Sarcopenia is an age-related progressive muscle disease characterized by loss of muscle mass, muscle strength and physical performance with high prevalence in chronic kidney disease (CKD). CKD is associated with decreased muscle protein synthesis and muscle breakdown due to a number of factors including, the uremic inflammatory environment of the disease. CKD patients are highly sedentary and at risk of malnutrition which may exacerbate sarcopenia outcomes even further. Short and long-term exercise and nutritional interventions have been studied and found to have some positive effects on sarcopenia measures in CKD. This narrative review summarized evidence between 2010 and 2020 of resistance exercise (RE) alone or combined with nutritional interventions for improving sarcopenia outcomes in CKD. Due to lack of CKD-specific sarcopenia measures, the second European Working Group on Sarcopenia in Older People (EWGSOP2) definition has been used to guide the selection of the studies. The literature search identified 14 resistance exercise-based studies and 5 nutrition plus RE interventional studies. Muscle strength outcomes were increased with longer intervention duration, intervention supervision, and high participant adherence. Data also suggested that CKD patients may require increased RE intensity and progressive loading to obtain detectable results in muscle mass. Unlike muscle strength and muscle mass, physical performance was readily improved by all types of exercise in long or short-term interventions. Four studies used RE with high-protein nutritional supplementation. These showed significant benefits on muscle strength and physical performance in dialysis patients while non-significant results were found in muscle mass. More research is needed to confirm if a combination of RE and vitamin D supplementation could act synergistically to improve muscle strength in CKD. The current evidence on progressive RE for sarcopenia in CKD is encouraging; however, real-life applications in clinical settings are still very limited. A multidisciplinary patient-centred approach with regular follow-up may be most beneficial due to the complexity of sarcopenia in CKD. Long-term randomized control trials are needed to verify optimal RE prescription and explore safety and efficacy of other nutritional interventions in CKD.

中文翻译：

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抗阻运动和营养干预可增加慢性肾病的肌肉减少症结局：叙述性回顾

肌肉减少症是一种与年龄相关的进行性肌肉疾病，其特征是肌肉质量、肌肉力量和身体机能下降，在慢性肾脏病 (CKD) 中发病率很高。由于多种因素，包括疾病的尿毒症炎症环境，CKD 与肌肉蛋白质合成减少和肌肉分解有关。CKD 患者久坐不动，有营养不良的风险，这可能会进一步加剧肌肉减少症的后果。已经研究了短期和长期运动和营养干预，发现对 CKD 的肌肉减少症措施有一些积极影响。这篇叙述性综述总结了 2010 年至 2020 年期间单独使用抗阻运动 (RE) 或与营养干预相结合以改善 CKD 肌肉减少症结局的证据。由于缺乏 CKD 特异性肌少症措施，第二个欧洲老年人肌肉减少症工作组 (EWGSOP2) 的定义已被用于指导研究的选择。文献检索确定了 14 项基于阻力运动的研究和 5 项营养加 RE 干预研究。肌肉力量结果随着干预时间的延长、干预监督和参与者的高依从性而增加。数据还表明，CKD 患者可能需要增加 RE 强度和渐进性负荷才能获得可检测的肌肉质量结果。与肌肉力量和肌肉质量不同，身体表现很容易通过长期或短期干预中的各种运动得到改善。四项研究使用 RE 和高蛋白营养补充剂。这些对透析患者的肌肉力量和身体机能显示出显着的益处，而在肌肉质量中发现的结果不显着。需要更多的研究来确认 RE 和维生素 D 补充剂的组合是否可以协同作用以提高 CKD 的肌肉力量。目前关于 CKD 肌肉减少症进行性 RE 的证据令人鼓舞；然而，在临床环境中的实际应用仍然非常有限。由于 CKD 中肌肉减少症的复杂性，多学科以患者为中心并定期随访可能是最有益的。需要长期随机对照试验来验证最佳 RE 处方，并探索其他营养干预措施在 CKD 中的安全性和有效性。需要更多的研究来确认 RE 和维生素 D 补充剂的组合是否可以协同作用以提高 CKD 的肌肉力量。目前关于 CKD 肌肉减少症进行性 RE 的证据令人鼓舞；然而，在临床环境中的实际应用仍然非常有限。由于 CKD 中肌肉减少症的复杂性，多学科以患者为中心并定期随访可能是最有益的。需要长期随机对照试验来验证最佳 RE 处方，并探索其他营养干预措施在 CKD 中的安全性和有效性。需要更多的研究来确认 RE 和维生素 D 补充剂的组合是否可以协同作用以提高 CKD 的肌肉力量。目前关于 CKD 肌肉减少症进行性 RE 的证据令人鼓舞；然而，在临床环境中的实际应用仍然非常有限。由于 CKD 中肌肉减少症的复杂性，多学科以患者为中心并定期随访可能是最有益的。需要长期随机对照试验来验证最佳 RE 处方，并探索其他营养干预措施在 CKD 中的安全性和有效性。由于 CKD 中肌肉减少症的复杂性，多学科以患者为中心并定期随访可能是最有益的。需要长期随机对照试验来验证最佳 RE 处方，并探索其他营养干预措施在 CKD 中的安全性和有效性。由于 CKD 中肌肉减少症的复杂性，多学科以患者为中心并定期随访可能是最有益的。需要长期随机对照试验来验证最佳 RE 处方，并探索其他营养干预措施在 CKD 中的安全性和有效性。