RELATIONSHIP OF QUADRICEPS MUSCLE THICKNESS WITH NUTRITIONAL STATUS AND PHYSICAL FUNCTIONING IN END STAGE RENAL DISEASE

Abstract

Objective:

The objective of this study is to observe relationship of quadriceps muscle thickness with nutrionional status and physical functioning in end stage renal disease

Study design: Cross-sectional analytical study

Place and duration of study: Department of Nephrology, Tertiary Care Hospital, Lahore from February 2025-April 2025.

Methodology: A total of 127 adult patients undergoing maintenance dialysis for at least three months were enrolled through consecutive sampling. Demographic and clinical information, including age, sex, comorbidities, and dialysis duration, were collected from patient interviews and medical records. Quadriceps muscle thickness was measured using B-mode ultrasonography at the midpoint between the anterior superior iliac spine and the superior border of the patella. Nutritional status was assessed using body mass index (BMI), mid-upper arm circumference (MUAC), serum albumin levels, and Malnutrition Inflammation Score (MIS). Physical functioning was evaluated through handgrip strength, gait speed, sit-to-stand test, and Karnofsky performance score. Statistical analysis was performed using appropriate parametric and non-parametric tests, including correlation analysis and multivariate regression, with p <0.05 considered statistically significant.

Results: The study included 127 ESRD patients with a mean age of 52.4 ± 13.1 years, of whom 58.3% were male. Hypertension and diabetes were the most common comorbidities. The mean quadriceps muscle thickness was 20.4 ± 4.9 mm, and nearly half of the patients demonstrated moderate to severe muscle wasting. Significant positive correlations were observed between quadriceps thickness and nutritional indicators including BMI, serum albumin, MUAC, and prealbumin, while a negative correlation was found with the malnutrition-inflammation score. Patients with greater quadriceps thickness also exhibited significantly better physical performance. Handgrip strength showed the strongest positive correlation, whereas sit-to-stand time was inversely related to muscle thickness.

Conclusion: Quadriceps muscle thickness is significantly associated with both nutritional status and physical functioning in patients with end-stage renal disease. Reduced muscle thickness reflects underlying protein-energy wasting and impaired functional capacity. Ultrasonographic assessment of quadriceps muscle offers a simple, non-invasive, and reliable method for identifying patients at risk.