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Dysfonction musculaire en hémodialyse : de la sarcopénie à la myopathie urémique

Abstract : Muscle dysfunction, a common feature in chronic haemodialysis patients, is associated with an increased risk of mortality independently of the disease severity, like sarcopenia in elderly patients. Despite similarities between the two situations, muscle dysfunction in chronic haemodialysis patients must be distinguished from sarcopenia. Some molecular abnomalities observed, such as the transition from slow to fast-fibre in muscle, appear to be different from those described during aging. This thesis comprises four studies which aim to identify and characterize the muscle dysfunction in chronic haemodialysis patients. In the first study, we developed a reliable and reproducible tool allowing the measurement of quadriceps muscle strength at the bedside. The second one showed that clinical and biological factors associated with a decrease in muscle strength were different from those associated with a decrease in muscle mass. In this study we were also able to identify patients with a decrease in muscle strength without a decrease in muscle mass, which characterizes dynapenic patients. The prognosis of these patients was studied in the third study. The risk of death was similar in these patients compared to sarcopenic patients, even though dynapenic patients were younger with fewer comorbidities.. This work also showed that muscle strength is a better prognosis marker than muscle mass. Finally, in the fourth study, we showed in hemodialysis patients on the waiting list for a kidney transplant, that a true renal insufficiency-induced myopathy with specific histological characteristics could exist. These characteristics are compatible with the decrease in endurance observed in this population. Thus, starting from the universally recognized clinical criterion of muscle mass, we have evolved towards the exploration of strength and endurance. Finally, this work provides some elements that confirm the existence of muscle abnormalities specific to chronic renal failure.
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Jean Sébastien Souweine. Dysfonction musculaire en hémodialyse : de la sarcopénie à la myopathie urémique. Médecine humaine et pathologie. Université Montpellier, 2019. Français. ⟨NNT : 2019MONTT040⟩. ⟨tel-02866707⟩

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