BackgroundSarcopenia is a risk‐factor for all‐cause mortality among older adults, but it is unknown if sarcopenia predisposes older adults to specific causes of death. Further, it is unknown if the prognostic role of sarcopenia differs between males and females, and obese and non‐obese individuals.MethodsA population‐based cohort study among 4425 older adults from the Third National Health and Nutrition Survey (1988–1994). Muscle mass was quantified using bioimpedance analysis, and muscle function was quantified using gait speed. Multivariable‐adjusted Cox regression analysis examined the relationship between sarcopenia and mortality outcomes.ResultsThe mean age of study participants was 70.1 years. The prevalence of sarcopenia was 36.5%. Sarcopenia associated with an increased risk of all‐cause mortality [hazard ratio (HR): 1.29 (95% confidence interval (95% CI): 1.13–1.47); P < 0.001] among males and females. Sarcopenia associated with an increased risk of cardiovascular‐specific mortality among females [HR: 1.61 (95% CI: 1.22–2.12); P = 0.001], but not among males [HR: 1.07 (95% CI: 0.81–1.40; P = .643); P interaction = 0.079]. Sarcopenia was not associated with cancer‐specific mortality among males and females [HR: 1.07 (95% CI: 0.78–1.89); P = 0.672]. Sarcopenia associated with an increased risk of mortality from other causes (i.e. non‐cardiovascular and non‐cancer) among males and females [HR: 1.32 (95% CI: 1.07–1.62); P = 0.008]. Obesity, defined using body mass index (P interaction = 0.817) or waist circumference (P interaction = 0.219) did not modify the relationship between sarcopenia and all‐cause mortality.ConclusionsSarcopenia is a prevalent syndrome that is associated with premature mortality among community‐dwelling older adults. The prognostic value of sarcopenia may vary by cause‐specific mortality and differ between males and females.

chronic kidney disease; CST, Canadian Society of Transplantation; CT, computed tomography; DASI, Duke activity status index; DEXA, dual energy X-ray absorptiometry; ESRD, end-stage renal disease; FFP, fried frailty phenotype; HR, hazard ratio; HRQO, health-related quality of life; MCSD, mechanical circulatory support device; MELDNa, model for end-stage liver disease and sodium; MRI, magnetic resonance imaging; SPPB, short physical performance battery.

Kidney transplantation is a cost-saving treatment that extends the lives of patients with ESRD. Unfortunately, the kidney transplant waiting list has ballooned to over 100,000 Americans. Across large areas of the United States, many kidney transplant candidates spend over 5 years waiting and often die before undergoing transplantation. However, more than 2500 kidneys (.17% of the total recovered from deceased donors) were discarded in 2013, despite evidence that many of these kidneys would provide a survival benefit to wait-listed patients. Transplant leaders have focused attention on transplant center report cards as a likely cause for this discard problem, although that focus is too narrow. In this review, we examine the risks associated with accepting various categories of donated kidneys, including discarded kidneys, compared with the risk of remaining on dialysis. With the goal of improving access to kidney transplant, we describe feasible proposals to increase acceptance of currently discarded organs.

Background In the context of an aging end-stage renal disease population with multiple comorbidities, transplantation professionals face challenges in evaluating the global health of patients awaiting kidney transplantation. Functional status might be useful for identifying which patients will derive a survival benefit from transplantation versus dialysis. Study Design Retrospective cohort study of wait-listed patients using data on functional status from a national dialysis provider linked to United Network for Organ Sharing registry data. Setting & Participants Adult kidney transplant candidates added to the waiting list between the years 2000 and 2006. Predictor Physical function scale of the Medical Outcomes Study 36-Item Short Form Healthy Survey, analyzed as a time-varying covariate. Outcomes Kidney transplantation; Survival benefit of transplantation versus remaining wait-listed. Measurements We used multivariable Cox regression to assess the association between physical function with study outcomes. In survival benefit analyses, transplant status was modeled as a time-varying covariate. Results The cohort comprised 19,242 kidney transplant candidates (median age, 51 years; 36% black race) receiving maintenance dialysis. Candidates in the lowest baseline physical function quartile were more likely to be inactivated (adjusted HR vs. highest quartile, 1.30; 95% CI, 1.21-1.39) and less likely to undergo transplantation (adjusted HR vs. highest quartile, 0.64; 95% CI, 0.61-0.68). After transplantation, worse physical function was associated with shorter 3-year survival (84% vs. 92% for the lowest vs. highest function quartiles). However, compared to dialysis, transplantation was associated with a statistically significant survival benefit by 9 months for patients in every function quartile. Limitations Functional status is self-reported. Conclusions Even patients with low function appear to live longer with kidney transplantation versus dialysis. For waitlisted patients, global health measures like functional status may be more useful in counseling patients about the probability of transplantation than in identifying who will derive a survival benefit from it.

Background:We tested the hypothesis that objectively measured physical function predicts mortality among cancer survivors.Methods:We assessed objectively measured physical function including the short physical performance battery (SPPB) and fast walk speed in older adult cancer survivors.Results:Among 413 cancer survivors, 315 (76%) died during a median follow-up of 11.0 years. In multivariable-adjusted analyses, each 1-unit increase in the SPPB score and 0.1 m s−1 increase in fast walk speed predicted a 12% reduction in mortality (hazard ratio (HR): 0.88 (95% confidence interval (CI): 0.82–0.94); P<0.001, and HR: 0.88 (95% CI: 0.82–0.96); P=0.003, respectively).Conclusions:Objectively measured physical function may predict mortality among cancer survivors.