Measurement and evaluation of echointensity in rectus femoris and anterior tibialis muscles as a marker of sarcopenia in patients with chronic renal failure

Besides proteins, skeletal muscle consists of non-contractile elements such as fat cells and fibrous tissue. B-mode ultrasonography images provide varying levels of echogenicity (EI); Skeletal muscle appears hypoechoic, while intramuscular fat and fibrous tissue appear hyperechoic. EI is the determination of the average pixel density in a certain area (ROI), which is determined manually by drawing a box or polygon around the muscle tissue, by trying to exclude subcutaneous and fibrous tissue as much as possible, with the help of some computer programs such as Image-J. Patients diagnosed with Chronic Kidney Disease (CKD), which is an important public problem, are at increased risk of sarcopenia due to various reasons such as dietary restrictions and decreased physical activity. Sarcopenia is defined by progressive loss of muscle and performance because of loss of muscle volume associated with age. In this study, it was aimed to investigate the relationship between sarcopenia and EI in patients followed up with hemodialysis program for CKD. 38 patients who were followed up in hemodialysis unit were determined as case group, 37 patients who did not need hemodialysis as control group. Patients with severe neuropathy, stroke sequelae, history of amputation, severe chronic obstructive pulmonary disease, Parkinson's disease, history of active malignancy, severe skeletal deformity, end-stage renal disease due to genetic/acquired muscle and connective tissue disease, and AIDS patients were not included in the study. EI values ​​in the case group were higher than control group. Positive between measured EI values ​​and corrected EI values; it was determined that there was a negative correlation with hand grip test results. It was determined that EI values ​​were statistically significantly higher. It was determined that age, gender, BMI and GFR were independent factors that determined the value of EI. In the evaluation of sarcopenia, it was determined that the EI values ​​of the rectus femoris (RF) muscle were a better predictor than the anterior tibialis muscle. The overall accuracy of the ROC curve analysis for estimating the diagnosis of sarcopenia of the right RF muscle EI value was (AUC: Accuracy) = 0.794 (95% G.A.: 0.695-0.894 p<0.001), the optimum cut-off value was 83.7 a.u (sensitivity = 73.7% specificity = 73%). The study draws attention to the relationship between sarcopenia, which develops because of the increasing elderly population and chronic diseases, and EC values, and reveals the need for more comprehensive prospective studies on this subject.