Publication: Kronik Böbrek Hastalığı Olan Çocuklarda İskelet Kas Kütle İndeksi: Yorgunluk, Uykubozukluğu, Yaşam Kalitesi ve Fonksiyonel Performans İle İlişkisi
Abstract
Giriş: Sarkopeni yaşla artan ilerleyici kas gücü ve kütlesindeki azalma olarak tanımlanır. Kronik böbrek hastalığı (KBH) sekonder olarak sarkopeniye neden olabilir. Amaç: Bu çalışmanın amacı KBH tanısı almış çocuklarda iskelet kas kütle indeksini değerlendirmek ve bunun fonksiyonel performans, denge, yaşam kalitesi, yorgunluk ve uyku bozukluğu ile ilişkisini tespit etmektir. Gereç ve Yöntem: Çalışmamızda pediatrik nefroloji bölümünde KBH tanısıyla takip edilen 83 hasta (E/K=49/34) ve 71 sağlıklı kontrol (E/K=40/31) prospektif olarak değerlendirildi. Hasta ve kontrol grubunun verilerinin karşılaştırılması iki yaş aralığında gerçekleştirildi (5-12 yaş) ve (13-17 yaş). Ayrıca diyaliz öncesi bulunan hastalar, diyaliz tedavisi gören hastalar ve böbrek nakli yapılmış hastalar olmak üzere üç farklı grup arasında bir karşılaştırma yapıldı. Tüm katılımcıların el ve kuadriseps kas gücü dinamometre ile ölçüldü. Fonksiyonel değerlendirmeleri altı dakika yürüme testi, zamanlı kalk yürü testi, beş tekrarlı otur kalk testi ve yürüme hızı ölçümleri ile yapıldı. Yaşam kalitesi pediatrik yaşam kalitesi envanteri 4.0 versiyonu ile, yorgunluk düzeyi çocuk yorgunluk ölçeği ebeveyn formu ile, uyku bozukluğu çocuklar için uyku bozukluğu ölçeği ile ve denge bozukluğu ise pediatrik denge ölçeği ile değerlendirildi. Biyoelektrik impedans analizi yöntemi ile hesaplanan vücut kas ve yağ kütle ölçümleri kaydedildi. Apendiküler kas kütle indeksi (AKKİ), elde edilen apendiküler kas kütlesinin boyun karesine bölünmesiyle hesaplandı. Bulgular: AKKİ, el, kuadriseps kas güçleri ve fonksiyonel ölçümler açısından hasta ve kontrol grubu arasında anlamlı fark tespit edildi (p<0.001). Gruplar arasında yorgunluk, denge, uyku toplam skor ve yaşam kalitesi parametreleri açısından da anlamlı farklar görüldü (p<0.001). Tanita ölçümleri karşılaştırmasında yağ kütlesi dışındaki değerlerde anlamlı fark tespit edildi (p<0.005). Hasta alt grupları (diyaliz öncesi, diyalize giren ve nakil uygulanan hastalar) ve kontrol grubu olarak dört grup karşılaştırıldığında, tüm parametrelerde en düşük değerler diyaliz grubunda tespit edildi. Hasta grubunda yağsız kütle ve apendiküler kas kütle indeksi ile kas gücü, fonksiyonel performans ve denge arasında anlamlı düzeyde pozitif korelasyon saptandı (p<0.001). iv Sonuçlar: KBH olan çocuklarda denge düzeyi, kas gücü ve fonksiyonel performans sağlıklı çocuklara göre anlamlı düzeyde azalmış olarak tespit edildi. Kas kütle indeksi ile bu ölçümler arasında ilişki mevcuttu. Aynı zamanda bu çocukların daha yorgun, uykularının daha bozuk ve yaşam kalitelerinin daha düşük olduğu tespit edildi. Hasta grupları kendi içerisinde karşılaştırıldığında, diyalize giren grupta tüm parametreler daha düşük olarak bulundu. Bu çocuklarda kas kütle ve gücündeki azalmayı önlemek için hastalığın daha erken dönemlerinde egzersiz ve iyi bir beslenme programının başlanması önemlidir. Ayrıca uyku kalitesi, yorgunluk ve emosyonel duruma katkı sağlayacak tedavilerle hayata katılımlarının sağlıklı bir şekilde devam etmesi sağlanabilir. Anahtar Kelimler: kronik böbrek hastalığı, apendiküler kas kütle indeksi, denge, yorgunluk, yaşam kalitesi
Introduction: Sarcopenia is a age-related condition characterized by progressive loss of muscle mass and strength. Chronic kidney disease (CKD) can cause sarcopenia as a secondary condition. Objective: The aim of this study is to evaluate the skeletal muscle mass index in children diagnosed with CKD and to determine its relationship with functional performance, balance, quality of life, fatigue and sleep disorders. Materials and Methods: In our study, 83 patients (49M/34F) diagnosed with CKD and followed up in the Pediatric Nephrology Department, and 71 healthy controls (40M/31F) were prospectively evaluated. Comparisons of the data of the patient and control groups were carried out in two age ranges (5-12 years) and (13-17 years). Additionally, a comparison was made between three different groups: pre-dialysis patients, patients undergoing dialysis treatment, and patients who had undergone kidney transplantation. Hand and quadriceps muscle strength of all participants were measured using a dynamometer. Six-minute walk test, timed up-and-go test, fiverepetition sit-to-stand test, and gait speed were used to assess functional performance. Quality of life, fatigue and sleep disorder were evaluated with the Pediatric Quality of Life Inventory 4.0, the Child Fatigue Scale parent form and the Children's Sleep Habits Questionnaire, respectively. Balance was assessed with Pediatric Balance Scale. Body muscle and fat mass measurements, which were calculated using bioelectrical impedance analysis, were recorded. Appendicular muscle mass index (ASMI) was calculated by dividing the appendicular muscle mass by the square of the height. Results: When patient and control groups were compared in terms of ASMI, hand and quadriceps muscle strength, and functional measurements, significant differences were found between the two groups (p<0.001). There were also significant differences between the groups regarding fatigue, balance, total score of sleep, and quality of life parameters (p<0.001). In the comparison of Tanita measurements, significant differences were detected in all values except fat mass (p<0.005). When the four groups as patient subgroups (pre-dialysis, dialysis, and transplant) and the control group were compared, the lowest values in all parameters were observed in the dialysis group. A significant positive correlation was found between fat-free mass and ASMI vi with muscle strength, functional performance, and balance (p<0.001) in the patient group. Conclusions: Balance level, muscle strength and functional performance were significantly decreased in children with CKD compared to healthy children. There was a correlation between muscle mass index and these measurements. It was also found that these children were more tired, had more disturbed sleep and lower quality of life. When the patient groups were compared within themselves, all parameters were found to be lower in the dialysis group. In order to prevent the decrease in muscle mass and strength in these children, it is important to start exercise and a good nutrition program early in the disease. In addition, treatments that will contribute to sleep quality, fatigue and emotional state can ensure that their participation in life continues in a healthy way. Keywords: chronic kidney disease, appendicular muscle mass index, balance, fatigue, quality of life
Introduction: Sarcopenia is a age-related condition characterized by progressive loss of muscle mass and strength. Chronic kidney disease (CKD) can cause sarcopenia as a secondary condition. Objective: The aim of this study is to evaluate the skeletal muscle mass index in children diagnosed with CKD and to determine its relationship with functional performance, balance, quality of life, fatigue and sleep disorders. Materials and Methods: In our study, 83 patients (49M/34F) diagnosed with CKD and followed up in the Pediatric Nephrology Department, and 71 healthy controls (40M/31F) were prospectively evaluated. Comparisons of the data of the patient and control groups were carried out in two age ranges (5-12 years) and (13-17 years). Additionally, a comparison was made between three different groups: pre-dialysis patients, patients undergoing dialysis treatment, and patients who had undergone kidney transplantation. Hand and quadriceps muscle strength of all participants were measured using a dynamometer. Six-minute walk test, timed up-and-go test, fiverepetition sit-to-stand test, and gait speed were used to assess functional performance. Quality of life, fatigue and sleep disorder were evaluated with the Pediatric Quality of Life Inventory 4.0, the Child Fatigue Scale parent form and the Children's Sleep Habits Questionnaire, respectively. Balance was assessed with Pediatric Balance Scale. Body muscle and fat mass measurements, which were calculated using bioelectrical impedance analysis, were recorded. Appendicular muscle mass index (ASMI) was calculated by dividing the appendicular muscle mass by the square of the height. Results: When patient and control groups were compared in terms of ASMI, hand and quadriceps muscle strength, and functional measurements, significant differences were found between the two groups (p<0.001). There were also significant differences between the groups regarding fatigue, balance, total score of sleep, and quality of life parameters (p<0.001). In the comparison of Tanita measurements, significant differences were detected in all values except fat mass (p<0.005). When the four groups as patient subgroups (pre-dialysis, dialysis, and transplant) and the control group were compared, the lowest values in all parameters were observed in the dialysis group. A significant positive correlation was found between fat-free mass and ASMI vi with muscle strength, functional performance, and balance (p<0.001) in the patient group. Conclusions: Balance level, muscle strength and functional performance were significantly decreased in children with CKD compared to healthy children. There was a correlation between muscle mass index and these measurements. It was also found that these children were more tired, had more disturbed sleep and lower quality of life. When the patient groups were compared within themselves, all parameters were found to be lower in the dialysis group. In order to prevent the decrease in muscle mass and strength in these children, it is important to start exercise and a good nutrition program early in the disease. In addition, treatments that will contribute to sleep quality, fatigue and emotional state can ensure that their participation in life continues in a healthy way. Keywords: chronic kidney disease, appendicular muscle mass index, balance, fatigue, quality of life
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