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The electrochemiluminescence method was employed to analyze the plasma levels of creatinine, urea, C-Reactive Protein, glucose, triglycerides, and total and fraction cholesterol levels. Low density lipoprotein LDL-c was calculated using the Friedewald equation. The glomerular filtration rate was estimated by the chronic kidney disease epidemiology collaboration CKD-EPI equation [ 34 ]. The tacrolimus and cyclosporine levels were measured using micro-particle-based immune aggregation. The enzymatic colorimetric method was used to assess the UA serum levels.
The participants were characterized according to the UA classification elevated vs. For the continuous variables, the t-Student test or Mann—Whitney test was performed, and the data were described as mean and standard deviation, or median, minimum and maximum. The chi-squared test was used to compare the data in percentages the categorical variables. A multiple linear regression model was performed to associate the UA levels with the muscle mass, strength, and functional capacity. The R 2 value of each statistical model was generated, and then, a second analysis was performed, removing the UA from the model.
The difference between the R 2 values of the two models was used to estimate the prediction of muscle mass, strength or functional capacity values by the UA levels in an isolated form. These analyses were also performed by evaluating men and women separately. For the total sample, we performed an additional linear regression analysis adjusting for the following: sex, age, physical activity, protein intake, glomerular filtration rate, allopurinol use, waist circumference, triglyceride levels, diabetes, hypertension, tacrolimus and cyclosporine blood levels, smoking status and loop diuretic use Table S1.
The participants with the elevated UA levels presented higher values of triglycerides, urea and creatinine levels. They used higher doses of loop diuretics No difference was observed between the groups in terms of demographics, physical activity, anthropometric measurements, body composition, physical performance, strength, medicine use, tacrolimus and cyclosporine blood levels, kidney transplantation and biochemical parameters, and dietary intake Table 1.
The use of drugs is also described as mean values in Table S3. The multiple linear regression showed that the UA levels were positively associated with the muscle mass, fat-free mass, appendicular muscle mass, muscle mass index and appendicular muscle mass index. The UA predicted the variances of these muscle parameters by 1. The 5STS s was inversely associated with the UA levels, showing that individuals with higher UA were more likely to have more strength.
All these associations remained the same after additional adjustments were made for diabetes, triglyceride levels, hypertension, tacrolimus and cyclosporine blood levels, smoking status and loop diuretic use Table S1. Linear regression analysis of uric acid with muscle mass, strength and functional capacity.
In a sub-analysis, which evaluated men and women separately, the UA was associated with the muscle mass and 5STS results s in men as was observed for the total sample ; whereas no significant associations were observed for women Table S2. In addition, the UA was positively associated with strength when it was evaluated by 5STS, but no association was observed when it was assessed by the HGS. Collectively, these results suggest that UA seems to be a factor in protecting the muscle mass and the strength of the lower limbs in KTPs.
In a sub-analysis, which was separated by sex, the UA was associated with the muscle mass and strength in men, but not in women, which suggests that these associations can be sex-specific. However, we cannot ignore the fact that the limited number of women who were evaluated in the present study could also explain the absence of this association. The exact mechanism that explains the positive associations of UA with muscle mass and strength in KTPs remains unclear, but it is possible to suggest that it could be related to the antioxidant properties of UA [ 10 ].
Particularly in KTPs, oxidative stress is higher than in other populations for example, healthy individuals [ 8 ], and the excess of reactive oxygen and nitrogen species seems to affect muscle size, fiber activation and excitation—contraction [ 11 ]. In this way, the KTPs with higher UA levels could have greater protection against the excesses of reactive oxygen species, preserving their higher muscle mass and strength.
We did not observe an association between UA and functional capacity. Although the exact mechanism is unknown, it can be possibly explained due to the age range of the KTPs evaluated in the present study. Although the decreases in functional capacity begin at approximately the age of 40 y, important decreases in functional capacity occur mainly in individuals aged 70 y or more [ 35 ].
Elevated oxidative stress is associated with a low gait speed, but this association is observed mainly in older adults [ 36 ]. In middle-aged individuals, such as most of the participants in the present study, the effects of increased oxidative stress on the decreases in gait speed are in their infancy. Therefore, these individuals probably have sufficient reserve capacity for short-term walking, despite the excessive oxidative stress induced by renal disease. Thus, future studies that associate UA and functional capacity exclusively in older adults with renal disease should be performed.
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The present study has limitations. We evaluated body composition using bioimpedance; the muscle mass was estimated using equations that were not validated for KTPs. It shows that although there is not a valid equation that can estimate the muscle mass of KTPs, our results are trustworthy. In addition, the cross-sectional design does not allow us to determine the cause—effect relationship. Elevated UA is usually considered a risk factor for the progression of reduced kidney function and the loss of transplantation [ 37 ], and, therefore, drug interventions are often performed to reduce the UA levels; however, these deleterious effects are not a consensus [ 38 , 39 ].
Thus, the results of the present study may have important clinical implications because we showed that UA can be a potential protective factor for muscle mass and strength in KTPs. Future randomized clinical trials should be performed, in order to investigate the possible causal effect of UA on the muscle mass and strength in this population. This may show that it would not be beneficial to decrease the UA levels in KTPs, at least where muscle mass is concerned.
In conclusion, UA levels were positively associated with muscle mass and strength, but not with functional capacity, in KTPs. Figure S1: Flow-chart of the participants, Table S1: Linear regression analysis of uric acid with muscle mass, strength, and functional capacity, Table S2: Linear regression analysis of uric acid with muscle mass, strength, and functional capacity according to sex, Table S3: Characteristics of the participants according to uric acid levels.
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They wrote the manuscript and participated in the analysis of the data. All authors have read and agreed to the published version of the manuscript.
National Center for Biotechnology Information , U. Journal List Nutrients v. Published online Aug Rossato , 1 Heitor O. Santos , 1 Larissa S. Ferreira-Filho , 2 and Erick P. Paula C. Find articles by Paula C. Aline S. Find articles by Aline S. Luana T. Find articles by Luana T. Heitor O. Find articles by Heitor O. Larissa S. Find articles by Larissa S. Erick P. Find articles by Erick P. Author information Article notes Copyright and License information Disclaimer.
Received Jul 14; Accepted Aug 5. Associated Data Supplementary Materials nutrientss Abstract Background: Our aim was to associate serum uric acid UA with muscle mass, strength and functional capacity in kidney transplant patients KTPs. Keywords: uric acid, sarcopenia, muscle function, renal patients. Introduction Chronic kidney patients may present decreased muscle mass, strength and functional capacity [ 1 ], which impacts their general health [ 2 ] and increases the risk of mortality [ 3 ].
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Methods 2. Participants A cross-sectional study was conducted at the Hospital of the Federal University of Uberlandia Minas Gerais, Brazil , which has a kidney disease ambulatory clinic. Blood Sample Analysis The blood samples were collected after a 12 h overnight fast, on the same day that the bioimpedance was performed.
Statistical Analysis The participants were characterized according to the UA classification elevated vs. Results The participants with the elevated UA levels presented higher values of triglycerides, urea and creatinine levels. Table 1 Characteristics of the participants according to uric acid levels. Open in a separate window. Table 2 Linear regression analysis of uric acid with muscle mass, strength and functional capacity.
Acknowledgments We are thankful for the patients that participated in this study.
Click here for additional data file. Author Contributions J. Conflicts of Interest The authors declare no conflict of interest. References 1. Takahashi A. Kidney Dis. Kittiskulnam P. Sarcopenia and its individual criteria are associated, in part, with mortality among patients on hemodialysis. Kidney Int. Limirio L.
Dis Agreement between the first and the recent European consensus on definition and diagnosis for sarcopenia in kidney transplant patients. Cruz-Jentoft A. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. Walston J. Sarcopenia in older adults. Sato A. Nafar M. Oxidative stress in kidney transplantation: Causes, consequences, and potential treatment.
Mazzali M. Seminars in Nephrology.
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Elsevier; Amsterdam, The Netherlands: Uric acid and transplantation; pp. High plasma uric acid concentration: Causes and consequences. Fulle S. The contribution of reactive oxygen species to sarcopenia and muscle ageing. This entry gives the cumulative US dollar value of all investments in the home country made directly by residents - primarily companies - of other countries as adult hookup sites wenceslau braz of the end of the time period indicated.
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