Sarcopenia en pacientes con y sin insuficiencia renal crónica: diagnóstico, evaluación y tratamiento

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Ana María Cusumano


Se define sarcopenia como la pérdida de masa y función musculares, no sólo por disminución del tamaño sino también del número de fibras musculares. Altamente prevalente en el adulto mayor, aparece también en pacientes con enfermedades crónicas. En la insuficiencia renal crónica (IRC) contribuyen a su aparición la enfermedad crónica per se, la edad avanzada, el sedentarismo habitual, sumado a múltiples factores que deterioran el estado nutricional, tales como reducción de la ingesta asociada o no a drogas anorexígenas, inflamación crónica, déficit de hormonas anabólicas, bajos niveles de vitamina D, resistencia insulínica y disminución de gelsolina (proteína clave en el ensamblaje y desensamblaje de filamentos de actina). La presencia de sarcopenia correlaciona con mayor mortalidad, discapacidad y aumento del riesgo de caídas. El diagnóstico se basa en medir la fuerza muscular y el rendimiento físico; para lo primero se utiliza el dinamómetro, y para lo segundo la medida de la velocidad de la marcha (registra el tiempo necesario para caminar una distancia determinada) y el test “Time Up and Go” (evalúa el tiempo para levantarse, recorrer 3 metros y volver a sentarse). En pacientes con IRC, una adecuada ingesta proteica, sumado a actividad física (particularmente ejercicios de resistencia) mejoran el rendimiento físico, la aptitud respiratoria y la sobrevida en general, y reducen la mortalidad cardiovascular. Asimismo, el ejercicio aumenta elcontenido muscular de IGF-1, y del ARNm para factor de crecimiento tipo insulina II, la capacidad oxidativa muscular y el número de células satélites necesarias para regenerar las fibras musculares.

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Cusumano AM. Sarcopenia en pacientes con y sin insuficiencia renal crónica: diagnóstico, evaluación y tratamiento. Rev Nefrol Dial Traspl. [Internet]. 1 de enero de 2015 [citado 21 de septiembre de 2021];35(1):32-3. Disponible en:
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1. Rosemberg IH. Epidemiologic and methodologic problems in determining nutritional status of older per sons. Am J Clin Nutr 1989; 50(5 Suppl):1121-235.

2. Baumgartner N, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998; 147:755-63.

3. Muscaritoli M, Anjer SD, Argilés J, et al. Consensus definition of sarcopenia, cachexia and precachexia: Joint document elaborated by Special Interest Group (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition and geriatrics”. Clin Nutr 2010; 29:154-59.

4. Cruz Jentoft A, Baeyens JP, Bauer JM, et al. Sarcopenia: european consensus on definition and diagnosis. Age ageing 2010; 39:412-23.

5. Tonelli F. As Leonardo da Vinci discovered sarcopenia. Clin Cases Miner Bone Metab 2014; 11: 82-3.

6. Nair KS, Aging Muscle. Am J Clin Nutr 2005; 81:953-63.

7. Nogueira FRD, Libardi CA, Vechin FC, Lixandrao ME, et al. Comparison of maximal muscle strength of elbow flexors and knee extensors between younger and older men with the same level of daily activity. Clin Interv Aging 2013; 8:401-7.

8. Barroso L, Roschel H, Ugrinowitsch C, Araujo R, et al. Effect of eccentric contraction velocity on muscle damage in repeated bouts of elbow flexor exercise. Appl Physiol Nutr Metab 2010; 35:534-40.

9. Cruz Jentoft A, Landi P, Topinkova E, Michel JP. Understanding sarcopenia as a geriataric syndrome. Curr Opin Clin Nutr Metab Care 2010; 13:1-7.

10. Cedergikn T, Cruz-Jentoft AJ, Maggi S. Sarcopenia and fragility fractures. Eur J Phys Rehabil Med 2013;49:117-7.

11. Thornell LE. Sarcopenic obesity: satellite cells in the aging muscle. Curr Opin Clin Nutr Metab Care 2011;14:22-7.

12. Kortebien P, Ferrando A, Lombeida J, et al. Effects of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA 2007; 297:1772–4.

13. Alley DE, Koster A, Mackey D, Cawthon P, et al. Hospitalization and Change in Body Composition and Strength in a Population-Based Cohort of Older Persons. J Am Geriatr Soc 2010; 58:2085–91.

14. Morley JE. Hormones and the aging process. J Am Geriatr Soc 2003; 51(7 Suppl):S333-7.

15. Visser M, Deeg D, Lips P. Low Vitamin D and High Parathyroid Hormone Levels as Determinants of Loss of Muscle Strength and Muscle Mass (Sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 2003; 88:5766–72.

16. Cesari M, Kritchevsky SB, Baumgartner RN, et al. Sarcopenia, obesity, and inflammation-results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors study. Am J Clin Nutr 2005; 82:428-434.

17. Houston DK, Tooze JA, Neiberg RH, Hausman DB, et al. 25-Hydroxyvitamin D Status and Change in Physical Performance and Strength in Older Adults. The Health, Aging, and Body Composition Study. Am J Epidemiol 2012; 176: 1025-34.

18. Kwan P. Sarcopenia: The gliogenic perspective. Mech Ageing Dev 2013; 134: 349–55.

19. Castaneda C, Charnley JM, Evans WJ, Crim MC. Elderly women accommodate to a low-protein diet with losses of body cell mass, muscle function, and immune response. Am J Clin Nutr 1995; 62: 30-9.

20. Chin SO, Rhee SY, Chon S, et al. Sarcopenia is independently associated with cardiovascular disease in older Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009. PLoS One.2013; 8:e60119.

21. Schaap LA, Plujim SMF, Deej DJH, et al. Inflammatory markers and loss of muscle mass (sarcopenia) and strength. Am J Med 2006; 119:e9-e17.

22. Visser M, Goodpaster BH, Kritchevsky SB, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol Biol Sci Med Sci 2005; 60:324-33.

23. Masanés Torán F, Navarro López M, Sacanella Meseguer E, López Soto A. ¿Qué es la sarcopenia? Semin Fund Esp Reumatol 2010; 11:14-23.

24. Scott W, Stevens J, Binder-Macleod S. Human Skeletal Muscle Fiber Type Classifications. Physical Ther 2001; 8:1810-16.

25. Frontera WR, Hugues VA, Fielding RA. Ageing of skeletal muscle: a 12 year longitudinal study. J Appl Physiol 2000; 88:1321-6.

26. Volpi E, Nazemi R, Fujita S. Muscle tissue changes with aging. Curr Opin Clin Nutr Metab Care 2004; 7:405-10.

27. Lexell J. Human aging, muscle mass, and fiber type composition. J Gerontol A Biol Sci Med Sci 1995; 50:11–16.

28. McCormick KM, Thomas DP. Exercise-induced satellite cell activation in senescent soleus muscle. J Appl Physiol 1992; 72: 888-93.

29. Allen RE, Rankin LL. Regulation of satellite cells during skeletal muscle growth and development. Proc Soc Exp Biol Med 1990; 194:81-6.

30. Jozsi AC, Campbell WW, Joseph L, et al. Changes in power with resistance training in older and younger men and women. J Gerontol A Biol Sci Med Sci 1999; 54:M591-6.

31. Registro Argentino de Diálisis Crónica SAN-INCUCAI 2011. Disponible en:

32. Johansen KL, Chertow GM, Kutner NG, Dalrymple LS, et al. Low level of self-reported physical activity in ambulatory patients new to dialysis. Kidney Int 2010; 78: 1164-70.

33. Cupisti A, Capitanini A, Betti G, D’Alesandro C, et al. Assessment of habitual physical activity and energy expenditure in dialysis patients and relatinship to nutritional parameters. Clin Nephrol 2011; 75:218-25.

34. Lee PS, Sampath K, Karumanchi SA, et al. Plasma gelsolin and circulating actin correlate with hemodialysis mortality. J Am Soc Nephrol 2009; 20:1140-8.

35. Kovesdy CP, Kalantar.Zadeh K. Why is proteinenergy wasting associated with mortality in chronic kidney disease? Semin Nephrol 2009; 29:3-14.

36. Lee PS, Bhan I, Thadhani R. The potential role of plasma gelsolin in dialysis-related protein-energy wasting. Blood Purif 2010; 29:99-101.

37. Huffman GB. Evaluating and treating unintentional weight loss in the elderly. Am Fam Phys 2002; 65:640-50.

38. Alibhai SM, Greenwood C, Payette H. An approach to the management of unintentional weight loss in elderly people. Can Med Assoc J 2005; 172:773-80.

39. Geriatric Nephrology Curriculum, American Society of Nephrology. Disponible en:

40. Boudville N, Inderjeeth C, Elder GI, Glendenning P. Association between 25-hydroxivitamin D, somatic muscle weakness and falls risks in end-stage renal failure. Clin Endocrinol 2010; 73:299-304.

41. Gómez Alonso C, Naves Díaz ML, Fernández Martín JL, et al. Vitamin D status and secondary hyperparathyroidism: the importance of 25-hydroxyvitamin D cut-off levels. Kidney Int 2003; (Supl 85):s44-8.

42. Boudville N, Inderjeeth C, Elder GJ, Glendenning P. Association between 25-hydroxyvitamin D, somatic muscle weakness and falls risk in end-stage renal failure. Clin Endocrinol 2010; 73:299-304.

43. May RC, Kelly RA, Mitch W. Mechanisms for defects in muscle protein metabolism in rats with chronic uremia: the influence of metabolic acidosis. J Clin Invest 1987; 79:1099-103.

44. Bailey JL, Price SR, Zheng B, et al. Chronic kidney disease causes defects in signaling through the insulin receptor substrate/phosphatidylinositol 3 kinase/Akt pathway: implications for muscle atrophy. J Am Soc Nephrol 2006; 17:1388-94.

45. Hu Z, Wang H, Lee IH, et al. Endogenous glucocorticoids and impaired insulin signaling are both required to stimulate muscle wasting under pathophysiological conditions in mice. J Clin Invest 2009; 119:7650-9.

46. Su J, Wang X, Meireles CL, et al. Activation of caspase-3 is an initial step triggering muscle proteolysis in catabolic conditions. J Clin Invest 2004; 113:115-23.

47. Bailey JL, Wang X, England BK, et al. The acidosis of chronic renal failure activates muscle proteolysis in rats by augmenting transcriptions of genes encoding proteins of the ATP-dependent ubiquitin proteasome pathway. J Clin Invest 2006; 97:1447-53.

48. Zhang L, Wang XH, Wang H,et al. Satellite cell dysfunction and impaired iGF-1 signaling contribute to muscle atrophy in chronic kidney disease. J Am Soc Nephrol 2010; 21:419-27.

49. Shoelson S, Leo J, Goldfine A. Inflammation and insulin resistance. J Clin Invest 2006; 116:1793-1801.

50. Milano C, Aimar A, Casonú M, et al. Sarcopenia y sobrevida en una población de pacientes prevalentes en hemodiálisis crónica. XVII Congreso Argentino de Nefrología, 2013.

51. Cusumano A, Lombardo M, Milano C, Navarro E, Turin M. Estado nutricional de pacientes en hemodiálisis crónica. Medicina 1996; 56:643-9.

52. Desmet C, Beguin C, Swine C, Jadoul M. Falls in hemodialysis patients; prospective study of incidence, risk factors and complications. Am J Kid Dis 2005; 45:148-53.

53. Cook WL, Tomlinson G, Donaldson M, et al. Falls and falls-related injuries in older dialysis patients. Clin J Am Soc Nephrol 2006; 1:1197-204.

54. Johansen K, Doyle J, Sakkas G, Kent-Braun J. Neural and metabolic mechanisms of excessive muscle fatigue in maintenance hemodialysis patients. Am J Physiol Regul Integr Comp Physiol 2005; 289:R805-13.

55. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39:142-8.

56. Borst SE. Interventions for sarcopenia and muscle weakness in older people. Age ageing 2004; 33:548-55.

57. Brioche T, Kireev RA, Cuesta S, et al. Growth Hormone Replacement Therapy Prevents Sarcopenia by a Dual Mechanism: Improvement of Protein Balance and of Antioxidant Defenses. J Gerontol A Biol Sci Med Sci 2014; 69:1186-98.

58. Fouque D, Guebre-Egziabeher F, Laville M. Advances in anabolic interventions for malnourished dialysis patients. J Ren Nutr 2003; 13:161-5.

59. Orr R, Fiatarone Singh M. The anabolic androgenic steoid oxandrolone in the treatment of wasting and catabolic disorders: review of efficacy and safety. Drugs 2004; 64:725-50.

60. Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet 2011; 378: 1244-53.

61. Huang G, Shi X, Davis-Brezette JA, Osness WH. Resting heart rate changes after endurance training in older adults: a meta-analysis. Med Sci Sports Exerc 2005; 37: 1381-6.

62. Tanaka H, Dinenno FA, Monahan KD, et al. Aging, habitual exercise, and dynamic arterial compliance. Circulation 2000; 102:1270-5.

63. De Souza CA, Shapiro LF, Clevenger CM, et al. Regular aerobic exercise prevents and restores age-related declines in endothelium-dependent vasodilatation in healthy men. Circulation 2000; 102:1351-7.

64. Gregg EW, Cauley JA, Stone K, et al, for Study of Osteoporotic Fractures Research Group. Relationship of changes in physical activity and mortality among older women. JAMA 2003; 289:2379-86.

65. Manini TM, Everhart JE, Patel KV, et al. Daily activity energy expenditure and mortality among older adults. JAMA 2006; 296:171-9.

66. Montero-Fernandez R, Serra-Rexach JA. Role of exercise on sarcopenia in the elderly. Eur J Phys Rehabil Med 2013; 49:131-43.

67. Short KR, Vittone JL, Bigelow ML, Proctor DN, Nair KS. Age and aerobic exercise training effects on whole body and muscle protein metabolism. Am J Physiol Endocrinol Metab 2004; 286: E92-101.

68. Latham NK, Bennet DA, Stretton CM Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci 2004; 59:48-61.

69. Newton RU, Hakkinen K, Hakkinen A, McCormick M, et al. Mixed-methods resistance training increases power and strength of young and older men. Med Sci Sports Exerc 2002; 34:1367-75.

70. Huang G, Shi X, Gibson CA, Huang SC, et al. Controlled aerobic exercise training reduces resting blood pressure in sedentary older adults. Blood Press 2013; 22:386-94.

71. Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res 2013; 16:105-14.

72. Kopple JD, Wang H, Casaburi R, et al. Exercise in maintenance hemodialysis patients induces transcriptional changes in genes favoring anabolic muscle. J Am Soc Nephrol 2007; 18:2975-86.

73. Van den Ham EC, Koonan JP, Schols AM, et al. The functional, metabolic, and anabolic responses to exercise training in renal transplant and hemodialysis patients. Transplantation 2007; 83:1059-68.

74. Wang XH; Du J, Klein JD et al. Exercise ameliorates chronic kidney disease-induced defects in muscle protein metabolism and progenitor cell function. Kidney Int 2009; 76:751-59.

75. Johansen KL, Chertow GM, Da Silva M, Carey S, et al. Determinants of physical performance in ambulatory patients on hemodialysis. Kidney Int 2001; 60: 1586-91.

76. Goldberg AP, Geltman EM, Favin JR, et al. Exercise training reducing coronary risk and effectively rehabilitates hemodialysis patients. Nephron 1986: 42; 311-16.

77. Johansen KL, Chertow GM, Ng AV, Zinmmerman SW, et al. Physical Activity Levels on patients on hemodialysis and healthy sedentary controls. Kidney Int 2000; 57:2564-70.

78. Matsuzawa R, Matsunaga A, Wang G et al. Habitual Physical Activity measured by accelerometer and survival en maintenance hemodialysis patients. Clin J Am Soc Nephrol 2012; 7:2010-16.

79. Johansen Kl, Kaysen GA, Dalrymple LS, et al. Association of physical activity with survival among ambulatory patients on dialysis: the comprehensive dialysis study. Clin J am Soc Nephrol 2013; 8:248-53.

80. Noori N, Kopple JD, Kovesdy CP, et al. Midarm muscle circumference and quality of life and survival in maintenance hemodialysis patients. Clin J Am Soc Nephrol 2010; 5: 2258-68.

81. Moreau-Gaudry X, Guebre-Egziabher F, Jean G, et al. Serum creatinine improves body mass index survival prediction in hemodialysis patients: a 1-year prospective cohort analysis from the ARNOS study. J Ren Nutr 2011; 21:369-75.

82. Johansen KL, Chertow GM, Kutner NG, Dalrymple LS, et al. Low level of self-reported physical activity in ambulatory patients new to dialysis. Kidney Int 2010; 78: 1164-70.

83. Majchrzak KM, Pupim LB, Sundell M, Ikizler TA Body composition and physical activity in end-stage renal disease. J Ren Nutr 2007; 17:196-204.

84. Cheema B, Abas H, Smith B et al. Progressive exercise for anabolism in kidney disease (PEAK): a randomized controlled trial of resistance training during hemodialysis. J Am Soc Nephrol 2007; 18:1594-601.

85. Johansen KL, Kutner NG, Young B, Chertow GM. Association of body size with health status in patients beginning dialysis. Am J Clin Nutr 2006; 83:543-49.

86. Delgado C, Johansen KL. Barriers to exercise participation among dialysis patients. Nephrol Dial Tranplant 2012; 27:1152-57.

87. O’Hare AM, Tawney K, Bacchetti P, Johansen KL. Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2. Am J Kidney Dis 2003; 41:447-54.