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Impact of Skeletal Muscle Mass on Long-Term Adverse Cardiovascular Outcomes in Patients With Chronic Kidney Disease

Published:January 25, 2017DOI:https://doi.org/10.1016/j.amjcard.2017.01.003
      Sarcopenia, defined as skeletal muscle loss and dysfunction, is attracting considerable attention as a novel risk factor for cardiovascular events. Although the loss of skeletal muscle is common in chronic kidney disease (CKD) patients, the relation between sarcopenia and cardiovascular events in CKD patients is not well defined. Therefore, we aimed to investigate the relation between skeletal muscle mass and major adverse cardiovascular events (MACE) in CKD patients. We enrolled 266 asymptomatic CKD patients (median estimated glomerular filtration rate: 36.7 ml/min/1.73 m2). To evaluate skeletal muscle mass, we used the psoas muscle mass index (PMI) calculated from noncontrast computed tomography. The patients were divided into 2 groups according to the cut-off value of PMI for MACE. There were significant differences in age and body mass index between the low and high PMI groups (median age: 73.5 vs 69.0 years, p = 0.002; median body mass index: 22.6 vs 24.2 kg/m2, p <0.001, respectively). During the follow-up period (median: 3.2 years), patients with low PMI had significantly higher risk of MACE than those with high PMI (31.7% and 11.2%, log-rank test, p <0.001). The Cox proportional hazard model showed that low PMI is an independent predictor of MACE in CKD patients (hazard ratio 3.98, 95% confidence interval 1.65 to 9.63, p = 0.0022). In conclusion, low skeletal muscle mass is an independent predictor of MACE in CKD patients. The assessment of skeletal muscle mass may be a valuable screening tool for predicting MACE in clinical practice.
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      References

        • Avin K.G.
        • Moorthi R.N.
        Bone is not alone: the effects of skeletal muscle dysfunction in chronic kidney disease.
        Curr Osteoporos Rep. 2015; 13: 173-179
        • Johansen K.L.
        • Chertow G.M.
        • Jin C.
        • Kutner N.G.
        Significance of frailty among dialysis patients.
        J Am Soc Nephrol. 2007; 18: 2960-2967
        • Moon S.J.
        • Kim T.H.
        • Yoon S.Y.
        • Chung J.H.
        • Hwang H.J.
        Relationship between stage of chronic kidney disease and sarcopenia in Korean aged 40 years and older using the Korea National Health and Nutrition Examination Surveys (KNHANES IV-2, 3, and V-1, 2), 2008-2011.
        PLoS One. 2015; 10: e0130740
        • Cruz-Jentoft A.J.
        • Baeyens J.P.
        • Bauer J.M.
        • Boirie Y.
        • Cederholm T.
        • Landi F.
        • Martin F.C.
        • Michel J.P.
        • Rolland Y.
        • Schneider S.M.
        • Topinková E.
        • Vandewoude M.
        • Zamboni M.
        • European Working Group on Sarcopenia in Older People
        Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People.
        Age Ageing. 2010; 39: 412-423
        • Leong D.P.
        • Teo K.K.
        • Rangarajan S.
        • Lopez-Jaramillo P.
        • Avezum Jr., A.
        • Orlandini A.
        • Seron P.
        • Ahmed S.H.
        • Rosengren A.
        • Kelishadi R.
        • Rahman O.
        • Swaminathan S.
        • Iqbal R.
        • Gupta R.
        • Lear S.A.
        • Oguz A.
        • Yusoff K.
        • Zatonska K.
        • Chifamba J.
        • Igumbor E.
        • Mohan V.
        • Anjana R.M.
        • Gu H.
        • Li W.
        • Yusuf S.
        • Prospective Urban Rural Epidemiology (PURE) Study investigators
        Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study.
        Lancet. 2015; 386: 266-273
        • Matsuo S.
        • Imai E.
        • Horio Y.
        • Tomita K.
        • Nitta K.
        • Yamagata K.
        • Tomino Y.
        • Yokoyama H.
        • Hishida A.
        • Collaborators developing the Japanese equation for estimated GER
        Revised equations for estimated GFR from serum creatinine in Japan.
        Am J Kidney Dis. 2009; 53: 982-992
        • Okumura S.
        • Kaido T.
        • Hamaguchi Y.
        • Fujimoto Y.
        • Masui T.
        • Mizumoto M.
        • Hammad A.
        • Mori A.
        • Takaori K.
        • Uemoto S.
        Impact of preoperative quality as well as quantity of skeletal muscle on survival after resection of pancreatic cancer.
        Surgery. 2015; 157: 1088-1098
        • Hamaguchi Y.
        • Kaido T.
        • Okumura S.
        • Fujimoto Y.
        • Ogawa K.
        • Mori A.
        • Hammad A.
        • Tamai Y.
        • Inagaki N.
        • Uemoto S.
        Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation.
        Liver Transpl. 2014; 20: 1413-1419
        • DeLong E.R.
        • DeLong D.M.
        • Clarke-Pearson D.L.
        Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.
        Biometrics. 1988; 44: 837-845
        • Pencina M.J.
        • D'Agostino Sr., R.B.
        • D'Agostino Jr., R.B.
        • Vasan R.S.
        Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond.
        Stat Med. 2008; 27: 157-172
        • Janssen I.
        • Ross R.
        Linking age-related changes in skeletal muscle mass and composition with metabolism and disease.
        J Nutr Health Aging. 2005; 9: 408-419
        • Arango-Lopera V.E.
        • Arroyo P.
        • Gutiérrez-Robledo L.M.
        • Pérez-Zepeda M.U.
        • Cesari M.
        Mortality as an adverse outcome of sarcopenia.
        J Nutr Health Aging. 2013; 17: 259-262
        • Domanski M.
        • Ciechanowski K.
        Sarcopenia: a major challenge in elderly patients with end-stage renal disease.
        J Aging Res. 2012; 2012: 1-12
        • Foley R.N.
        • Wang C.
        • Ishani A.
        • Collins A.J.
        • Murray A.M.
        Kidney function and sarcopenia in the United States general population: NHANES III.
        Am J Nephrol. 2007; 27: 279-286
        • Kim J.E.
        • Lee Y.H.
        • Huh J.H.
        • Kang D.R.
        • Rhee Y.
        • Lim S.K.
        Early-stage chronic kidney disease, insulin resistance, and osteoporosis as risk factors of sarcopenia in aged population: the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV), 2008-2009.
        Osteoporos Int. 2014; 25: 2189-2198
        • Workeneh B.T.
        • Mitch W.E.
        Review of muscle wasting associated with chronic kidney disease.
        Am J Clin Nutr. 2010; 91: 1128-1132
        • Qureshi A.R.
        • Alvestrand A.
        • Danielsson A.
        • Divino-Filho J.C.
        • Gutierrez A.
        • Lindholm B.
        • Bergström J.
        Factors predicting malnutrition in hemodialysis patients: a cross-sectional study.
        Kidney Int. 1998; 53: 773-782
        • Kalantar-Zadeh K.
        • Kopple J.D.
        Relative contributions of nutrition and inflammation to clinical outcome in dialysis patients.
        Am J Kidney Dis. 2001; 38: 1343-1350
        • Malafarina V.
        • Uriz-Otano F.
        • Iniesta R.
        • Gil-Guerrero L.
        Effectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age: a systematic review.
        J Am Med Dir Assoc. 2013; 14: 10-17
        • Peterson M.D.
        • Rhea M.R.
        • Sen A.
        • Gordon P.M.
        Resistance exercise for muscular strength in older adults: a meta-analysis.
        Ageing Res Rev. 2010; 9: 226-237
        • Komar B.
        • Schwingshackl L.
        • Hoffmann G.
        Effects of leucine-rich protein supplements on anthropometric parameter and muscle strength in the elderly: a systematic review and meta-analysis.
        J Nutr Health Aging. 2015; 19: 437-446
        • Bauer J.M.
        • Verlaan S.
        • Bautmans I.
        • Brandt K.
        • Donini L.M.
        • Maggio M.
        • McMurdo M.E.
        • Mets T.
        • Seal C.
        • Wijers S.L.
        • Ceda G.P.
        • De Vito G.
        • Donders G.
        • Drey M.
        • Greig C.
        • Holmbäck U.
        • Narici M.
        • McPhee J.
        • Poggiogalle E.
        • Power D.
        • Scafoglieri A.
        • Schultz R.
        • Sieber C.C.
        • Cederholm T.
        Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial.
        J Am Med Dir Assoc. 2015; 16: 740-747
        • Kim H.
        • Suzuki T.
        • Saito K.
        • Kojima N.
        • Hosoi E.
        • Yoshida H.
        Long-term effects of exercise and amino acid supplementation on muscle mass, physical function and falls in community-dwelling elderly Japanese sarcopenic women: a 4-year follow-up study.
        Geriatr Gerontol Int. 2016; 16: 175-181
        • Storz P.
        • Döppler H.
        • Wernig A.
        • Pfizenmaier K.
        • Müller G.
        TNF inhibits insulin induced STAT5 activation in differentiated mouse muscle cells pmi28.
        FEBS Lett. 1998; 440: 41-45
        • Houston D.K.
        • Cesari M.
        • Ferrucci L.
        • Cherubini A.
        • Maggio D.
        • Bartali B.
        • Johnson M.A.
        • Schwartz G.G.
        • Kritchevsky S.B.
        Association between vitamin D status and physical performance: the InCHIANTI study.
        J Gerontol A Biol Sci Med Sci. 2007; 62: 440-446
        • Montero-Odasso M.
        • Duque G.
        Vitamin D in the aging musculoskeletal system: an authentic strength preserving hormone.
        Mol Aspects Med. 2005; 26: 203-219