The Effect of Antihypertensive Therapy on Skeletal Muscle Mass and Bone Mineral Density in Patients With End-Stage Kidney Disease

Hiroko Hashimoto; Shintaro Mandai; Satomi Shikuma; Mai Kimura; Hayato Toma; Yuki Sakaguchi; Sayuka Shiraishi; Noriyuki Toshima; Motoki Hoshino; Moe Kimura; Jun Ota; Susumu Horiuchi; Susumu Adachi; Shinichi Uchida

doi:10.1053/j.jrn.2023.10.008

The Effect of Antihypertensive Therapy on Skeletal Muscle Mass and Bone Mineral Density in Patients With End-Stage Kidney Disease

J Ren Nutr. 2023 Oct 31:S1051-2276(23)00191-7. doi: 10.1053/j.jrn.2023.10.008. Online ahead of print.

Authors

Affiliations

¹ Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan; Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan.
² Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan. Electronic address: smandai.kid@tmd.ac.jp.
³ Department of Nephrology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
⁴ Department of Urology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
⁵ Department of Cardiology, Shuuwa General Hospital, Kasukabe, Saitama, Japan.
⁶ Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan.

PMID: 37918643
DOI: 10.1053/j.jrn.2023.10.008

Abstract

Objective: Sarcopenia and osteoporosis substantially influence health and lifespan. However, the variables affecting skeletal muscle mass (SMM) or bone mineral density (BMD) remain unknown.

Design and methods: From August 1, 2018 to July 31, 2019, we conducted a single-center, observational cohort study with 291 Japanese adult patients on maintenance hemodialysis due to end-stage kidney disease, who had their femoral neck BMD measured using dual-energy X-ray absorptiometry. After 1-year follow-up, we measured annual changes of BMD (ΔBMD) and SMM (ΔSMM), which were calculated through a modified creatinine index (mg/kg/day) using age, sex, serum creatinine, and single-pooled Kt/V for urea. The factors associated with ΔSMM/ΔBMD or progressive loss of SMM/BMD, defined as ΔSMM/ΔBMD < 0 per year, respectively, were analyzed with multivariable, linear regression or logistic regression models.

Results: The median age of the patients was 66 years and 33% were female. Dialysis vintage and β-blocker-use were inversely correlated to ΔSMM. In comparison to nonusers, β-blockers users had 2.5-fold higher SMM loss odd ratios [95% confidence interval, 1.3-4.8]. The risk for SMM loss caused by β-blockers was not increased in users of renin-angiotensin system inhibitors. The ΔBMD was negatively correlated to the usage of calcium channel blockers. The risk of developing osteosarcopenia, which was defined as annual loss of both SMM and BMD, increased in calcium channel blockers users.

Conclusions: The use of β-blockers is associated with an elevated risk of developing sarcopenia, whereas renin-angiotensin system inhibitors may minimize this effect in patients with end-stage kidney disease. Use of calcium channel blocker therapy was associated with a faster decline of BMD.

Keywords: Sarcopenia; antihypertensive class; end-stage kidney disease; osteoporosis; osteosarcopenia.