Physical Therapy Considerations for Chronic Kidney Disease and Secondary Sarcopenia

Abstract

Chronic kidney disease (CKD) is a progressive condition that may negatively affect musculoskeletal health. These comorbidities may include malnutrition, osteoporosis, and decreased lean body mass. Secondary sarcopenia due to CKD may be associated with mobility limitations and elevated fall risk. Physical therapists are well-positioned among the health care team to screen for secondary sarcopenia in those with CKD and for the treatment of musculoskeletal comorbid conditions that may affect functional performance. Given the consequences of both low muscle mass and low bone mineral density, appropriate and timely physical therapy is important for fall risk assessment and intervention to minimize the susceptibility to bone fracture. While strength training has been studied less frequently than aerobic training for the management of secondary CKD conditions, evidence suggests that this patient population benefits from participation in strength training programs. However, the provision of a formal exercise prescription by a health care professional, along with formal implementation of an exercise program, may need to be more fully integrated into the standard plan of care for individuals with CKD.

Keywords: chronic kidney disease; geriatrics; muscle; physical therapy; sarcopenia.

Figure 1

Sarcopenia Screening and Staging Outcomes. Sarcopenia screening and staging criteria include measures of muscle mass, strength, and function. Grip strength is recognized is an objective impairment measure used for staging, but it has also been proposed as an alternate screening tool (Panel (A)). In addition, common functional assessments for sarcopenia include the repeated sit-to-stand test and habitual gait speed (Panel (B–C)). While no single measure has been designated to characterize functional status for sarcopenia staging, an outcome used with increasing frequency is the Short Physical Performance Battery (SPPB). The SPPB includes commonly used physical assessments such as gait speed (4 m), static balance testing, and the repeated sit-to-stand test (Panels (B–D)). Detection of functional limitations or low grip strength may merit confirmatory standardized assessments of muscle mass. Dual-energy X-ray absorptiometry (Panel (E)) is often used to estimate muscle mass in medical centers, but alternative assessment methods such as bioelectrical impedance analysis may be used in ambulatory clinics and other settings.