Relative sarcopenia and mortality and the modifying effects of chronic kidney disease and adiposity

Ziolkowski, Susan L.; Long, Jin; Baker, Joshua F.; Chertow, Glenn M.; Leonard, Mary B.

doi:10.1002/jcsm.12396

Cited by 30 publications

(18 citation statements)

References 45 publications

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“…On the other hand, increased fat mass has been shown to increase the risk of metabolic derangements and poor cardiovascular outcome . Moreover, the substantial loss of muscle mass relative to fat mass, termed as ‘sarcopenia’, has been found to have a negative effect on various cardiometabolic parameters and on mortality . This relationship has been observed not only in the elderly population and in patients with cancer, in whom muscle loss is prevalent, but also in the general population .…”

Section: Introductionmentioning

confidence: 99%

High muscle‐to‐fat ratio is associated with lower risk of chronic kidney disease development

Jhee

Joo

Han

et al. 2020

J cachexia sarcopenia muscle

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Background Obesity, a known risk factor for chronic kidney disease (CKD), is generally assessed using body mass index (BMI). However, BMI may not effectively reflect body composition, and the impact of muscle‐to‐fat (MF) mass balance on kidney function has not been elucidated. This study evaluated the association between body muscle and fat mass balance, represented as the MF ratio, and incident CKD development. Methods Data were retrieved from a prospective community‐based cohort study (Korean Genome and Epidemiology Study). Muscle and fat mass were measured using multifrequency bioelectrical impedance analysis. The study endpoint was incident CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 in at least two or more consecutive measurements during the follow‐up period). Results Totally, 7682 participants were evaluated. Their mean age was 51.7 ± 8.7 years, and 48% of the subjects were men. During a median follow‐up of 140.0 (70.0–143.0) months, 633 (8.2%) subjects developed incident CKD. When the association between body composition and incident CKD was investigated, multivariable Cox proportional hazard analysis revealed that increase in MF ratio was related with a decreased risk of CKD development [per 1 increase in MF ratio: hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.77–0.96; P = 0.008]. This association was also maintained when MF ratio was dichotomized according to sex‐specific median values (high vs. low: HR, 0.83; 95% CI, 0.70–0.98; P = 0.031). Analyses preformed in a propensity score matched group also revealed a similar decreased risk of incident CKD in high MF ratio participants (high vs. low: HR, 0.84; 95% CI, 0.71–0.98; P = 0.037). This relationship between MF ratio and incident CKD risk was consistently significant across subgroups stratified by age, sex, hypertension, estimated glomerular filtration rate categories, and proteinuria. Among different BMI groups (normal, overweight, and obese), the relationship between high MF ratio and lower incident CKD risk was significant only in overweight and obese subjects. Conclusions Lower fat mass relative to muscle mass may lower the risk of CKD development in individuals with normal renal function. This relationship seems more prominent in overweight and obese subjects than in normal weight subjects.

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Section: Introductionmentioning

confidence: 99%

High muscle‐to‐fat ratio is associated with lower risk of chronic kidney disease development

Jhee

Joo

Han

et al. 2020

J cachexia sarcopenia muscle

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“…Increased CO 2 was associated with low dietary protein intake in CKD patients [43] which facilitates muscle loss or inhibits muscle protein synthesis [44]. Loss of muscle mass can lead to sarcopenia and subsequently increased morality [45]. High mortality in higher CO 2 groups in our study may be explained partly by low dietary protein intake.…”

Section: Discussionmentioning

confidence: 72%

“…High mortality in higher CO 2 groups in our study may be explained partly by low dietary protein intake. Although this group had the highest BMI which may reflect overnutrition, sarcopenic obesity may occur and is also associated with mortality [45].…”

Section: Discussionmentioning

confidence: 99%

Association of Pre-ESRD Serum Bicarbonate with Post-ESRD Mortality in Patients with Incident ESRD

et al. 2021

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Background: Serum bicarbonate or total carbon dioxide (CO2) concentrations decline as chronic kidney disease (CKD) progresses and rise after dialysis initiation. While metabolic acidosis accelerates the progression of CKD and is associated with higher mortality among patients with end stage renal disease (ESRD), there are scarce data on the association of CO2 concentrations before ESRD transition with post-ESRD mortality. Methods: A historical cohort from the Transition of Care in CKD (TC-CKD) study includes 85,505 veterans who transitioned to ESRD from October 1, 2007, through March 31, 2014. After 1,958 patients without follow-up data, 3 patients with missing date of birth, and 50,889 patients without CO2 6 months prior to ESRD transition were excluded, the study population includes 32,655 patients. Associations between CO2 concentrations averaged over the last 6 months and its rate of decline during the 12 months prior to ESRD transition and post-ESRD all-cause, cardiovascular (CV), and non-CV mortality were examined by using hierarchical adjustment with Cox regression models. Results: The cohort was on average 68 ± 11 years old and included 29% Black veterans. Baseline concentrations of CO2 were 23 ± 4 mEq/L, and median (interquartile range) change in CO2 were −1.8 [−3.4, −0.2] mEq/L/year. High (≥28 mEq/L) and low (<18 mEq/L) CO2 concentrations showed higher adjusted mortality risk while there was no clear trend in the middle range. Consistent associations were observed irrespective of sodium bicarbonate use. There was also a U-shaped association between the change in CO2 and all-cause, CV, and non-CV mortality with the lowest risk approximately at −2.0 and 0.0 mEq/L/year among sodium bicarbonate nonusers and users, respectively, and the highest mortality was among patients with decline in CO2 >4 mEq/L/year. Conclusion: Both high and low pre-ESRD CO2 levels (≥28 and <18 mEq/L) during 6 months prior to dialysis transition and rate of CO2 decline >4 mEq/L/year during 1 year before dialysis initiation were associated with greater post-ESRD all-cause, CV, and non-CV mortality. Further studies are needed to determine the optimal management of CO2 in patients with advanced CKD stages transitioning to ESRD.

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“…Clinically, it is defined by an unintentional weight loss of ≥5% in the last 12 months and three of the following five components: abnormalities in blood tests (increased inflammatory biomarkers, hemoglobin <12 g/dL, and serum albumin <3.2 g/dL), reduced muscular strength, anorexia, low fat-free mass index, and signs of fatigue [134]. It also occurs, under the common denominator of chronic inflammation [138,139], in other various chronic diseases, e.g., in chronic obstructive pulmonary disease (COPD) [140], chronic kidney disease (CKD) [141,142], and cancer [143].…”

Section: Sarcopenia In Cardiac Cachexiamentioning

confidence: 99%

Muscle Wasting and Sarcopenia in Heart Failure—The Current State of Science

Lena

Anker

Springer

2020

IJMS

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Sarcopenia is primarily characterized by skeletal muscle disturbances such as loss of muscle mass, quality, strength, and physical performance. It is commonly seen in elderly patients with chronic diseases. The prevalence of sarcopenia in chronic heart failure (HF) patients amounts to up to 20% and may progress into cardiac cachexia. Muscle wasting is a strong predictor of frailty and reduced survival in HF patients. Despite many different techniques and clinical tests, there is still no broadly available gold standard for the diagnosis of sarcopenia. Resistance exercise and nutritional supplementation represent the currently most used strategies against wasting disorders. Ongoing research is investigating skeletal muscle mitochondrial dysfunction as a new possible target for pharmacological compounds. Novel agents such as synthetic ghrelin and selective androgen receptor modulators (SARMs) seem promising in counteracting muscle abnormalities but their effectiveness in HF patients has not been assessed yet. In the last decades, many advances have been accomplished but sarcopenia remains an underdiagnosed pathology and more efforts are needed to find an efficacious therapeutic plan. The purpose of this review is to illustrate the current knowledge in terms of pathogenesis, diagnosis, and treatment of sarcopenia in order to provide a better understanding of wasting disorders occurring in chronic heart failure.

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Relative sarcopenia and mortality and the modifying effects of chronic kidney disease and adiposity

Cited by 30 publications

References 45 publications

High muscle‐to‐fat ratio is associated with lower risk of chronic kidney disease development

High muscle‐to‐fat ratio is associated with lower risk of chronic kidney disease development

Association of Pre-ESRD Serum Bicarbonate with Post-ESRD Mortality in Patients with Incident ESRD

Muscle Wasting and Sarcopenia in Heart Failure—The Current State of Science

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