Associação da anemia, força muscular, performance física e marcadores inflamatórios nos pacientes em hemodiálise

Abstract

Chronic Kidney Disease is defined by structural or functional abnormalities of the kidneys for a period equal to or greater than three months, according to Kidney Disease: Improving Global Outcomes of 2013, the progression of the disease can evolve with several complications, including anemia, inflammation, decreased muscle strength and physical performance. This study aimed to analyze whether hemodialysis patients with anemia had an increase in inflammatory cytokines, with a decrease in muscle strength and physical performance. This is a cross-sectional study, carried out in 3 hemodialysis clinics, with a population of both sexes, aged over 18 years, undergoing conventional hemodialysis for at least six months. Participants completed a standardized socioeconomic questionnaire, anthropometric assessment, sarcopenia risk assessment (SARC-F and SARC-CalF questionnaire), handgrip test with a hydraulic dynamometer, and gait speed test. The tests analyzed were: hematocrit, hemoglobin, iron, ferritin, transferrin saturation, total iron binding capacity, albumin and single-pool Kt/V. The weekly dose of erythropoietin and the erythropoietin resistance index were calculated and inflammatory cytokines (C-reactive protein, interleukin-6 and tumor necrosis factor-α) were collected. Anemia was considered as a dependent variable, the cut-off value was the indication of the use of erythropoiesis-stimulating agents (Hemoglobin <10 g/dL) and it was divided into two groups (without and with indication for replacement). There were 145 participants, with a mean age of 58.4 ± 14.6 years, 62.5% were male, 47.7% were elderly, 89.8% were hypertensive and 54.7% were anemic. Initially, data analysis did not show a correlation between anemia, muscle strength, physical performance and inflammation. However, after multivariate adjustment, the increase in IL-6 (OR= 3.97, 95% CI: 1.064-14.856 and p = 0.040) and the decrease in left arm muscle strength (OR= 0.675, 95% CI: 0.467- 0.975 and p = 0.036) gained importance and independently explained the presence of anemia. With this, he concluded that the presence of anemia was associated with increased levels of IL-6 and decreased muscle strength.