The association of muscle size, strength and exercise capacity with all‐cause mortality in non‐dialysis‐dependent CKD patients

Abstract

Background/Objective: Patients with chronic kidney disease (CKD) are commonly reported to exhibit skeletal muscle wasting, reduced strength and exercise capacity. Evidence from patients with end-stage renal disease (ESRD) demonstrates these factors are associated with mortality, but it is unclear whether this relationship exists earlier in the illness. Our objective was to determine whether muscle size, strength or exercise capacity was associated with all-cause mortality, unscheduled hospital admissions or time to ESRD in patients not requiring dialysis. Methods: This is a prospective cohort study of 89 patients with CKD stages 3b-5 not requiring renal replacement therapy with a mean follow-up period of 3.3 years in which the contribution of predictors of rectus femoris muscle size, muscle strength, exercise capacity to all-cause mortality rates, progression to ESRD and time to first hospitalization were investigated. Results: Unadjusted analysis suggested each 1 cm 2 increase in quadriceps muscle size (measured by ultrasonography cross-sectional area) was associated with a 38% reduced risk for death (p = .006), and a 10 m improvement on the incremental shuttle walk test was associated with a 3% reduced risk for death (p = .04). However, this relationship was not present in analysis adjusted for age, gender and eGFR. No association was seen between any factor for the development of ESRD or time to first hospitalization. Conclusion: These results suggest that in this small cohort, muscle size and exercise capacity are associated with mortality when considered alone, but this relationship was not present in adjusted analyses. Further investigation in a larger patient group is warranted.

Muscle-Bone Crosstalk in Chronic Kidney Disease: The Potential Modulatory Effects of Exercise

“…Less vigorous exercise (aerobic, resistance or other alternative forms), may also be valuable, challenging the concern clinicians have about the application of resistance exercise to fight skeletal muscle loss of mass and function, and disproving the gradually less common conviction of exercise as a contraindication to the patients' health [175]. Indeed, a recently published prospective cohort study on 89 patients with CKD stages 3b-5 with a follow-up period of 3.3 years reported that each 1 cm 2 increase in muscle size (quadriceps) and 10 m improvement on the incremental shuttle walk test was associated with a 38% and 3% reduction in risk of mortality, respectively [176].…”

Measurement properties of performance-based measures to assess physical function in chronic kidney disease: recommendations from a COSMIN systematic review

“…Validity was assessed in three studies, one of which reported that ISWT correlated with the gold standard VO 2peak [ 41 ]. Improvements in the distance walked during the ISWT were associated with reduced mortality and cardiovascular morbidity risk [ 57 ] whereas worsening of ISWT performance was not associated with development of end-stage kidney disease [ 58 ]. Two small studies reported on the reliability (ICC values ranging from 0.950 to 0.973) and measurement error (SEM ranging from 7.1 to 34.1 m) of the ISWT [ 41 , 56 ].…”

Quantitative Muscle Ultrasonography Using 2D Textural Analysis: A Novel Approach to Assess Skeletal Muscle Structure and Quality in Chronic Kidney Disease

“…9 The features extracted from ultrasound images commonly evaluate muscle size, for example, cross-sectional area (CSA) or muscle thickness. 3,5,[9][10][11][12] Ultrasound elastography 13,14 and supersonic shear imaging 15 can also be used to assess the mechanical and viscoelastic properties of tissue, including muscle stiffness, which contribute to physical function. However, these techniques are subject to variability and its unknown how reliable these measurements are in fibrotic muscle tissue, as found in CKD.…”

“…Ultrasound is a valid 6 and recommended tool to monitor skeletal muscle health in CKD, 7 used to accurately diagnose sarcopenia 8 and predict mortality risk in CKD. 9 The features extracted from ultrasound images commonly evaluate muscle size, for example, cross-sectional area (CSA) or muscle thickness. 3,5,[9][10][11][12] Ultrasound elastography 13,14 and supersonic shear imaging 15 can also be used to assess the mechanical and viscoelastic properties of tissue, including muscle stiffness, which contribute to physical function.…”

“…Ultrasound is a valid 6 and recommended tool to monitor skeletal muscle health in CKD, 7 used to accurately diagnose sarcopenia 8 and predict mortality risk in CKD. 9 …”