The Effect of Non-Pharmacological and Pharmacological Interventions on Measures Associated with Sarcopenia in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol Registration
2.2. Settings and Trial Population
2.3. Intervention
2.4. Comparison
2.5. Outcome
2.6. Trial Design
2.7. Search Strategy
2.8. Selection Criteria, Data Extraction, and Quality Appraisal
2.9. Data Synthesis
3. Results
3.1. Characteristics of Included Trials
3.2. Risk of Bias
3.3. Muscle Strength
3.3.1. Hand Grip Strength
- Exercise Interventions
- 2.
- Nutritional Interventions
- 3.
- Pharmacological Interventions
3.3.2. Sit-to-Stand
- Exercise Interventions
- 2.
- Nutritional Interventions
- 3.
- Pharmacological Intervention
3.4. Muscle Quality/Quantity
3.4.1. Exercise Interventions
3.4.2. Nutritional Interventions
3.4.3. Pharmacological Interventions
3.5. Physical Performance
3.5.1. Gait Speed
- Exercise Interventions
- 2.
- Nutritional Interventions
- 3.
- Pharmacological Interventions
3.5.2. Timed-Up-and-Go and Short Physical Performance Battery
- Exercise Intervention
- 2.
- Nutritional Intervention
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Appendix B
References
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Trial | Country | Trial Design | Age; Sex | Haemodialysis or Peritoneal Dialysis | Sample Size (n = Randomised) | Dialysis Vintage | Type of Intervention | Intervention Description (Method of Delivery, Dose, Frequency, Duration) | Intervention Compliance | Type of Comparison | Length of Follow-Up | Sarcopenia- Related Outcomes | Prospective Power Calculation Reported |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Assawasaksakul et al., 2021 [14] | Thailand | Parallel group RCT | Intervention = 52.5 ± 12.9 years; 33.3% male. Control = 53.7 ± 17.2 years; 50% male. | Haemodialysis | 12 | Intervention = 105 (30.0,155.3) months. Control = 66.5 (20.0, 89.8). Date presented as median (IQR). | Intradialytic aerobic exercise programme. | 3 × week. Participants performed cycling exercise training for 60 min during the first 2 h of each dialysis session using a cycle ergometer at an RPE up to 12. | Not reported | Usual care. | 6 months | Gait Speed, LBM, STS5 | Not reported |
Bennett et al., 2020 [23] | USA | Parallel group RCT | Intervention = 57.7 ± 16.3 years; 61% male. Control = 58.3 ± 16.7 years; 46% male. | Peritoneal dialysis | 36 | Intervention = 18 (8, 28) months. Control = 23 (6, 48). Date presented as median (IQR). | Home-based exercise programme. | 3 × week. Walking or cycling exercise (for 10–30 min). Frequency increased by 1 day per week until 300 min reached. 3–5 × week upper and lower body resistance exercises. | 77% | Usual care. | 3 months | STS30, TUG | Not reported |
Cheema et al., 2007 [24] | Australia | Parallel group RCT | Intervention = 60.0 ± 15.3 years; 71% male. Control = 65.0 ± 12.9 years; 68% male. | Haemodialysis | 49 | Intervention = 3.3 (0.3, 16.7) years. Control = 1.6 [0.6,10.3]. Date presented as median (IQR). | Intradialytic resistance exercise programme. | 3 × week. Upper and lower body exercises at an RPE of 15 to 17. Duration not reported. | ≈80% | Usual care. | 3 months | MT-CSA | Yes |
Dong et al., 2019 [25] | China | Parallel group RCT | Intervention = 59 (32.5, 66.5) years; 42.9% males. Control = 62.5 (50.5, 70) years; 60%. Date presented as median (IQR). | Haemodialysis | 45 | Intervention = 69 (31.5, 87.5) months. Control = 57.5 (32.5, 86.5). Date presented as median (IQR). | Intradialytic resistance exercise programme. | 3 × week. Upper and lower body exercises lasting 1–2 h during dialysis. | Not reported | Usual care. | 3 months | Gait Speed, Hand Grip Strength, SMM, FFM | Not reported |
Frih et al., 2017 [26] | Tunisia | Parallel group RCT | Intervention = 64.2 ± 3.4 years. Control = 65.2 ± 3.1 years. Sex not reported. | Haemodialysis | 50 | Intervention = 72.7 ± 12.7 months. Control = 73.6 ± 13.4 months. | Aerobic and resistance exercise programme on non-haemodialysis days. | 4 × week. Upper and lower body exercises lasting 60 min during dialysis. Aerobic exercise included cycling and walking for 20 min at 5–6 RPE. | Not reported | Usual care. | 4 months | Hand Grip Strength, STS60, TUG | Not reported |
Giannaki et al., 2013 [21] | Greece | Parallel group RCT | Intervention 1 = 56.4 ± 12.5 years; 73% male. Intervention 2 = 55.7 ± 10.4 years; 57% male. Control = 56.8 ± 16.5 years; 71% male. | Haemodialysis | 45 | Intervention 1 = 3.9 ± 1.3 years. Intervention 2 = 4.0 ± 1.7 years. Control = 3.6 ± 1.5 years. | Intradialytic aerobic exercise programme and intradialytic aerobic exercise programme and dopamine. | Intervention 1 = 3 × week. Cycling at an intensity of 60–65% of maximal exercise capacity. Intervention 2 = 0.25 mg/dose of ropinirole (a dopamine agonist) in an empty capsule. Duration not reported. | Not reported | The control group took a plain flour placebo capsule. | 6 months | Gait Speed, LBM, MT-CSA, STS5, STS30, STS60 | Yes |
Graham-Brown et al., 2021 [16] | UK | Parallel group RCT | Intervention 1 = 55.5 ± 15.5 years; 65% male. Control = 58.9 ± 14.9 years; 82% male. | Haemodialysis | 130 | Intervention = 1.2 (0.5, 3.7) years. Control = 1.3 (0.4, 3.2) years. Date presented as median (IQR) | Intradialytic aerobic exercise programme. | 3 × week, for 30 min for 6 months. Cycling at an intensity of RPE 12–14. | 71.7% | Usual care. | 6 months. | Gait Speed, SPPB, STS5, STS60 | Yes |
Greenwood et al., 2021 [27] | UK | Parallel group RCT | Intervention 1 = 60.5 ± 15 years; 58% male. Control = 59.8 ± 14.1 years; 62% male. | Haemodialysis | 335 | Not reported. | Intradialytic aerobic and resistance exercise programme. | 3 × week, for 30–40 min. 2 × week, lower extremity muscular conditioning exercises. | 48.7% | Usual care. | 6 months. | STS60, TUG | Yes |
Groussard et al., 2015 [28] | France | Parallel group RCT | Intervention 1 = 66.5 ± 4.6. years; 63% male. Control = 68.4 ± 3.7 years; 70% male. | Haemodialysis | 20 | Intervention = 36.6 ± 8.2 months. Control = 41.2 ± 8 months. | Intradialytic aerobic exercise programme. | 3 × week, for 30 min. Cycling at an intensity of 55–60% peak power. | Not reported | Usual care. | 3 months | FFM | Not reported |
Johansen et al., 2006 [15] | USA | Parallel group RCT | Intervention 1 = 55.7 ± 13.4 years; 53% male; intervention 2 = 54.4 ± 13.6 years; 60% male; intervention 3 = 55.5 ± 12.5 years; 65% male; control = 56.8 ± 13.8 years; 70% male. | Haemodialysis | 79 | Intervention 1 = 40 (3, 288) months. Intervention 2 = 33 (3.5, 108) months. Intervention 3 = 14 (4, 152) months. Control = 25.5 (3, 156) months. Data presented as median (IQR). | Intradialytic resistance exercise programme and nandrolone decanoate. | Intervention 1 = × 1 a week intramuscular injections of nandrolone decanoate. Intervention 2 = × 3 a week lower body resistance training during haemodialysis. Duration not reported. Intervention 3 = nandrolone injections + resistance exercise during haemodialysis. | Six participants discontinued study drug (four who were receiving placebo and two who were receiving nandrolone) before the end of the treatment period. | Control group received a placebo injection that was identical in appearance to the active drug. | 3 months | Gait Speed, LBM, MT-CSA, STS5 | Yes |
Koh et al., 2010 [29] | Australia | Parallel group RCT | Intervention 1 = 52.3 ± 10.9 years; 66.6% male; intervention 2 = 52.1 ± 13.6 years; 73.3% male; control = 51.3 ± 14.4 years; 50% male. | Haemodialysis | 70 | Intervention 1 = 32.1 ± 26.7 months. Intervention 2 = 37.0 ± 31.1 months. Control = 25.8 ± 22.2 months. | Intradialytic aerobic exercise and home -based walking programme. | Intervention 1 = 3 × week, for 15–45 min. Cycling at an intensity of RPE 12–13. Intervention 2 = 3 × week unsupervised walking at RPE 12–13 for 15–45 min. | Intradialytic training = 75% ± 19%. Home- based walking = 71% ± 13%. | Usual care. | 6 months | Hand Grip Strength, TUG | Yes |
Krase et al., 2021 [30] | Greece | Parallel group RCT | Intervention 1 = 66.04 ± 15.35 years; 76% male. Control = 68.26 ± 11.07 years; 43% male. | Haemodialysis | 48 | Intervention = 7.29 ± 4.0 years. Control = 5.39 ± 5.55 years. | Intradialytic aerobic exercise programme. | 3 × week, for 60 min. Ergometer cycling at an intensity of 60% peak power. | Not reported. | Usual care. | 7 months | Hand Grip Strength, STS5, STS60 | Yes |
Manfredini et al., 2017 [31] | Italy | Parallel group RCT | Intervention 1 = 63 ± 13 years; 64% male. Control = 64 ± 12 years; 68% male. | Haemodialysis & Peritoneal dialysis | 296 | Not reported. | Home-based walking programme. | 3 × week for 10 min | Out of 104 patients in the exercise arm who were re-evaluated after 6 months, level of adherence to the exercise program was high for 55 patients and low for 49 patients. | Usual care. | 6 months | STS5 | Yes |
Marinho et al., 2016 [32] | France | Parallel group RCT | Intervention = 71.5 (58.5, 87.2) years; 50% males. Control = 76 (59, 83) years; 43%. Date presented as median (IQR). | Haemodialysis | 14 | Not reported. | Intradialytic resistance exercise programme. | 3 × week of lower body resistance training at 60% 1 RM. Duration not reported. | Not reported. | Usual care | 2 months | LBM | Not reported |
Maynard et al., 2019 [33] | Brazil | Parallel group RCT | Intervention = 49 ± 15.2 years; 60% male. Control = 43.9 ± 11.7 years; 50% male. | Haemodialysis | 45 | Intervention = 62.7 ± 34.20 months. Control = 55.95 ± 38.87 months. | Intradialytic aerobic and resistance exercise programme performed with video games. | 3 × week, for 30–60 min. Lower and upper body resistance exercises and ergometer cycling. At an intensity of 12–14 RPE. | Not reported. | Usual care | 3 months | Gait Speed, TUG | Yes |
Myers et al., 2021 [17] | USA | Parallel group RCT | Intervention = 66.3 ± 7.6years; 85% male. Control = 66.2 ± 6.7 years; 66% male. | Haemodialysis | 28 | Intervention = 4.25 ± 3.9 years. Control = 4.05 ± 3.9 years. | Home-based exercise programme. | 7 × week, for 45 min. Aerobic and resistance exercise performed at an intensity of 12–14 RPE. | Not reported. | Usual care | 3 months | Hand Grip Strength, STS5, STS60 | Yes |
Olvera-Soto et al., 2016 [34] | USA | Parallel group RCT | Intervention = 28.5 (23, 46) years; 47% males. Control = 29 (19, 38) years; 61%. Date presented as median (IQR). | Haemodialysis | 61 | Intervention = 12 (5.75, 37.7) months. Control = 18 (8, 39). Date presented as median (IQR). | Intradialytic resistance exercise programme. | 2 × week, for 50 min. Upper and lower body resistance exercises. | Not reported. | Usual care | 3 months | Hand Grip Strength, MAMA, MAMC | Not reported |
Rosa et al., 2021 [35] | Brazil | Parallel group RCT | Intervention 1 = 53 ± 13 years; 55% male. Intervention 2 = 54 ± 10 years; 58% male. Control = 52 ± 17 years; 57% male. | Haemodialysis | 266 | Intervention 1 = 54.4 ± 13.8 months. Intervention 2 = 52.1 ± 11.1 months. Control = 51.7 ± 12.5 months. | Pre-dialysis dynamic and isometric resistance exercise programme. | Intervention 1 = 3 × week for 40 min. Upper and lower body exercises increasing to an RPE of 7–8. 2 = same programme as intervention 1, however they performed isometric contractions. | Not reported. | Usual care | 6 months | Hand Grip Strength, FFM | Not reporter |
Sheshadri et al., 2020 [36] | USA | Parallel group RCT | Intervention = 60 (53,66) years; 93% males. Control = 56 (51, 65) years; 63%. Date presented as median (IQR) | Haemodialysis & Peritoneal dialysis | 60 | Intervention = 3.7 (1.5, 7.2) months. Control = 1.9 (0.95, 4.7). Date presented as median (IQR). | Home-based walking programme. | Participants were provided with pedometers and were provided with weekly step goals and counselling sessions. | 95% | Usual care | 6 months | SPPB | Yes |
Song et al., 2012 [37] | South Korea | Parallel group RCT | Intervention = 52.1 ± 12.4 years; 60% male. Control = 54.6 ± 10.1 years; 60% male. | Haemodialysis | 44 | Intervention = 38.9 ± 26.1 months. Control = 45.9 ± 56.2 months. | Pre-dialysis resistance exercise programme. | 3 × week lasting 30 min. Consisting of upper and lower body exercises. | Not reported. | Usual care | 3 months | Hand Grip Strength, MAMC, SMM | Yes |
Sovatzidis et al., 2020 [38] | Greece | Parallel group RCT | Intervention = 52.8 ± 17.1 years; 80% male. Control = 53 ± 7.6 years; 90% male. | Haemodialysis | 24 | Not reported. | Intradialytic aerobic exercise programme. | 3 × week, for 6 months. Duration was self-selected. Ergometer cycling at an intensity of RPE 11–13. | 81% | Usual care | 6 months | Hand Grip Strength, STS60 | Yes |
Tayebi et al., 2018 [39] | Iran | Parallel group RCT | Intervention = 64.4 ± 8.4 years; 71% male. Control = 63.2 ± 11.6 years; 50% male. | Haemodialysis | 34 | Intervention 1 = 3.81 ± 4.3 years. Control = 3.12 ± 3.9 years. | Intradialytic resistance training programme and exercise counselling. | 3 × week. Upper and lower body resistance training. Duration not reported. | Not reported. | Usual care | 2 months | Hand Grip Strength | Not reported |
Uchiyama et al., 2019 [40] | Japan | Parallel group RCT | Intervention = 64.9 ± 9.2 years; 79% male. Control = 63.2 ± 9.5 years; 70% male. | Peritoneal dialysis | 47 | Intervention 1 = 3.6 ± 2.7 years. Control = 4.0 ± 2.8 years. | Home-based exercise programme. | 3 × week for 30 min at an exercise intensity 11–13 RPE. Upper and lower body resistance exercises. | 52 ± 40% for aerobic exercise; 76 ± 37% for resistance exercise. | Usual care. | 3 months | Hand Grip Strength | Yes |
Umami et al., 2019 [41] | Indonesia | Parallel group RCT | Intervention 1 = 49.78 ± 11.65 years; 66.7% male. Intervention 2 = 46.38 ± 14.19 years; 53.8% male. Control = 50.54 ± 10.83 years; 46.2% male. | Haemodialysis | 120 | Intervention 1 = 48 (4, 192) months. Intervention 2 = 48 (6, 204) months. Control = 60 (5, 240) months. Data presented as median (IQR). | Intradialytic aerobic exercise programme and intradialytic aerobic and resistance exercise programme. | Intervention 1 = 2 × week for 30 min. Ergometer cycling at an intensity increasing to 60% to 80% HRmax. Intervention 2 = Lower body resistance training exercises. 3 × 10 repetitions. | Not reported | Usual care. | 3 months | Gait Speed, Hand Grip Strength | Yes |
Yeh et al., 2020 [42] | Taiwan | Parallel group RCT | Intervention = 57.87 ± 13.21 years; 63% male. Control = 53.91 ± 12.60 years; 47% male. | Haemodialysis | 76 | Intervention 1 = 63.47 ± 71.98 months. Control = 78.28 ± 63.95 months. | Intradialytic aerobic exercise programme | 3 × week, for 30 min. Ergometer cycling at an intensity of RPE 12–14. | Not reported | Usual care. | 3 months | STS60 | Yes |
Trial | Country | Trial Design | Participants | Haemodialysis or Peritoneal Dialysis | Sample Size (n = Randomised) | Dialysis Vintage | Type of Intervention | Intervention Description (Method of Delivery, Dose, Frequency, Duration) | Intervention Compliance | Type of Comparison | Length of Follow- Up | Sarcopenia- Related Outcomes | Prospective Power Calculation Reported |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Ahmad et al., 1990 [43] | USA | Parallel group RCT | Intervention = 47.5 ± 2.5 years; 63% male. Control = 48 ± 2.4 years; 61% male. Data presented as mean ± SEM. | Haemodialysis | 97 | Intervention = 56.2 ± 6.6 months. Control = 60.7 ± 7.9 months. Data presented as mean ± SEM. | L-carnitine. | 20 mg/kg of L-carnitine injected into the venous port of the blood circuit at the end of each dialysis session. | Not reported. | 0.9% saline solution (placebo). | 6 months | MAMA, MAMC | Not reported |
Allman et al., 1990 [44] | Australia | Parallel group RCT | Intervention = 50 ± 11 years; 77.8% male. Control = 41 ± 18 years; 75% male. | Haemodialysis | 32 | Intervention = 40 ± 23 months. Control = 41 ± 28 months. | Water-soluble vitamin supplement. | A water-soluble vitamin supplement taken after each haemodialysis treatment. | Not reported. | Usual care (no placebo). | 6 months | LBM | Not reported |
Argani et al., 2014 [45] | Iran | Parallel group RCT | Intervention = 55.6 ± 4 years; 63% male. Control = 55.6 ± 8 years; 56% male. | Haemodialysis | 66 | Not reported. | Zinc sulphate. | A daily supplement of 440 mg of zinc sulphate in two divided doses for 60 days. | Not reported. | Placebo (corn starch) capsules. | 60 days | FFM | Not reported |
Brockenbrough et al., 2006 [46] | USA | Parallel group RCT | Intervention = 58.9 ± 14.9 years; 100% male. Control = 53.0 ± 17.2 years; 46% male. | Haemodialysis | 40 | Intervention = 43.6 ± 53.3 months. Control = 32.4 ± 47.2 months. | 1% testosterone gel. | 100 mg of topical 1% testosterone gel applied to the skin of the upper extremities or placebo for 6 months. | 76% to 94% for the intervention and 61% to 84% for the placebo group. | Same as intervention but no active ingredient. | 6 months | LBM | Yes |
Calegari et al., 2011 [47] | Brazil | Parallel group RCT | Reported as total cohort = 56.4 ± 15.58; 83.3% male. | Haemodialysis | 18 | Reported as total cohort = 81.6 ± 36.76 years. | Oral nutritional supplement during each haemodialysis session. | 3 × week. Oral nutritional supplement. | Not reported. | Not reported. | 3 months | LBM | Not reported |
Feldt-Rasmussen et al., 2007 [48] | Czech Republic, Denmark, France, Hong Kong, Israel, Poland, Singapore, Sweden & UK | Parallel group RCT | Intervention 1 = 58 ± 14 years; 62% male. Intervention 2 = 60 ± 15; 47% male. Intervention 3 = 61 ± 12; 62% male. Control = 59 ± 14 years; 68% male. | Haemodialysis | 68 | Intervention 1 = 48 ± 55 months. Intervention 2 = 42 ± 32 months. Intervention 3 = 26 ± 25 months. Control = 45 ± 62 months. | Daily subcutaneous injections of growth hormone. | Intervention 1 = 20 µg/kg per day. Intervention 2 = 35 µg/kg per day. Intervention 3 = 50 µg/kg per day. | Not reported. | Placebo injections. | 6 months | Gait Speed, Hand Grip Strength, LBM | Yes |
Fitschen et al., 2017 [49] | USA | Parallel group RCT | Intervention = 57 ± 8 years; 69% male. Control = 53 ± 13 years; 47% male. | Haemodialysis | 41 | Intervention = 43 ± 44 months. Control = 58 ± 35 months. | Beta-hydroxy-beta-methylbutyrate supplementation. | 3 × a day; 1000 mg capsules of calcium beta-hydroxy-beta methylbutyrate. | 5 participants in the intervention group were deemed noncompliant | Non-nutritive placebo capsule. | 6 months | ALM, Gait Speed, LBM, STS30 | Not reported |
González-Espinoza et al., 2005 [50] | Mexico | Parallel group RCT | Intervention = 45.7 ± 14.4 years; 62% male. Control = 47.6 ± 17.4 years; 73% male | Peritoneal dialysis | 30 | Intervention = 20 (8, 35) months. Control = 15 (7.5, 24) months. Date presented as median (IQR). | Dried egg albumin-based supplement. | 2 × day of 15 g of egg-based albumin supplement (equivalent of 11 g of high biological value protein). | 90% | Usual care. | 6 months | MAMA, MAMC | Not reported |
Guida et al., 2019 [51] | Italy | Parallel group RCT | Intervention = 50.5 ± 11.5 years; 62% male. Control = 53.7 ± 10.6 years; 70% male. | Haemodialysis | 23 | Not reported. | Egg white dietary intervention. | 3 × week; participants were instructed to replace one meal of the day with egg white. | Not reported. | Usual care | 3 months | FFM | Yes |
Hansen et al., 2000 [52] | Denmark | Parallel group RCT | Intervention = 44.4 ± 13 years; 55% male. Control = 48.3 ± 15 years; 64% male. | Haemodialysis | 31 | Intervention = 50 ± 43 months. Control = 71 ± 90 months. | Daily injection of growth hormone. | 1 × day; administered by the participant at bedtime. At a dosage of 4 IU/mL. | Compliance was high, as only 1.7% of the total injections were missed. | Placebo consisted of freeze-dried glycine, mannitol, and sodium bicarbonate. | 6 months | LBM | Not reported |
Hewitt et al., 2013 [53] | Australia | Parallel group RCT | Intervention = 60 (53,71) months; 53% male. Control = 67 (54, 72) months; 43% male. Date presented as median (IQR). | Haemodialysis | 60 | Intervention = 38 (25, 66) months. Control = 42 (18, 89) months. Date presented as median [IQR]. | Oral cholecalciferol. | 1 × week, then 1 × month; 10 mL of an oral solution of medium-chain tri-glyceride containing 50,000 IU of cholecalciferol. | Not reported | Indistinguishable medium- chain triglyceride oral solution placebo. | 6 months | Hand Grip Strength, STS5 | Not reported |
Hiroshige et al., 2001 [54] | Japan | Crossover RCT | Intervention = 75 ± 7 years; 43% male. Control = 74 ± 8 years; 50% male. | Haemodialysis | 28 | Intervention = 6.9 ± 3.1 years. Control = 6.8 ± 3.4 years. | Oral branch chained amino acid supplementation. | 3 × day participant received oral branch chained amino acids at a total dose of 12 g per day. | 100% | × 3 times a day. The placebo containing 6 g dextrose was identical in appearance and taste. | 6 months | LBM | Not reported |
Jeong et al., 2019 [22] | USA | Parallel group RCT | Intervention 1 = 56.6 ± 13 years; 51% male. Intervention 2 = 53.7 ± 11.4 years; 59% male. Control = 54.4 ± 12.3 years; 64% male. | Haemodialysis | 138 | Intervention 1 = 45.6 ± 38.7 months. Intervention 2 = 34.3 ± 34.8 months. Control = 47.9 ± 37.5 months. | Oral protein supplementation and intradialytic aerobic exercise programme. | Intervention 1 = 3 × week of 30 g of whey protein supplement. Intervention 2 = 3 × week of 30 g of whey protein and 45 min of ergometer cycling at RPE of 12–14. | >90% for study beverage and 80% exercise sessions. | Participants received 150 g of a non-nutritive beverage. | 12 months | Gait Speed, LBM, STS30, TUG | Yes |
Johannsson et al., 1999 [55] | Sweden | Parallel group RCT | Intervention = 73.5 ± 9 years; 70% male. Control = 72.7 ± 9 years; 70% male. | Haemodialysis | 20 | Not reported. | Post-dialysis subcutaneous injections of growth hormone. | 3 × week. At a dose of 66.7 µg/kg (0.2 IU/kg of body weight). | Not reported | Indistinguishable placebo injections. | 6 months | FFM, Gait Speed, Hand Grip Strength | Not reported |
Johansen et al., 1999 [20] | USA | Parallel group RCT | Intervention = 44 ± 15 years; 79% male. Control = 50 ± 10 years; 80% male. | Haemodialysis & Peritoneal dialysis | 29 | Intervention = 2.9 ± 2.7 years. Control = 2.3 ± 2.0 years. | Intramuscular injection of nandrolone decanoate. | 1 × week. At a dose of 100 mg/week. | Not reported. | Placebo injection of saline solution. | 6 months | Hand Grip Strength, LBM | Not reported |
Kopple et al., 2011 [56] | USA | Parallel group RCT | Intervention = 62 (26–96) years; 49% male. Control = 61 (19–95) years; 60% male. Data reported as mean (range). | Haemodialysis | 712 | Intervention = 4.2 (0.2–27.1) years. Control = 4.9 (0.3–34.6) years. Date presented as mean (range). | Injections of growth hormone. | Subcutaneous injections of growth hormone at a dose of 20 µg/kg/day. | Not reported. | Placebo injections. | 104 weeks (terminated early, mean duration treatment = 20 weeks). | Hand Grip Strength, LBM | Yes |
Kotzmann et al., 2001 [57] | Austria | Parallel group RCT | Intervention = 54.2 ± 14.3 years; 50% male. Control = 65.1 ± 11.4 years; 60% male. | Haemodialysis | 19 | Not reported. | Injections of growth hormone. | 3 × week of 0.125 IU/kg (40.5 µg/kg) for the first four weeks and 0.25 IU/kg (81 µg/kg) thereafter. | Not reported. | Placebo injections. | 3 months | LBM | Not reported |
Li et al., 2020 [58] | China | Parallel group RCT | Intervention = 55.33 ± 10.11 years; 46% male. Control = 52 ± 12.3 years; 57% male. | Haemodialysis | 29 | Intervention = 6 (3, 9) years. Control = 3.5 (2, 6) years. Date presented as median (IQR). | Keto acid supplementation. | The intervention group supplemented with 0.1 g/kg/day of keto acid. | Not reported. | Usual care. | 6 months | Gait Speed, Hand Grip Strength, LBM | Not reported |
Luo et al., 2020 [59] | China | Parallel group RCT | Intervention = 55.8 ± 13.4 years; 52.9% male. Control = 55.3 ± 13.2 years; 56.7% male. | Peritoneal dialysis | 142 | Intervention = 3–12 months (n = 15), 12–26 months (n = 37), >36 months (n = 16). Control = 3–12 months (n = 18), 12–26 months (n = 34), >36 months (n = 15). | Nurse led personalised dietary plans. | Personal dietary plans based on the food exchange models. | Not reported. | Usual care. | 12 months | MAMC | Not reported |
Marini et al., 2020 [60] | Brazil | Parallel group RCT | Intervention 1 = 41.86 ± 3.32 years; 71% male. Control = 41.79 ± 2.72 years; 64% male. Data presented as mean ± SEM. | Haemodialysis | 30 | Not reported. | Creatine supplementation. | (5 g) 4 × day for week 1 (loading period) and then 1 × day for 2–4 weeks. | Not reported. | 10 g of maltodextrin (placebo). | 1 month | Gait Speed, LBM | Yes |
Maruyama et al., 2019 [18] | Japan | Parallel group RCT | Intervention = 72 ± 9 years; 42% male. Control = 72 ± 10 years; 42% male. | Haemodialysis | 91 | Intervention = 79 ± 47 months. Control = 74 ± 47 months. | L-carnitine supplementation. | 3 × week; injections of L-carnitine (1000 mg) after each dialysis session. | Not reported. | Usual care. | 12 months | Hand Grip Strength, LBM, MAMA, SMM | Yes |
Sahathevan et al., 2018 [61] | Malaysia | Parallel group RCT | Intervention = 50.84 ± 15.20 years; 45.9% male. Control = 42.14 ± 14.57 years; 40.5% male. | Peritoneal dialysis | 126 | Intervention = 3.27 ± 3.03 years. Control = 3.19 ± 2.59 years. | Whey protein supplementation. | 2 × day of 15 g whey protein sachets. | Compliance for the intervention was 75 ± 18%. | Usual care. | 6 months | Hand Grip Strength, LBM, MAMA, MAMC | Yes |
Schincaglia et al., 2020 [62] | Brazil | Parallel group RCT | Intervention = 49.3 ± 3.4 years; 66.6% male. Control = 51.3 ± 3 years; 64.7%. | Haemodialysis | 43 | Not reported | Baru almond oil supplementation. | 10 × day; 500 mg capsules of Baru oil each day. | Not reported. | Capsules of mineral oil placebo. | 3 months | FFM | Yes |
Supasyndh et al., 2013 [63] | Thailand | Parallel group RCT | Intervention = 41.0 ± 10.5 years; 52.6% male. Control = 45.1 ± 8.5 years; 68.2% male. | Haemodialysis | 43 | Intervention = 98 (61, 110) months. Control = 96 (59, 115.7) months. Date presented as median (IQR). | Oxymetholone | 2 × day of oxymetholone 50 mg orally. | Not reported. | Received a placebo that was identical in appearance to the active drug. | 6 months | FFM, Hand Grip Strength | Not reported |
Singer et al., 2019 [64] | Australia | Parallel group RCT | Intervention = 59.5 ± 15.6 years; 64% male. Control = 63.8 ± 14.2 years; 72% male | Haemodialysis & Peritoneal dialysis | 68 | Intervention = 21.7 (5.3, 54.9] months. Control = 7.6 [3.7, 43.1]. Date presented as median [IQR]. | Cholecalciferol supplementation | 1 × week of a capsule containing 50,000 U of cholecalciferol. Study dose was adjusted at 3 and 6 months. | Adherence reported as excellent. | Placebo capsules. | 12 months | Hand Grip Strength | Yes |
Teixido-Planas et al., 2005 [65] | Spain | Parallel group RCT | Intervention = 56.57 (13, 22) years; 57% male. Control = 58.43 (14, 63) years; 56% male. Data reported as mean (range). | Peritoneal dialysis | 65 | Not reported. | Oral protein supplement. | × 1 a day of a 200 mL oral protein drink. | Not reported. | Usual care. | 12 months | LBM, MAMC | Yes |
Tomayko et al., 2015 [66] | USA | Parallel group RCT | Intervention 1 = 57 ± 4.8 years; 63.6% male. Intervention 2 = 52.5 ± 4.3 years; 58.3% male. Control = 53.3 ± 2.4; 66.7% male. | Haemodialysis | 46 | Not reported. | Oral protein supplement. | Intervention 1 = × 3 a week. 27 g of whey protein provided during dialysis. Intervention 2 = × 3 a week. 27 g of soy protein during dialysis. | A level of 75% compliance was established for the study. | A non-caloric placebo powder during dialysis. | 6 months | Gait Speed, LBM, STS30, TUG | Not reported |
Wu et al., 2011 [67] | Taiwan | Parallel group RCT | Intervention = 45.2 ± 12.9 years; 37% male. Control = 40.5 ± 12.9 years; 36% male | Peritoneal dialysis | 44 | Intervention = 4 ± 2.2 years. Control = 3.1 ± 2.7 years. | L-carnitine supplementation | 1 × day of a 600 mg oral L-carnitine tablet. | Not reported. | Usual care (no placebo). | 6 months | Hand Grip Strength, MAMA, MAMC | Not reported |
Wu et al., 2015 [68] | USA | Parallel group RCT | Intervention = 52.6 ± 3.3 years; 61.5% male. Control = 55.9 ± 2.6 years; 64.3% male. | Haemodialysis | 33 | Intervention = 75.5 ± 14.1 months. Control = 59.8 ± 10.6 months. | Pomegranate extract supplementation | 1 × day of 1000 mg oral capsule containing purified pomegranate polyphenol extract. | 95.9% and 98.2% for the intervention and placebo groups respectively. | A non-caloric placebo capsule. | 6 months | STS30, TUG, 1 RM | Not reported |
Trial | Country | Trial Design | Participants | Sample Size (n = Randomised) | Dialysis Vintage | Type of Intervention | Intervention Description (Method of Delivery, Dose, Frequency, Duration) | Intervention Compliance | Type of Comparison | Length of Follow- Up | Sarcopenia- Related Outcomes | Prospective Power Calculation Reported |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Greenwood et al., 2015 [69] | UK | Parallel group RCT | Intervention 1 = 53.9 ± 10.7 years; 77% male. Intervention 2 = 54.6 ± 10.6 years; 54% male. Control = 49.5 ± 10.6 years; 50% male. | 60 | Not reported. | Aerobic and resistance exercise programme. | Intervention 1 = 3 × week aerobic training. Treadmill running, cycling, and elliptical training at an RPE 13–15 for 60 min. Intervention 2 = × 3 upper and lower body resistance exercises for 60 min. | 87.4 ± 5.2%. | Usual care. | 3 months | STS60 | Not reported |
Henggeler et al., 2018 [70] | New Zealand | Parallel group RCT | Intervention = 49.2 ± 14.6 years; 66% male. Control = 48.3 ± 13.9 years; 72% male. | 37 | Not reported. | Lifestyle intervention (physical activity and nutritional counselling). | × 8 additional consultations with a dietitian, physical activity and exercise advice at 2, 3, and 6 months post-transplant. | 93% for intervention; 97% for control. | Usual care. | 12 months | FFM, Gait Speed, Hand Grip Strength, LBM, MAMA | Yes |
Hernández Sánchez et al., 2021 [71] | Spain | Parallel group RCT | Intervention = 49.7 ± 9.6 years; 37.5% male. Control = 48.6 ± 10.6 years; 75% male. | 16 | Intervention = 115 ± 54 months. Control = 88 ± 53 months. | Resistance exercise programme. | 2 × week. For 60 min. Walking plus upper and lower body resistance training. | 100%. | Usual care. | 2.5 months | Hand Grip Strength, STS60, TUG | Not reported |
Karelis et al., 2016 [72] | Canada | Parallel group RCT | Intervention = 45.3 ± 14 years; 60% male. Control = 39.4 ± 8 years; 60% male. | 24 | Not reported. | Resistance exercise programme. | 3 × week. For 45–60 min. Upper and lower body resistance exercises. | 80%. | Usual care. | 4 months | LBM | Not reported |
Lima et al., 2021 [73] | Brazil | Parallel group RCT | Intervention = 54 ± 3 years; 43% male. Control = 43 ± 18 years; 0% male. | 41 | Intervention = 4 ± 1 years. Control = 4 ± 2 years. | Aerobic and resistance exercise programme | 3 × week. 30 min of aerobic cycling and upper and lower body resistance exercises. | Not reported. | Usual care. | 4 months | Hand Grip Strength, LBM | Yes |
Painter et al., 2002 [74] | USA | Parallel group RCT | Intervention = 39.7 ± 12.6 years; 55.5% male. Control = 43.7 ± 10.7 years; 69.1% male. | 167 | Not reported. | Aerobic exercise programme. | 4 × week. Primarily walking or cycling exercise. 30 m mins duration. | Not reported. | Usual care. | 12 months | LBM | Not reported |
Painter et al., 2003 [75] | USA | Parallel group RCT | Intervention = 48.3 ± 12.7 years; 66% male. Control = 46.8 ± 14.4 years; 78% male. | 36 | Not reported. | Early steroid withdrawal. | Participants randomised into rapid elimination of steroids were decreased to 30 mg at day 4 and were withdrawn at day 5. | Not reported. | Usual care. | 12 months | LBM | Not reported |
Riess et al., 2014 [76] | Canada | Parallel group RCT | Intervention = 56.9 ± 12.2 years; 50% male. Control = 52.4 ± 14.3 years; 40% male. | 31 | Intervention = 6.4 ± 4.1 years. Control = 9.1 ± 8.8 years. | Aerobic and resistance exercise programme. | 2 × week. Cycling and treadmill training for 30–60 min at 60–80 VO2 peak. Lower body resistance training. | 81% | Usual care. | 3 months | LBM | Not reported |
Tzvetanov et al., 2014 [77] | USA | Parallel group RCT | Intervention = 46.9 ± 6.9 years; 50% male. Control = 45 ± 19 years; 37.5% male. | 17 | Intervention = 8.6 ± 6.2 months. Control = 10.9 ± 7.6 years. | Lifestyle intervention (resistance training and nutritional support). | 2 × week. Resistance exercise sessions. Duration not reported. Cognitive behavioural therapy and nutritional support. | 100% adherence in the intervention group. | Usual care. | 12 months | LBM | Not reported. |
van den Ham et al., 2003 [78] | Netherlands | Parallel group RCT | Intervention 1 = 56.3 ± 17.2 years; 70% male. Control = 52.4 ± 13.6 years; 82% male. | 27 | Not reported. | Early steroid withdrawal. | Participants in the intervention group were withdrawnfrom steroids within 2 weeks. | Not reported. | Usual care. | 6 months | LBM | Not reported. |
Intervention | Control | |||
---|---|---|---|---|
Trial | Baseline | Follow-up | Baseline | Follow-up |
Frih et al., 2017 [26] | 29.8 ± 6 N (n = 21) | 37.4 ± 4.8 N (n = 21) | 29.3 ± 5.6 N (n = 20) | 30 ± 5.2 N (n = 20) |
Koh et al., 2010 [29] | 36 ± 15 kg (n = 14) (home-based) | 37 ± 14 kg (n = 14) (home-based) | 28 ± 13 kg (n = 14) | 31 ± 12 kg (n = 14) |
Rosa et al., 2021 [35] | 23 ± 6 kg (n = 55) (Dynamic training group); 25 ± 5 (n = 51) (isometric training group) | 35 ± 4 kg (n = 55) (Dynamic training group); 38 ± 7 (n = 51) (isometric training group) | 24 ± 8 kg (n = 52) | 26 ± 5 kg (n = 52) |
Song et al., 2012 [37] | 26.3 ± 8.5 kg (n = 20) | 28.7 ± 9 kg (n = 20) | 26.2 ± 10.2 kg (n = 20) | 27.8 ± 11.8 kg (n = 20) |
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March, D.S.; Wilkinson, T.J.; Burnell, T.; Billany, R.E.; Jackson, K.; Baker, L.A.; Thomas, A.; Robinson, K.A.; Watson, E.L.; Graham-Brown, M.P.M.; et al. The Effect of Non-Pharmacological and Pharmacological Interventions on Measures Associated with Sarcopenia in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis. Nutrients 2022, 14, 1817. https://doi.org/10.3390/nu14091817
March DS, Wilkinson TJ, Burnell T, Billany RE, Jackson K, Baker LA, Thomas A, Robinson KA, Watson EL, Graham-Brown MPM, et al. The Effect of Non-Pharmacological and Pharmacological Interventions on Measures Associated with Sarcopenia in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis. Nutrients. 2022; 14(9):1817. https://doi.org/10.3390/nu14091817
Chicago/Turabian StyleMarch, Daniel S., Thomas J. Wilkinson, Thomas Burnell, Roseanne E. Billany, Katherine Jackson, Luke A. Baker, Amal Thomas, Katherine A. Robinson, Emma L. Watson, Matthew P. M. Graham-Brown, and et al. 2022. "The Effect of Non-Pharmacological and Pharmacological Interventions on Measures Associated with Sarcopenia in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis" Nutrients 14, no. 9: 1817. https://doi.org/10.3390/nu14091817
APA StyleMarch, D. S., Wilkinson, T. J., Burnell, T., Billany, R. E., Jackson, K., Baker, L. A., Thomas, A., Robinson, K. A., Watson, E. L., Graham-Brown, M. P. M., Jones, A. W., & Burton, J. O. (2022). The Effect of Non-Pharmacological and Pharmacological Interventions on Measures Associated with Sarcopenia in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis. Nutrients, 14(9), 1817. https://doi.org/10.3390/nu14091817