Sarcopenia and Mortality in Patients With Chronic Non-dialytic Renal Disease: Systematic Review and Meta-Analysis.

OBJECTIVE: To analyze the results of prospective studies on the presence of sarcopenia and its association with cardiovascular events and mortality in patients with non-dialysis-dependent chronic renal disease. METHODS: This study used the PRISMA protocol for systematic review. The systematic review and meta-analysis protocol was recorded in the prospective record of systematic reviews by PROSPERO International: CRD42019120391. DATA SOURCES: MEDLINE via PubMed, Embase, Cochrane Library, CINAHL, Scopus, Web of Science and LILACS from December 2018 to April 20, 2019, with the survey results updated in January 2021. DATA ANALYSIS: Random effect models were calculated to compare the results due to high heterogeneity identified. RESULTS: The survey identified 951 studies. Of these, 392 were removed by duplicates and 559 references were selected for analysis. In the stage of evaluating titles and abstracts, 555 articles were excluded because they did not include inclusion criteria related to the population and study design, leaving 4 articles that were included in the systematic review and meta-analysis. A meta-analysis identified that the presence of sarcopenia increased the risk of mortality by 143%. CONCLUSION(S): The meta-analysis identified the influence of sarcopenia on mortality in non-dialysis-dependent chronic renal disease.

Association between sarcopenic obesity and cardiovascular risk: where are we?

INTRODUCTION: The main changes in the body composition refer to the increase of adipose tissue and/or the decrease of muscular mass, and these changes have effect in many clinical outcomes. Sarcopenic obesity (SO) consists of the presence of excessive adipose tissue and deficit of muscular mass simultaneously. People with SO may have synergistic effect due to obesity and sarcopenia, with increases cardiovascular risk more than obesity itself. OBJECTIVE: To describe the findings in the literature about the association between SO and risk factors and/or cardiometabolic disease (CMD) or cardiovascular disease (CVD). METHODS: An electronic search was done on the following databases: MEDLINE, Scopus, SciELO, LILACS and Web of Science, using the matching expressions and Boolean operators: "obesity sarcopenic" OR "sarcopenic obesity", in the titles of the studies, AND "cardiometabolic disease" OR "cardiovascular disease" OR "metabolic syndrome" OR "insulin resistance", in the abstract. RESULTS: Most of studies are cross-sectional and present many different diagnosis criteria for SO. It was possible to verify the association of the SO and the risk factors and/or CMD or CVD. CONCLUSION: SO is associated with risk factors and/or CMD or CVD. The lack of a consensus about this definition jeopardizes the effective clinical practice and the research about the subject.

Association between sarcopenic obesity and cardiovascular risk: where are we? / Asociación entre obesidad sarcopénica y riesgo cardiovascular: ¿dónde estamos?

Introduction: The main changes in the body composition refer to the increase of adipose tissue and/or the decrease of muscular mass, and these changes have effect in many clinical outcomes. Sarcopenic obesity (SO) consists of the presence of excessive adipose tissue and deficit of muscular mass simultaneously. People with SO may have synergistic effect due to obesity and sarcopenia, with increases cardiovascular risk more than obesity itself. Objective: To describe the findings in the literature about the association between SO and risk factors and/or cardiometabolic disease (CMD) or cardiovascular disease (CVD). Methods: An electronic search was done on the following databases: MEDLINE, Scopus, SciELO, LILACS and Web of Science, using the matching expressions and Boolean operators: «obesity sarcopenic» OR «sarcopenic obesity», in the titles of the studies, AND «cardiometabolic disease» OR «cardiovascular disease» OR «metabolic syndrome» OR «insulin resistance», in the abstract. Results: Most of studies are cross-sectional and present many different diagnosis criteria for SO. It was possible to verify the association of the SO and the risk factors and/or CMD or CVD. Conclusion: SO is associated with risk factors and/or CMD or CVD. The lack of a consensus about this definition jeopardizes the effective clinical practice and the research about the subject (AU)

Introducción: los principales cambios en la composición del cuerpo refi eren el incremento de tejido adiposo y/o la disminución de masa muscular, y estos cambios tienen efecto en varios resultados clínicos. La obesidad sarcopénica (OS) consiste en la presencia simultánea del exceso de tejido adiposo y el déficit de masa muscular. Las personas con OS pueden tener un efecto sinérgico debido a la obesidad y la sarcopenia, lo que incrementa el riesgo de enfermedad cardiovascular, más que la obesidad en sí. Objetivo: describir los hallazgos en la literatura científica sobre la asociación de la SO y los factores de riesgo y/o ECM (enfermedad cardiometabólica) o enfermedad cardiovascular (ECV). Métodos: se realizó una búsqueda electrónica en las siguientes bases de datos: MEDLINE, Scopus, SciELO, LILACS y Web of Science, usando las expresiones coincidentes y los operadores booleanos: «obesidad sarcopénica» o «sarcopénica obesidad», en los títulos de los estudios, y «enfermedad cardiometabólica» o «enfermedad cardiovascular» o «síndrome metabólico» o «resistencia a la insulina», en el abstract. Resultados: la mayoría de los estudios son de corte transversales y presentan diferentes criterios de diagnóstico para la OS. Fue posible verificar la asociación de la OS y los factores de riesgo y/o ECM o ECV. Conclusión: la OS está asociada con los factores de riesgo y/o ECM o ECV. La falta de un consenso sobre esta definición pone en peligro la efectividad de la práctica clínica y la investigación sobre el tema (AU)

Inflammatory, nutritional and clinical parameters of individuals with chronic kidney disease undergoing conservative treatment / Inflamación, estado clínico y nutricional de pacientes renales crónicos en tratamiento conservador

Introduction: due to the relevance of inflammation in individuals with chronic kidney disease (CKD), inflammation should be taken into account in the interpretation of the clinical-nutritional status. Objective: assess the association between inflammation, nutritional and clinical parameters in patients with CKD. Materials and methods: 92 patients with CKD. C-reactive protein (CRP) was used as an inflammation marker. Assessed nutritional parameters were anthropometry and biochemical exams. Evaluated clinical parameters were comorbidities, CKD characteristics, lipid profile, lipid-lowering agents, urea, creatinine and total leukocytes. Comparisons between two groups (with or without inflammation) were performed using Student’s t-test or chi-square test. Results: 15 (16.3%) patients had CRP above greater than or equal to 10mg/L and were considered with inflammation. In the group with inflammation, 05 (33%) had hypoalbuminemia as compared with 05 (6.5%) in the group without inflammation (p = 0.002). Lipid values were lower in the group with inflammation, with mean total cholesterol 171 (± 41.2) mg/dL and mean LDL-C 95 (± 31.2) mg/dL as compared with the group without inflammation, which had and a mean total cholesterol 198 (± 46) mg/dL and mean LDL-C 124 (± 40.1) mg/dL, p = 0,038 and p = 0.011, respectively. No other statistically significant differences between groups were found. Conclusion: inflammation was associated with changes in the total cholesterol and LDL levels and with an increased incidence of hypoalbuminemia. We suggest that serum albumin levels should only be used to assess nutritional status in the absence of inflammation and CRP levels ought to be considered in nutritional status interpretation in patients with CKD (AU)

Introducción: la inflamación es un problema frecuente en pacientes con enfermedad renal crónica (ERC) y se debe relacionar con el estado clínico y nutricional de estos. Objetivo: evaluar si existe una asociación entre la inflamación y los parámetros clínicos y nutricionales en los pacientes con ERC. Material y métodos: fueron evaluados 92 pacientes con ERC. Se utilizo la proteína C reactiva (PCR) como marcador de la inflamación. Los parámetros nutricionales evaluados fueron antropometría y exámenes bioquímicos. Los parámetros clínicos evaluados fueron comorbilidades, características de la ERC, perfil lipidico, hipolipemiantes, urea, creatinina y leucocitos totales. Para analizar las diferencias entre los grupos (con o sin inflamación) se utilizo el test t de Student o el test de Chi-cuadrado. Resultados: 15 pacientes (16,3%) presentaban PCR más o igual a 10,0 mg/dL y tenían inflamación. De estos, 05 (33%) tuvieron hipoalbuminemia, en comparacion con 05 (6,5%) en el grupo sin inflamación (p = 0,002). Los valores de lípidos fueron inferiores en el grupo con inflamación, con colesterol total medio de 171 mg/dL (} 41,2) e LDL-C medio de 95 mg / dL (} 31,2) en comparación con aquellos sin inflamación con medias de 198 mg / dL (} 46) y 124 mg/dL (} 40,1), respectivamente. No se encontraron otras diferencias significativas entre los grupos. Conclusión: la inflamación se ha asociado con modificaciones en el colesterol total, LDL e hipoalbuminemia. Se concluye que la albumina sérica solo se debe utilizar para evaluar el estado nutricional en ausencia de inflamación. El nivel de PCR es un marcador sensible de la inflamación y debe ser empleado en la interpretación del estado nutricional en pacientes con ERC (AU)

INFLAMMATORY, NUTRITIONAL AND CLINICAL PARAMETERS OF INDIVIDUALS WITH CHRONIC KIDNEY DISEASE UNDERGOING CONSERVATIVE TREATMENT.

INTRODUCTION: due to the relevance of inflammation in individuals with chronic kidney disease (CKD), inflammation should be taken into account in the interpretation of the clinical-nutritional status. OBJECTIVE: assess the association between inflammation, nutritional and clinical parameters in patients with CKD. MATERIALS AND METHODS: 92 patients with CKD. C-reactive protein (CRP) was used as an inflammation marker. Assessed nutritional parameters were anthropometry and biochemical exams. Evaluated clinical parameters were comorbidities, CKD characteristics, lipid profile, lipid-lowering agents, urea, creatinine and total leukocytes. Comparisons between two groups (with or without inflammation) were performed using Student's t-test or chi-square test. RESULTS: 15 (16.3%) patients had CRP above ≥ 10mg/L and were considered with inflammation. In the group with inflammation, 05 (33%) had hypoalbuminemia as compared with 05 (6.5%) in the group without inflammation (p = 0.002). Lipid values were lower in the group with inflammation, with mean total cholesterol 171 (± 41.2) mg/dL and mean LDL-C 95 (± 31.2) mg/dL as compared with the group without inflammation, which had and a mean total cholesterol 198 (± 46) mg/dL and mean LDL-C 124 (± 40.1) mg/dL, p = 0,038 and p = 0.011, respectively. No other statistically significant differences between groups were found. CONCLUSION: inflammation was associated with changes in the total cholesterol and LDL levels and with an increased incidence of hypoalbuminemia. We suggest that serum albumin levels should only be used to assess nutritional status in the absence of inflammation and CRP levels ought to be considered in nutritional status interpretation in patients with CKD.

Introducción: la inflamacion es un problema frecuente en pacientes con enfermedad renal cronica (ERC) y se debe relacionar con el estado clinico y nutricional de estos. Objetivo: evaluar si existe una asociacion entre la inflamacion y los parametros clinicos y nutricionales en los pacientes con ERC. Material y métodos: fueron evaluados 92 pacientes con ERC. Se utilizo la proteina C reactiva (PCR) como marcador de la inflamacion. Los parametros nutricionales evaluados fueron antropometria y examenes bioquimicos. Los parametros clinicos evaluados fueron comorbilidades, caracteristicas de la ERC, perfil lipidico, hipolipemiantes, urea, creatinina y leucocitos totales. Para analizar las diferencias entre los grupos (con o sin inflamacion) se utilizo el test t de Student o el test de Chi-cuadrado. Resultados: 15 pacientes (16,3%) presentaban PCR ≥ 10,0 mg/dL y tenian inflamacion. De estos, 05 (33%) tuvieron hipoalbuminemia, en comparacion con 05 (6,5%) en el grupo sin inflamacion (p = 0,002). Los valores de lipidos fueron inferiores en el grupo con inflamacion, con colesterol total medio de 171 mg/dL (} 41,2) e LDL-C medio de 95 mg / dL (} 31,2) en comparacion con aquellos sin inflamacion con medias de 198 mg / dL (} 46) y 124 mg/dL (} 40,1), respectivamente. No se encontraron otras diferencias significativas entre los grupos. Conclusión: la inflamacion se ha asociado con modificaciones en el colesterol total, LDL e hipoalbuminemia. Se concluye que la albumina serica solo se debe utilizar para evaluar el estado nutricional en ausencia de inflamacion. El nivel de PCR es un marcador sensible de la inflamacion y debe ser empleado en la interpretacion del estado nutricional en pacientes con ERC.