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

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...

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Autores principales: Wilkinson, Thomas J., Miksza, Joanne, Yates, Thomas, Lightfoot, Courtney J., Baker, Luke A., Watson, Emma L., Zaccardi, Francesco, Smith, Alice C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200422/
https://www.ncbi.nlm.nih.gov/pubmed/33949807
http://dx.doi.org/10.1002/jcsm.12705
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author Wilkinson, Thomas J.
Miksza, Joanne
Yates, Thomas
Lightfoot, Courtney J.
Baker, Luke A.
Watson, Emma L.
Zaccardi, Francesco
Smith, Alice C.
author_facet Wilkinson, Thomas J.
Miksza, Joanne
Yates, Thomas
Lightfoot, Courtney J.
Baker, Luke A.
Watson, Emma L.
Zaccardi, Francesco
Smith, Alice C.
author_sort Wilkinson, Thomas J.
collection PubMed
description 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 m(2)) 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 m(2)) 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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spelling pubmed-82004222021-06-15 Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study Wilkinson, Thomas J. Miksza, Joanne Yates, Thomas Lightfoot, Courtney J. Baker, Luke A. Watson, Emma L. Zaccardi, Francesco Smith, Alice C. J Cachexia Sarcopenia Muscle Original Articles 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 m(2)) 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 m(2)) 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. John Wiley and Sons Inc. 2021-05-05 2021-06 /pmc/articles/PMC8200422/ /pubmed/33949807 http://dx.doi.org/10.1002/jcsm.12705 Text en © 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Wilkinson, Thomas J.
Miksza, Joanne
Yates, Thomas
Lightfoot, Courtney J.
Baker, Luke A.
Watson, Emma L.
Zaccardi, Francesco
Smith, Alice C.
Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study
title Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study
title_full Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study
title_fullStr Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study
title_full_unstemmed Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study
title_short Association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a UK Biobank study
title_sort association of sarcopenia with mortality and end‐stage renal disease in those with chronic kidney disease: a uk biobank study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200422/
https://www.ncbi.nlm.nih.gov/pubmed/33949807
http://dx.doi.org/10.1002/jcsm.12705
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