Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patients

Lee, Yu Ho; Kim, Jin Sug; Jung, Su Woong; Hwang, Hyeon Seok; Moon, Ju Young; Jeong, Kyung Hwan; Lee, Sang Ho; Lee, So Young; Ko, Gang Jee; Lee, Dong Hoon; Lee, Hong Joo; Kim, Yang‐Gyun

doi:10.1186/s12882-020-01831-8

Cited by 48 publications

(32 citation statements)

References 58 publications

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“…It implied that the muscle function of the lower extremities may be important in cardiovascular outcomes. Consistent with our findings, recent studies revealed gait speed was associated with an increased HRs for death and cardiovascular mortality (44,45).…”

Section: Discussionsupporting

confidence: 93%

Relationship Between Sarcopenia and Electrocardiographic Abnormalities in Older People: The Bushehr Elderly Health Program

et al. 2021

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Background: Sarcopenia is characterized by low skeletal muscle mass and function, which is associated with cardiovascular risk factors and may even be related to adverse cardiovascular events and mortality. This study aimed to evaluate whether sarcopenia is related to electrocardiographic (ECG) abnormalities in a large sample of older adults.Methods: We performed a cross-sectional study based on the data collected during the Bushehr Elderly Health (BEH) cohort study. Body composition was measured by dual X-ray absorptiometry (DXA) and muscle strength was measured using a digital dynamometer for each hand of every participant. A person who had low muscle strength, as well as low muscle mass was identified as having sarcopenia. The subjects were classified into three groups according to the Minnesota Code (MC) as major, minor ECG abnormalities and participants with no abnormalities ECG.Results: Of the 2,426 participants, 354 (14.6%) had major ECG abnormalities and 193 (8%) had minor ECG abnormalities. Sarcopenia was associated with an increased risk of major ECG abnormality in all models. After adjustment for confounders of CHD in full model, the OR for major ECG abnormality was 1.47 (95% CI 1.11–1.95) in those with sarcopenia. Low muscle strength and low muscle performance were both with an increased risk of major ECG abnormality in all models. Sarcopenia and low muscle strength increased 28% and 62% risk of any ECG abnormality in the full models [sarcopenia: 1.28(1.01–1.63), low muscle strength: 1.62(1.30–2.03)], respectively.Conclusions: This study showed that sarcopenia and its components are associated with ECG abnormalities in Iranian older people. Although some older adults have higher cardiovascular risk factors, these data showed that further factors such as sarcopenia may be identified as a particular risk factor for future cardiovascular events. Therefore, sarcopenia could be added to the screening of the older population to reduce the risk of cardiovascular events.

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Section: Discussionsupporting

confidence: 93%

Relationship Between Sarcopenia and Electrocardiographic Abnormalities in Older People: The Bushehr Elderly Health Program

et al. 2021

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“…Whilst the concept of probable sarcopenia is new, the recognition of low muscle strength as a prognostic marker is well established 39,40 . HGS is shown to be a reliable nutritional marker in dialysis patients 41 and low HGS predicts mortality in patients with ESRD 42–44 . We found that CKD and non‐CKD participants with probable sarcopenia had a 33% and 37% greater risk of death.…”

Section: Discussionmentioning

confidence: 77%

Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study

Wilkinson

Miksza

Yates

et al. 2021

J cachexia sarcopenia muscle

115

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Background Sarcopenia, a degenerative and generalized skeletal muscle disorder involving the loss of muscle function and mass, is an under‐recognized problem in clinical practice, particularly in chronic kidney disease (CKD). We aimed to investigate the prevalence of sarcopenia in individuals with CKD, its risk factors, and its association with all‐cause mortality and progression to end‐stage renal disease (ESRD). Methods UK Biobank participants were grouped according to the presence of CKD (defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2) and as having probable (low handgrip strength), confirmed (plus low muscle mass), and severe sarcopenia (plus poor physical performance) based on the 2019 European Working Group of Sarcopenia in Older People and Foundation for the National Institutes of Health criteria. Risk factors were explored using logistic regression analysis. Survival models were applied to estimate risk of mortality and ESRD. Results A total of 428 320 participants, of which 8767 individuals with CKD (46% male, aged 62.8 (standard deviation 6.8) years, median estimated glomerular filtration rate 54.5 (interquartile range 49.0–57.7) mL/min/1.72 m2) were included. Probable sarcopenia was present in 9.7% of individuals with CKD compared with 5.0% in those without (P < 0.001). Sarcopenia was associated with being older; inflammation; poorer renal function; and lower serum albumin, total testosterone, and haemoglobin. The largest risk factors for sarcopenia were having three or more comorbidities (odds ratio: 2.30; 95% confidence interval: 1.62 to 3.29; P < 0.001) and physical inactivity: participants in the highest quartile of weekly activity were 43% less likely to have sarcopenia compared to the lowest quartile (odds ratio: 0.57; 0.42 to 0.76; P < 0.001). Participants with CKD and sarcopenia had a 33% (7% to 66%; P = 0.011) higher hazard of mortality compared with individuals without. Sarcopenic CKD individuals had a 10 year survival probability of 0.85 (0.82 to 0.88) compared with 0.89 (0.88 to 0.30) in those without sarcopenia, an absolute difference of 4%. Those with sarcopenia were twice as likely to develop ESRD (hazard ratio: 1.98; 1.45 to 2.70; P < 0.001). Conclusions Participants with reduced kidney function are at an increased risk of premature mortality. The presence of sarcopenia increases the risk of mortality and ESRD. Appropriate measurement of sarcopenia should be used to identify at‐risk individuals. Interventions such as physical activity should be encouraged to mitigate sarcopenia.

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“…It was interesting to note that within the sarcopenia and malnutrition group, the mean values of body fat markers, such as BMI, percentage of body fat, and standard triceps SKFs were within the normal range for non-CKD individuals (15,30,31). Similarly, Lee et al (32) also observed in a group of older adults on HD that patients with low gait speed and low HGS combined had BMI within the normal range. Additionally, in the study from Ren et al (24), no significant differences were found between no-sarcopenia and sarcopenia in relation to anthropometric indexes, namely TSF, BMI, MAC, and MAMC.…”

Section: Discussionmentioning

confidence: 84%

“…As far as we are concerned, there are no previous studies assessing the role of malnutrition and sarcopenia combined in older adults on HD, but studies in older adults hospitalized without CKD, showed that older adults with combined sarcopenia and malnutrition had a risk for mortality of close to five times higher when compared to the group with none of these nutritional disturbances (38). In patients on dialysis, previous studies have consistently shown that malnutrition (36,39), sarcopenia (25), and low muscle strength (23,32,40) were associated with increased mortality. Some limitations and strengths of this study can be listed.…”

Section: Discussionmentioning

confidence: 96%

Malnutrition and Sarcopenia Combined Increases the Risk for Mortality in Older Adults on Hemodialysis

et al. 2021

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Aim: Sarcopenia and malnutrition are highly prevalent in older adults undergoing hemodialysis (HD) and are associated with negative outcomes. This study aimed to evaluate the role of sarcopenia and malnutrition combined on the nutritional markers, quality of life, and survival in a cohort of older adults on chronic HD.Methods: This was an observational, longitudinal, and multicenter study including 170 patients on HD aged >60 years. Nutritional status was assessed by 7-point-subjective global assessment (7p-SGA), body composition (anthropometry and bioelectrical impedance), and appendicular skeletal muscle mass (Baumgartner's prediction equation). Quality of life was assessed by KDQoL-SF. The cutoffs for low muscle mass and low muscle strength established by the 2019 European Working group on sarcopenia for Older People (EWGSOP) were used for the diagnosis of sarcopenia. Individuals with a 7p-SGA score ≤5 were considered malnourished, individuals with low strength or low muscle mass were pre-sarcopenic, and those with low muscle mass and low muscle strength combined as sarcopenic. The sample was divided into four groups: sarcopenia and malnutrition; sarcopenia and no-malnutrition; no-sarcopenia with malnutrition; and no-sarcopenia and no-malnutrition. Follow-up for survival lasted 23.5 (12.2; 34.4) months.Results: Pre-sarcopenia, sarcopenia, and malnutrition were present in 35.3, 14.1, and 58.8% of the patients, respectively. The frequency of malnutrition in the group of patients with sarcopenia was not significantly higher than in the patients without sarcopenia (66.7 vs. 51.2%; p = 0.12). When comparing groups according to the occurrence of sarcopenia and malnutrition, the sarcopenia and malnutrition group were older and presented significantly lower BMI, calf circumference, body fat, phase angle, body cell mass, and mid-arm muscle circumference. In the survival analysis, the group with sarcopenia and malnutrition showed a higher hazard ratio 2.99 (95% CI: 1.23: 7.25) for mortality when compared to a group with no-sarcopenia and no-malnutrition.Conclusion: Older adults on HD with sarcopenia and malnutrition combined showed worse nutritional parameters, quality of life, and higher mortality risk. In addition, malnutrition can be present even in patients without sarcopenia. These findings highlight the importance of complete nutritional assessment in patients on dialysis.

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Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patients

Cited by 48 publications

References 58 publications

Relationship Between Sarcopenia and Electrocardiographic Abnormalities in Older People: The Bushehr Elderly Health Program

Relationship Between Sarcopenia and Electrocardiographic Abnormalities in Older People: The Bushehr Elderly Health Program

Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study

Malnutrition and Sarcopenia Combined Increases the Risk for Mortality in Older Adults on Hemodialysis

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