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Abstract: PO2064

Metabolic Acidosis and Muscle Metabolic Health Are Important Determinants of Fatigue in Persons with CKD

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Kim, Tae Youn, University of California Davis, Davis, California, United States
  • Bae, Se Ri, University of California Davis, Davis, California, United States
  • Gamboa, Jorge, University of Washington, Seattle, Washington, United States
  • Vargas, Chenoa R., University of California Davis, Davis, California, United States
  • Liu, Sophia, University of Washington, Seattle, Washington, United States
  • Patel, Kushang V., University of Washington, Seattle, Washington, United States
  • de Boer, Ian H., University of Washington, Seattle, Washington, United States
  • Kestenbaum, Bryan R., University of Washington, Seattle, Washington, United States
  • Roshanravan, Baback, University of California Davis, Davis, California, United States
Background

Chronic kidney disease (CKD) is associated with a high prevalence of physical frailty, reduced physical function and fatigue, contributing to increased morbidity, mortality risk, and poor quality of life. Impaired muscle mitochondrial oxidative capacity (ATPmax) underlies poor physical endurance in persons with CKD. Metabolic acidosis may mediate effects of CKD on ATPmax. Little is known about the relevance of metabolic acidosis and ATPmax on patient-reported fatigue in CKD.

Methods

We performed a cross-sectional analysis of 58 participants (39 CKD and 19 non-CKD) from the CKD Muscle Mitochondrial ENergetics and Dysfunction (MEND). Muscle metabolic health of the tibialis anterior leg muscle was measured from the time course of phosphocreatine after exercise using 31Phosphorus Magnetic Resonance Spectroscopy. Fatigue was measured using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale. Metabolic acidosis (MA) was determined from serum bicarbonate (< 22 mmol/L). Linear regression was used to test associations adjusting for age, sex, body mass index (BMI), and diabetes.

Results

The cohort included 48% female and 29% diabetes with a mean age of 61±12 years and a mean BMI of 28±5. The mean eGFR was 39±19ml/min per 1.73m2 in CKD and 98±15 in non-CKD. The mean ATPmax was 0.672±0.185mM/sec and mean FACIT-F score was 40±11.5. CKD was associated with increased fatigue (mean difference: 7.6, 95% CI [1.8, 13.5], p<.05) compared to non-CKD after adjustment. Of those with CKD each 1 SD (standard deviation) greater ATPmax was associated with a 5.4-point (95% CI [1.03, 9.7], p=.017) reduction in fatigue after adjustment. Further adjustment for MA attenuated the estimated association by 38% (3.3 points, 95% CI [-1.1, 7.7], p=.134). Of those with CKD, participants with MA (n=18) had a 10. points greater fatigue (95% CI [1.8,18.1], p=.018) after adjustment compared to those without MA (n=21).

Conclusion

ATPmax is directly associated with fatigue. MA might play an important role in the association of muscle metabolic health with fatigue in CKD. Further research is needed to examine the impact of treating MA on improvement in muscle metabolic health, fatigue and quality of life in CKD.

Funding

  • NIDDK Support