Differences in the prevalence of sarcopenia in haemodialysis patients: the effects of gender and ethnicity.

BACKGROUND: There is no universal consensus definition of sarcopenia, although there is agreement that sarcopenia is a risk factor for mortality in haemodialysis (HD) patients. We aimed to determine the effect of using different operational definitions in a multiracial group of HD patients. METHODS: We measured hand grip strength (HGS) and appendicular lean mass (ALM) by segmental bioimpedance using the Foundation for the National Institutes of Health Sarcopenia Project (FNIH), European Working Group on Sarcopenia (EWGS) and Asian Working Group on Sarcopenia definitions for HGS weakness and loss of appendicular lean mass. RESULTS: In total, there were 600 HD patients: 373 men (62.2%), mean (SD) age 66.3 (14.7) years, 45.6% diabetic, ethnicity: 281 (48.5%) White, 167 (27.8%) Asian and 149 (24.8%) Black. On HGS criteria, 90.5% of Asian women and 88.5% of Asian men were weak according to EWGS compared to 62.3% of Black women and 52.5% of Black men and 64.5% of White women and 69.1% of White men by FNIH criteria (P < 0.001). On adding appendicular lean mass, the prevalence of sarcopenia was 68.3% for Asian, 27.1% for Black and 36.6% for White women by FNIH and 59.6% Asian, 21.3% Black and 39.9% White men by EWGS criteria. CONCLUSIONS: Current definitions of sarcopenia report a greater prevalence of muscle weakness compared to appendicular muscle loss in female compared to male HD patients and this is greater for Asian compared to Black and White patients. Because HGS weakness is a greater risk for death, definitions of sarcopenia may underestimate risk in HD patients.

Lubiprostone plus polyethylene glycol electrolyte lavage solution (PEG-ELS) versus PEG-ELS for bowel preparation in chronic constipation: a randomized controlled trial.

Colonoscopy is considered the standard procedure for early detection and prevention of colorectal cancer. Adequate bowel cleansing is an important determinant of the efficacy of colonoscopy screening. Currently, there is no standard method of bowel preparation for patients with chronic constipation. The aim was to access the rate of adequate bowel cleansing achieved using split-dose polyethylene glycol electrolyte lavage solution (PEG-ELS) plus lubiprostone in comparison with split-dose PEG-ELS alone. A single-centre, endoscopist-blinded, randomized controlled trial was conducted. Seventy-eight constipated patients aged 18-75 years who were indicated for colonoscopy in the gastroenterology unit of Srinagarind Hospital, Khon Kaen University, between February 2020 and February 2021 were randomly allocated to receive either split-dose PEG-ELS in combination with lubiprostone (N = 39) or split-dose PEG-ELS alone (N = 39) before colonoscopy. Adequate bowel cleansing was defined as an Ottawa bowel preparation score ≤ 7. The rate of adequate bowel cleansing was comparable between the PEG-ELS plus lubiprostone group and the PEG-ELS alone group (50% vs. 52.9%, p value = 0.81) with a relative risk of 1.13 (95% CI = 0.43-2.91). There were no significant differences in adenoma detection rate (41.2% vs. 35.3%, p value = 0.62), adverse events, acceptance, compliance, or patient satisfaction between the 2 groups. No additional benefit to successful bowel preparation was achieved by the combination of lubiprostone and PEG-ELS in chronic constipation patients undergoing colonoscopy.

Changes in body composition following haemodialysis as assessed by bioimpedance spectroscopy.

BACKGROUND/OBJECTIVES: Patients with chronic kidney disease treated by haemodialysis (HD) are at increased risk of sarcopenia. Bioelectrical impedance spectroscopy (BIS) can be used to determine body composition, and is one of the several potential screening tools for sarcopenia. The newer generation of portable hand-held devices can be readily used in dialysis centres. The results from BIS devices using a two-compartmental model of body composition can be affected by hydration status and so ideally measurements should be made when patients are not overhydrated. More recently BIS devices using a three-compartmental body model, which separate normally hydrated lean tissues from extracellular water (ECW) excess. We wished to determine whether body composition measured using such a BIS device was affected by hydration status. SUBJECTS/METHODS: We performed BISs pre and post HD using a three-body compartmental model. RESULTS: BISs were recorded in 48 patients; 68.8% male; mean age 67.70±14.21 years, weight pre dialysis 70.54±18.07, which fell post to 68.58±17.78 kg, ECW fell 16.92±4.76 vs 15.66±4.43 l, P<0.001, whereas there was no change for intracellular water 14.84±4.27 vs 14.90±4.68 l. Fat-free mass index (FFMI) fell 17.87±3.98 vs 16.78±3.97 kg/m2, P<0.001, whereas fat mass index (FMI) increased from 7.87±3.98 vs 8.12±3.81 kg/m2, P=0.002. A fall in FFMI was associated with an increase in FMI (r=0.804, P<0.001). CONCLUSION: FMI and FFMI measured by bioelectrical impedance assessment are both confounded by hydration status. Although pre-dialysis measurements are more convenient, we suggest BIS should preferably be performed post-dialysis when patients are less overhydrated and have less electrolyte imbalances.