Dissertação/Tese ASSOCIAÇÃO ENTRE FRAQUEZA MUSCULAR INSPIRATÓRIA NA SARCOPENIA E OSTEOPENIA EM INDIVÍDUOS COM DOENÇA RENAL CRÔNICA DIALÍTICA - PPGREAB

Introdução: Pacientes em hemodiálise frequentemente apresentam fraqueza muscular inspiratória, o que afeta negativamente a capacidade funcional e a qualidade de vida. Tal condição pode ser consequência do complexo mecanismo patogênico, associado à doença e ao próprio tratamento dialítico, que leva à sarcopenia e osteopenia nestes pacientes. Entretanto, não é conhecido se pacientes em hemodiálise com sarcopenia e osteopenia possuem maior probabilidade de apresentar fraqueza muscular inspiratória. Objetivo: Avaliar a associação entre força muscular inspiratória, sarcopenia e osteopenia em pessoas em hemodiálise. Metodologia: Pacientes em hemodiálise foram submetidos ao exame de Absormetria Radiológica de Dupla Energia, para registro da densidade mineral óssea (DMO) e da massa magra apendicular; testes de medida da Força de Preensão Palmar, pelo dinamômetro analógico Jamar®; e da força muscular inspiratória, por meio da mensuração da pressão inspiratória máxima (PImáx), utilizando um manovacuômetro analógico. As associações entre fraqueza muscular inspiratória, sarcopenia e osteopenia foram analisadas por regressão logística binária. Resultados: foram avaliados 91 pacientes, com média de idade de 52,4 anos. Houve correlação significativa moderadada PImax com FPP, DMO total e massa magra apendicular (r = 0,69; r = 0,40; r = 0,52 respectivamente), assim como correlação fraca entre PImáx e %gordura (r = -0,25). Indivíduos com fraqueza muscular inspiratória apresentaram menor FPP [diferença de 12,4 kgf (IC95% 8,8 – 16,0)], massa magra apendicular [diferença de 3,92 kg (IC95% 2,0 – 5,8)] e DMO [diferença de 0,10 g/cm³ (IC95% 0,04 – 0,16)], e maior % de gordura [diferença de 5,1% (IC95% 0,87 – 9,34)]. A presença de baixa FPP e sarcopenia na amostra foi associada a um risco 8,3 e 5,3 vezes maior, respectivamente, de apresentar fraqueza muscular inspiratória. Conclusão: As alterações da estrutura e função muscular, provocadas pela DRC e pela hemodiálise, e que são manifestadas pela sarcopenia e baixa FPP, estão associadas a fraqueza muscular inspiratória. Entretanto, as alterações da função óssea parecem não interferir na força muscular inspiratória.

Introduction: Patients on hemodialysis often have inspiratory muscle weakness, which negatively affects functional capacity and quality of life. This condition may be a consequence of the complex pathogenic mechanism associated with the disease and the dialysis treatment itself, which leads to sarcopenia and osteopenia in these patients. However, it is not known whether hemodialysis patients with sarcopenia and osteopenia are more likely to have inspiratory muscle weakness. Purpose: To assess the association between inspiratory muscle strength, sarcopenia, and osteopenia in patients on hemodialysis. Methodology: Patients undergoing hemodialysis were assessed by Dual Energy Radiological Absormetry, to record bone mineral density (BMD) and appendicular lean mass; Measures of Hand Grip Strength, using the analog Jamar® dynamometer; and inspiratory muscle strength, by measuring the maximum inspiratory pressure (PImax) Abstract: Introduction: Patients on hemodialysis often have inspiratory muscle weakness, which negatively affects functional capacity and quality of life. This condition may be a consequence of the complex pathogenic mechanism associated with the disease and the dialysis treatment itself, which leads to sarcopenia and osteopenia in these patients. However, it is not known whether hemodialysis patients with sarcopenia and osteopenia are more likely to have inspiratory muscle weakness. Purpose: To assess the association between inspiratory muscle strength, sarcopenia, and osteopenia in patients on hemodialysis. Methodology: Patients undergoing hemodialysis were assessed by Dual Energy Radiological Absormetry, to record bone mineral density (BMD) and appendicular lean mass; Measures of Hand Grip Strength, using the analog Jamar® dynamometer; and inspiratory muscle strength, by measuring the maximum inspiratory pressure (PImax), using an analog manometer, were performed. Associations between inspiratory muscle weakness, sarcopenia, and osteopenia were analyzed by binary logistic regression. Results: 91 patients were evaluated, with a mean age of 52.4 years. There was a moderately significant correlation of PImax with HGS, total BMD and appendicular lean mass (r = 0.69; r = 0.40; r = 0.52 respectively), as well as a weak correlation between PImax and %fat (r = -0 ,25). Individuals with inspiratory muscle weakness had lower HGS [difference of 12.4 kgf (95%CI 8.8 – 16.0)], appendicular lean mass [difference of 3.92 kg (95%CI 2.0 – 5.8)] and BMD [difference of 0.10 g/cm³ (95%CI 0.04 – 0.16)], and higher % of fat [difference of 5.1% (95%CI 0.87 – 9.34)]. The presence of low HGS and sarcopenia in the sample was associated with an 8.3 and 5.3 times greater risk, respectively, of having inspiratory muscle weakness. Conclusion: Alterations in muscle structure and function, caused by CKD and hemodialysis, and which are manifested by sarcopenia and low HGS, are associated with inspiratory muscle weakness. However, changes in bone function do not seem to interfere with inspiratory muscle strength.