SP679PHYSICAL ACTIVITY AND MALNUTRITION INFLAMMATION COMPLEX SYNDROME CONSPIRE TO MUSCLE WEAKNESS AND ATROPHY IN HAEMODIALYSiS

Abstract

INTRODUCTION AND AIMS: Uremic sarcopenia in chronic haemodialysis (HD) patients, defined as skeletal muscle weakness and decline muscle mass is associated with increased mortality risk. Currently determinants of muscle strength is poorly understood. The aim of this study was to determine parameters involved in diminution of muscular strength assessed by the isometric maximal voluntary force (MVF) of quadriceps in chronic HD patients. METHODS: A belt-stabilized hand held dynamometer was used to measure the MVF. Muscle mass was estimated using creatinine index (CI), lean tissue index (LTI) and skeletal muscle mass (assessed by bioelectrical impedance analysis). Self-questionnaire of Voorrips estimated physical activity. Nutritional and inflammatory parameters were serum albumin, serum high-sensitivity C-reactive protein (hs-CRP), and normalised protein catabolism rate (nPCR). Multivariate analyse and Spearman partial correlation networks were used to analyse MVF determinants. In order to test the hypothesis that muscle size and strength are not as closely linked, the concordance between high strength and mass was analysed using a quartile distribution. RESULTS: One hundred twenty three HD patients (80 males, 43 females; 68,88 [57,91 - 78,82] y.o.) were enrolled from May to September 2015. The median of MVF was 76.12 [58.21 - 111,7] N.m. Maximal voluntary force was highly associated with CI (β=4.32 [2.208 - 6.438], p <0.001), LTI (β =3.302 [1.336 - 5.267], p = 0.001 respectively), Log-Voorrips score (β= 16.835[1.804 - 31.865], p = 0.03) and serum albumin (β = 2.299 [0.995 - 3.603], p = 0.001) . Pearson partial correlation showed that inflammation assessed by hs-CRP were negatively associated with LTI (ρ = -0.2 p = 0.03) and serum albumin (ρ = -0.2 p = 0.029) which in turn are linked to MVF. Finally, thirty three HD patients have a low MVF without low SMM. These patients are mainly male, with poor nutritional status assessed by serum albumin (p < 0.001) and nPCR (p = 0.031), low grade inflammation (p = 0.001), low physical activity (p =0.02) and reduced dialysis vintage (p < 0.046). CONCLUSIONS: Physical activity, serum albumin, and muscle mass were main determinants of muscle strength. The Spearman partial correlation demonstrates that physical activity remains independent of all other covariates. In patients with reduced strength but maintained muscle mass low physical activity and malnutrition inflammation complex syndrome are more important.In conclusion although, muscle mass is a major determinant of muscle strength, we demonstrated that malnutrition inflammation complex syndrome and low physical activity act synergistically to uremic sarcopenia.