Morphological, electrophysiological, and metabolic characteristics of skeletal muscle in people with end-stage renal disease: a critical review.
OBJECTIVE
Fatigue is one of the most frequent debilitating symptoms reported by people with end-stage renal disease (ESRD) on haemodialysis (HD) therapy. A wide range of underlying abnormalities, including skeletal muscle weakness, have been implicated as causes of this fatigue. Skeletal muscle weakness is well established in this population, and such muscle weakness is amenable to physical therapy treatment. The purpose of this review was to identify morphological, electrophysiological, and metabolic characteristics of skeletal muscles in people with ESRD/HD that may cause skeletal muscle weakness.


METHODS
Electronic databases were searched for relevant literature from inception to March 2010. Inclusion criteria were English language; adult subjects with ESRD/HD; and the use of muscle biopsy, electromyography, and nuclear magnetic spectroscopy ((31)P-NMRS) techniques to evaluate muscle characteristics.


RESULTS
In total, 38 studies were included. All studies of morphological characteristics reported type II fibre atrophy. Electrophysiological characteristics included both neuropathic and myopathic skeletal muscle changes. Studies of metabolic characteristics revealed higher cytosolic inorganic phosphate levels and reduced effective muscle mass.


CONCLUSIONS
The results indicate an array of changes in the morphological, electrophysiological, and metabolic characteristics of skeletal muscle structure in people with ESRD/HD that may lead to muscle weakness.
Anuradha Sawant, DPT:  PhD candidate, Graduate Program in Health and Rehabilitation Sciences, Physical Therapy Field, The University of Western Ontario, London, Ontario; Physiotherapist, London Health Sciences Centre, University Hospital Campus, 339 Windermere Road, London, Ontario.
Anuradha
A
Sawant
S Jayne
SJ
Garland
Andrew A
AA
House
Tom J
TJ
Overend
D004576:Electromyography; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism; D018482:Muscle, Skeletal / Q000378:metabolism; D009135:Muscular Diseases / Q000378:metabolism; D006435:Renal Dialysis