title: Muscle wasting in end-stage renal disease promulgates premature death: established, emerging and potential novel treatment strategies.
abstract: Muscle wasting (or sarcopenia) is a common feature of the uremic phenotype and predisposes this vulnerable patient population to increased risk of comorbid complications, poor quality of life, frailty and premature death. The old age of dialysis patients is in addition a likely contributor to loss of muscle mass. As recent evidence suggests that assessment of muscle strength (i.e. function) is a better predictor of outcome and comorbidities than muscle mass, this opens new screening, assessment and therapeutic opportunities. Among established treatment strategies, the benefit of resistance exercise and endurance training are increasingly recognized among nephrologists as being effective and should be promoted in sedentary chronic kidney disease patients. Testosterone and growth hormone replacement appear as the most promising among emerging treatments strategies for muscle wasting. As treatment of muscle wasting is difficult and seldom successful in this often old, frail, sedentary and exercise-hesitant patient group, novel treatment strategies are urgently needed. In this review, we summarize recent studies on stimulation of mitochondrial biogenesis, myogenic stem (satellite) cells and manipulation of transforming growth factor family members, all of which hold promise for more effective therapies to target muscle mass loss and function in the future.
authors.affiliation: Department of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.affiliation: Department of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Juan Jesus
authors.initials: JJ
authors.lastname: Carrero
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: von Walden
authors.affiliation: Division of Nephrology, Vanderbilt University Medical Center, Nashville, USA.
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
authors.affiliation: Department of Kinesiology, The Pennsylvania State University, University Park, USA.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Nader
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D061213:Mortality, Premature; D019282:Wasting Syndrome / Q000401:mortality / Q000628:therapy*
keywords: dialysis; exercise; growth hormone; inflammation; muscle wasting; sarcopenia