Sarcopenia em centros de diálise no Brasil
um estudo survey sobre avaliação e manejo
Palavras-chave:
Composição Corporal, Doença Renal Crônica, Hemodiálise, Massa Muscular, Força Muscular, SarcopeniaResumo
Objetivo
Identificar os centros de diálise brasileiros que avaliam a sarcopenia em sua rotina clínica, assim como os métodos de diagnóstico e manejo empregados.
Métodos
Estudo survey, estruturado com questões quali-quantitativas sobre como a sarcopenia é avaliada rotineiramente em centros de diálise. Os centros oficialmente cadastrados no site da Sociedade Brasileira de Nefrologia foram contatados por e-mail e/ou telefone. A pesquisa incluiu perguntas sobre o profissional de diálise, instrumentos, métodos e critérios para diagnosticar a sarcopenia e sobre como a sarcopenia foi tratada.
Resultados
Sessenta e dois centros de diálise responderam à pesquisa e 23 (37%) avaliaram a sarcopenia como rotina clínica. Destes, 13 contavam com profissional do exercício (57%) e todos contavam com nutricionista. Centros com profissional de exercício tiveram maior chance de avaliar sarcopenia (OR=4,23, IC 95%: 1,37 a 13,07). O principal consenso adotado para diagnosticar a sarcopenia foi o revisado European Working Group on Sarcopenia in Older People (EWGSOP2; n=10, 44%). A frequência de avaliação foi maioritariamente semestral e trimestral (n=8, 35% ambas). Os métodos mais comuns para avaliar os traços de sarcopenia foram força de preensão manual (n=16, 70%) para função física e bioimpedância (n=15, 65%) para massa muscular. Mudanças no plano alimentar (n=20, 87%) e prescrição de exercícios resistidos e combinados (n=8, 35% ambos) foram as estratégias de intervenção
mais adotadas.
Conclusão
A avaliação da sarcopenia nos centros de diálise brasileiros como rotina clínica foi baixa. A diretriz de definição mais utilizada foi o EWGSOP2, enquanto as avaliações mais utilizadas foram a força de preensão manual e a bioimpedância.
Referências
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing. 2010;39:412-23. https://doi.org/10.1093/ageing/afq034
D’alessandro C, Piccoli GB, Barsotti M, Tassi S, Giannese D, Morganti R, et al. Prevalence and correlates of sarcopenia among elderly CKD outpatients on tertiary care. Nutrients. 2018;10:1-13. https://doi.org/10.3390/nu10121951
Neves PDMM, Sesso RCC, Thomé FS, Lugon JR, Nasicmento MM. Brazilian dialysis census: Analysis of data from the 2009-2018 decade. J Bras Nefrol. 2020:181-200. https://doi.org/10.1590/2175-8239-jbn-2019-0234
Sabatino A, Cuppari L, Stenvinkel P, Lindholm B, Avesani CM. Sarcopenia in chronic kidney disease: What have we learned so far? J Nephrol. 2021;34:1347-72. https://doi.org/10.1007/s40620-020-00840-y
Duarte MP, Almeida LS, Neri SGR, Oliveira JS, Wilkinson TJ, Ribeiro HS, et al. Prevalence of sarcopenia in patients with chronic kidney disease: A global systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2024;15:501-12. https://doi.org/10.1002/jcsm.13425
Ribeiro HS, Neri SGR, Oliveira JS, Bennett PN, Viana JL, Lima RM. Association between sarcopenia and clinical outcomes in chronic kidney disease patients: A systematic review and meta-analysis. Clin Nutr. 2022;41:1131-40. https://doi.org/10.1016/j.clnu.2022.03.025
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16-1. https://doi.org/10.1093/ageing/afy169
Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020;21:300-7.e2. https://doi.org/10.1016/j.jamda.2019.12.012
Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, et al. The FNIH sarcopenia project: Rationale, study description, conference recommendations, and final estimates. J Gerontol: Ser A Biol Sci Med Sci. 2014;69A:547-58. https://doi.org/10.1093/gerona/glu010
Chumlea WC, Cesari M, Evans WJ, Ferrucci L, Fielding RA, Pahor M, et al. International working group on Sarcopenia. J Nutr Health Aging. 2011;15:450-5. https://doi.org/10.1007/s12603-011-0092-7
McLean RR, Kiel DP. Developing Consensus Criteria for Sarcopenia: An Update. J Bone Miner Res. 2015;30:58-92. https://doi.org/10.1002/jbmr.2492
Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021;36:3179-87. https://doi.org/10.1007/s11606-021-06737-1
Offord NJ, Clegg A, Turner G, Dodds RM, Sayer AA, Witham MD. Current practice in the diagnosis and management of sarcopenia and frailty: Results from a UK-wide survey. J Frailty Sarcopenia Falls. 2019;4(3):71-7. https://doi.org/10.22540/JFSF-04-071
Xu J, Wan CS, Ktoris K, Reijnierse EM, Maier AB. Sarcopenia is associated with mortality in adults: A systematic review and meta-analysis. Gerontology. 2022;68:361-76. https://doi.org/10.1159/000517099
Diz JBM, Leopoldino AAO, Moreira BDS, Henschke N, Dias RC, Pereira LSM, et al. Prevalence of sarcopenia in older Brazilians: A systematic review and meta-analysis. Geriatr Gerontol Int. 2017;17:5-16. https://doi.org/10.1111/ggi.12720
Bülow J, Ulijaszek SJ, Holm L. Rejuvenation of the term sarcopenia. J Appl Physiol. 2019;126:255-6. https://doi.org/10.1152/japplphysiol.00400.2018
Dent E, Woo J, Scott D, Hoogendijk EO. Sarcopenia measurement in research and clinical practice. Eur J Intern Med. 2021;90:1-9. https://doi.org/10.1016/j.ejim.2021.06.003
Cesari M, Kuchel GA. Role of Sarcopenia Definition and Diagnosis in Clinical Care: Moving from Risk Assessment to Mechanism-Guided Interventions. J Am Geriatr Soc. 2020;68:1406-9. https://doi.org/10.1111/jgs.16575
Morley JE, Sanford AM. Screening for sarcopenia. J Nutr Heal Aging. 2019;23:768-70. https://doi.org/10.1007/s12603-019-1259-x
Reis JMS, Alves LS, Vogt BP. According to Revised EWGSOP sarcopenia consensus cut-off points, low physical function is associated with nutritional status and quality of life in maintenance hemodialysis patients. J Ren Nutr. 2022;32(4):469-75. https://doi.org/10.1053/j.jrn.2021.06.011
Marini AC, Motobu RD, Freitas ATV, Laviano A, Pimentel GD. Pre-sarcopenia in patients undergoing hemodialysis: Prevalence and association with biochemical parameters. Clin Nutr ESPEN. 2018;28:236-8. https://doi.org/10.1016/j.clnesp.2018.07.014
Lopes LCC, Gonzalez MC, Avesani CM, Prado CM, Peixoto MRG, Mota JF. Low handgrip strength is associated with worse functional capacity and inflammation in maintenance hemodialysis patients. Nutrition. 2022;93:111469. https://doi.org/10.1016/j.nut.2021.111469
Kim S, Choi G, Song Y, Yoon H, Jeong HM, Gu JE, et al. Low muscle mass in patients receiving hemodialysis: Correlations with vascular calcification and vascular access failure. J Clin Med. 2021;10:3698. https://doi.org/10.3390/jcm10163698
Sai A, Tanaka K, Ohashi Y, Kushiyama A, Tanaka Y, Motonishi S, et al. Quantitative sonographic assessment of quadriceps muscle thickness for fall injury prediction in patients undergoing maintenance hemodialysis: An observational cohort study. BMC Nephrol. 2021;22:191. https://doi.org/10.1186/s12882-021-02347-5
Giglio J, Kamimura MA, Lamarca F, Rodrigues J, Santin F, Avesani CM. Association of sarcopenia with nutritional parameters, quality of life, hospitalization, and mortality rates of elderly patients on hemodialysis. J Ren Nutr. 2018;28:197-207. https://doi.org/10.1053/j.jrn.2017.12.003
Ferreira MF, Böhlke M, Pauletto MB, Frühauf IR, Gonzalez MC. Sarcopenia diagnosis using different criteria as a predictor of early mortality in patients undergoing hemodialysis. Nutrition. 2022;95:111542. Epub 2021 Nov 16. https://doi.org/10.1016/j.nut.2021.111542
Noor H, Reid J, Slee A. Resistance exercise and nutritional interventions for augmenting sarcopenia outcomes in chronic kidney disease: A narrative review. J Cachexia Sarcopenia Muscle. 2021;12:1621-40. https://doi.org/10.1002/jcsm.12791
Yoshimura Y, Wakabayashi H, Yamada M, Kim H, Harada A, Arai H. Interventions for Treating Sarcopenia: A systematic review and meta-analysis of randomized controlled studies. J Am Med Dir Assoc. 2017;18:553. e1-553.e16. https://doi.org/10.1016/j.jamda.2017.03.019
Mori K. Maintenance of skeletal muscle to counteract sarcopenia in patients with advanced chronic kidney disease and especially those undergoing hemodialysis. Nutrients. 2021;13:1538. https://doi.org/10.3390/nu13051538
Duarte MP, Ribeiro HS, Almeida LS, Baião VM, Inda-Filho A, Avesani CM, et al. SARC-F and SARC-CalF are associated with sarcopenia traits in hemodialysis patients. Nutr Clin Pract. 2022;37(6):1356-65. https://doi.org/10.1002/ncp.10819
Duarte MP, Vieira FA, Baião VM, Monteiro JS, Ferreira AP, Inda-Filho A, et al. 10-Item Physical Function Scale (PF-10) as a sarcopenia screening tool for patients on hemodialysis. J Ren Nutr. 2024;S1051-2276(24)00099-2. https://doi.org/10.1053/j.jrn.2024.05.012
Rosa CS da C, Ribeiro HS, Vogt BP, Sakkas GK, Monteiro HL. Sarcopenia diagnosis in patients receiving hemodialysis: Agreement among different consensuses. Nutr Clin Pract. 2022;37(6):1348-55. Epub 2021 Dec 30. https://doi.org/10.1002/ncp.10813
Ribeiro HS, Andrade FP, Leal DV, Oliveira JS, Wilund KR, Viana JL. How is exercise being prescribed for patients on hemodialysis? A scoping review. J Nephrol. 2022;36:1307-19. https://doi.org/10.1007/s40620-022-01513-8
Ministério da Saúde (Brasil). O procedimento de licenciamento das unidades privadas de diálise. Brasil: Ministério da Saúde; 2013.
Barros FS, Pinheiro BV, Ribeiro HS, Andrade FP, Souza CR de, Amorim AC do N, et al. Profile of professionals working in intradialytic exercise programs in Brazil: A national survey. J Bras Nefrol. 2022;44(4):573-8. https://doi.org/10.1590/2175-8239-jbn-2021-0264
Barros FS, Pinheiro BV, Lucinda LMF, Rezende GF, Segura-Ortí E, Reboredo MM. Exercise training during hemodialysis in Brazil: A national survey. Artif Organs. 2021;45:1368-76. https://doi.org/10.1111/aor.14018
Massuda A, Hone T, Leles FAG, de Castro MC, Atun R. The Brazilian health system at crossroads: Progress, crisis and resilience. BMJ Glob Health. 2018;3(4):e000829. https://doi.org/10.1136/bmjgh-2018-000829
Sesso R, Lugon JR. Global dialysis perspective: Brazil. Kidney360. 2020;1(3):216-9. https://doi.org/10.34067/KID.0000642019
Wilkinson TJ, McAdams-DeMarco M, Bennett PN, Wilund K. Advances in exercise therapy in predialysis chronic kidney disease, hemodialysis, peritoneal dialysis, and kidney transplantation. Curr Opin Nephrol Hypertens. 2020;29:471-9. https://doi.org/10.1097/MNH.0000000000000627
Bennett PN, Kohzuki M, Bohm C, Roshanravan B, Bakker SJL, Viana JL, et al. Global policy barriers and enablers to exercise and physical activity in kidney care. J Ren Nutr. 2022;32:441-9. https://doi.org/10.1053/j.jrn.2021.06.007
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2025 Marvery Peterson Duarte, Lucas Silva Almeida, Maristela Böhlke, Ricardo Moreno Lima, Otávio Toledo Nóbrega, Heitor Siqueira Ribeiro

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.