Quadriceps muscle mass variation in ultrasound linked to frailty among hemodialysis patients

A new study published in BMC Nephrology suggests that depending on the frailty instrument being used, ultrasound measurements of quadriceps thickness are variably related with frailty in frequent hemodialysis recipients.

Although quadriceps muscle mass quantification by ultrasound is becoming more popular for sarcopenia evaluation, its association to frailty in hemodialysis patients is unknown. This investigation by Benjamin Anderson and colleagues examines the link between sarcopenia, frailty, and BATT, an ultrasound-derived measure of bilateral anterior thigh thickness (Frailty Index [FI], Edmonton Frailty [EFS], Frailty Phenotype [FP], and Clinical Frailty Scale [CFS]).

This work was an exploratory study of a subset of adult prevalent (3 months) haemodialysis patients who were phenotyped for frailty. According to an established methodology, ultrasound assessment of BATT was performed with people at a 45° angle, with legs extended and knees resting at 10°-20°. Associations with frailty were investigated using linear and logistic regressions for BATT, LMM, and sarcopenia, with stepwise correction for a priori covariables.

The key findings of this study were:

1. Ultrasound measurements were taken on 223 research participants.

2. The percentage of frailty varied from 34% for FP to 58% for FI. BATT was related to increased frailty in simple linear regression by all frailty methods, however this relationship faded when covariables were included.

3. When frailty tools were dichotomized into Frail/Not Frail, BATT was linked with frailty by all tools on univariable analysis, but only EFS was associated with frailty on the fully adjusted model (OR 0.97, 95% C.I. 0.94-1.00, P = 0.05).

In hemodialysis patients, thigh ultrasound-derived sarcopenia is associated with frailty, but the relationship between frailty and muscle size alone is significantly more varied. Our findings imply that the use of quadriceps ultrasonography in risk assessment of hemodialysis patients is presently underutilized in the clinical context and warrants further exploration.

Reference:

Anderson, B. M., Wilson, D. V., Qasim, M., Correa, G., Evison, F., Gallier, S., Ferro, C. J., Jackson, T. A., & Sharif, A. (2023). Ultrasound quadriceps muscle thickness is variably associated with frailty in haemodialysis recipients. In BMC Nephrology (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12882-022-03043-8