Patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (MHD) commonly develop protein-energy wasting (PEW), a syndrome characterized by nutritional and metabolic abnormalities. Nutritional supplementation and exercise are recommended to prevent PEW. In a six-month prospective randomized, open-label, clinical trial, we reported that the combination of resistance exercise and nutritional supplementation does not have an additive effect on lean body mass measured by DEXA. In order to provide more mechanistic data, we performed a secondary analysis where we hypothesized that the combination of nutritional supplementation and resistance exercise would have additive effects on muscle protein accretion by stable isotope protein kinetic studies, muscle mass by MRI, and mitochondrial content markers in muscle. We found that six months of nutritional supplementation during hemodialysis increased muscle protein net balance [baseline: 2.5 (-17.8, 13.0) vs. 6-month: 43.7 (13.0, 98.5) µg/100ml/min, median (IQR), p=0.04], and mid-thigh fat area [baseline: 162.3 (104.7, 226.6) vs. 6-month: 181.9 (126.3, 279.2) cm², median (IQR), p=0.04]. Three months of nutritional supplementation also increased markers of mitochondrial content in muscle. Although the study is underpowered to detected differences, the combination of nutritional supplementation and exercise failed to show further benefit in protein accretion or muscle cross-sectional area. We conclude that long-term nutritional supplementation increases the skeletal muscle anabolic effect, the fat cross-sectional area of the thigh, and markers of mitochondrial content in skeletal muscle.

中文翻译：

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长期透析内口服营养和运动对血液透析患者肌肉蛋白稳态和线粒体含量标志物的影响


接受维持性血液透析 (MHD) 的终末期肾病 (ESKD) 患者通常会出现蛋白质能量消耗 (PEW)，这是一种以营养和代谢异常为特征的综合征。建议补充营养和锻炼来预防 PEW。在一项为期六个月的前瞻性随机、开放标签临床试验中，我们报告称，抗阻运动和营养补充的结合对 DEXA 测量的去脂体重没有附加作用。为了提供更多的机制数据，我们进行了二次分析，通过稳定同位素蛋白质动力学研究、MRI 的肌肉质量和线粒体含量标记物，我们假设营养补充和抗阻运动的结合会对肌肉蛋白质的增加产生附加影响。肌肉。我们发现，血液透析期间补充营养六个月增加了肌肉蛋白净平衡[基线：2.5 (-17.8, 13.0) 对比 6 个月：43.7 (13.0, 98.5) µg/100ml/min，中位数 (IQR)，p= 0.04]和大腿中部脂肪面积[基线：162.3 (104.7, 226.6) 对比 6 个月：181.9 (126.3, 279.2) cm ² ，中位数 (IQR)，p=0.04]。三个月的营养补充也增加了肌肉中线粒体含量的标志物。尽管该研究不足以检测到差异，但营养补充和锻炼的结合未能显示出对蛋白质积累或肌肉横截面积的进一步益处。我们得出的结论是，长期营养补充会增加骨骼肌的合成代谢作用、大腿的脂肪横截面积以及骨骼肌中线粒体含量的标志物。