Sarcopenia em pacientes com doença renal crônica em tratamento conservador em um hospital universitário da cidade do Recife : prevalência e fatores associados

Sarcopenia is a nutritional complication of Chronic Kidney Disease (CKD) and is related to increased morbidity, hospitalizations, frailty and increased mortality in these individuals. Uremic sarcopenia pathophysiology and its occurrence in CKD non-dialysis patients is poorly known. The aim of this study was to assess the prevalence and factors associated with sarcopenia in non-dialysis patients with chronic kidney disease. Cross-sectional study carried out at the non-dialysis CKD outpatient clinic of Hospital das Clinicas da UFPE, from April to October 2019, after approval by the ethics committee. Patients over 18 years old, with more than three months of regular outpatient follow-up and stages of CKD G3-G5 were included. Patients with acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, chronic liver disease, decompensated heart failure, wheelchair users and/or patients with limited mobility or bilateral amaurosis, history of hospitalization in the last six months were excluded. All patients were evaluated during their outpatient medical consultation. For the sarcopenia diagnosis, the European Working Group on Sarcopenia in Older People (EWGSOP) 2019 criteria were used. Muscle strength was assessed by the Hand Grip Strength Test, Muscle Mass by Bioelectrical Impedance and muscle performance by Gait Speed Test. 139 patients were evaluated, of which 53.2% were female, with a mean age of 57±13.48 years. Arterial Hypertension (AH) was the most frequent etiology with 42.4%, followed by diabetes mellitus (DM) with 38.1%. Most patients were in the G4 stage with 54.6%, followed by G5 with 28%, G3b 15.1% and G3a with 2.87%. The prevalence of sarcopenia was 20.9%, and severe sarcopenia 2.9%. Individuals classified as sarcopenic had a higher mean age (64.83±13.48 years vs 54.94±12.76 years; p <0.001), lower phase angle medians (4.5 (1.10) vs 5.6 (1.20) ); p<0.001), lowest median gait speed test (1.00 (0.5) vs 1.40 (0.42); p <0.001), and in the lowest median laboratory tests of serum creatinine (2.4 (1.5) vs 3 .00 (1.84); p: 0.032), Albumin / Creatinine Ratio (72.6 (1008.30) vs 342.30 (1172.13); p: 0.039) and Hemoglobin (11.45 (1.88) ) vs 12.6 (2.40): p: 0.003), and higher medians of CRP (0.24 (0.8) vs 0.03 (0.28); p: 0.045). In the bivariate analysis, there was no statistical correlation between sarcopenia with gender, etiology, stage of CKD, comorbidities, level of physical activity, daily protein intake, use of the evaluated drugs and inflammatory cytokines. In the multivariate model, after excluding confounding factors, only phase angle (RP: 0.36; CI 0.259-0.511; p <0.001), IL-6 (RP: 1,006; 1.001-1.011; p: 0.02) and serum creatinine (PR: 0.788; CI 0.641-0.969; p: 0.024) correlated with the presence of sarcopenia. The prevalence of sarcopenia in CKD-evaluated patients was high and correlated with lower phase angle values, higher IL-6 levels and lower serum creatinine levels.