared to individuals with no sarcopenia and probable sarcopenia. The aspects of functionality, HGS and GS, determine the physical impairment in this population.