Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Oct 7;9(10):1720-8.
doi: 10.2215/CJN.10261013. Epub 2014 Jul 29.

Comparative associations of muscle mass and muscle strength with mortality in dialysis patients

Naohito Isoyama  1 , Abdul Rashid Qureshi  2 , Carla Maria Avesani  3 , Bengt Lindholm  2 , Peter Bàràny  2 , Olof Heimbürger  2 , Tommy Cederholm  4 , Peter Stenvinkel  2 , Juan Jesús Carrero  5
Affiliations
Comparative Study

Comparative associations of muscle mass and muscle strength with mortality in dialysis patients

Naohito Isoyama et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Reduced muscle mass and strength are prevalent conditions in dialysis patients. However, muscle strength and muscle mass are not congruent; muscle strength can diminish even though muscle mass is maintained or increased. This study addresses phenotype and mortality associations of these muscle dysfunction entities alone or in combination (i.e., concurrent loss of muscle mass and strength/mobility, here defined as sarcopenia).

Design, setting, participants, & measurements: This study included 330 incident dialysis patients (203 men, mean age 53±13 years, and mean GFR 7±2 ml/min per 1.73 m(2)) recruited between 1994 and 2010 and followed prospectively for up to 5 years. Low muscle mass (by dual-energy x-ray absorptiometry appendicular mass index) and low muscle strength (by handgrip) were defined against young reference populations according to the European Working Group on Sarcopenia in Older People.

Results: Whereas 20% of patients had sarcopenia, low muscle mass and low muscle strength alone were observed in a further 24% and 15% of patients, respectively. Old age, comorbidities, protein-energy wasting, physical inactivity, low albumin, and inflammation associated with low muscle strength, but not with low muscle mass (multivariate ANOVA interactions). During follow-up, 95 patients (29%) died and both conditions associated with mortality as separate entities. When combined, individuals with low muscle mass alone were not at increased risk of mortality (adjusted hazard ratio [HR], 1.23; 95% confidence interval [95% CI], 0.56 to 2.67). Individuals with low muscle strength were at increased risk, irrespective of their muscle stores being appropriate (HR, 1.98; 95% CI, 1.01 to 3.87) or low (HR, 1.93; 95% CI, 1.01 to 3.71).

Conclusions: Low muscle strength was more strongly associated with aging, protein-energy wasting, physical inactivity, inflammation, and mortality than low muscle mass. Assessment of muscle functionality may provide additional diagnostic and prognostic information to muscle-mass evaluation.

Keywords: CKD; ESRD; malnutrition; mortality risk; nutrition.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Physical activity associates with muscle strength rather than with muscle mass. The figure shows appendicular muscle mass index (upper panel) and muscle strength (lower panel) in relation to self-reported physical activity (n=259). Whiskers represent the 10th and 90th percentiles.
Figure 2.
Figure 2.
Survival rate of incident dialysis patients stratified according to the presence of appropriate muscle mass and strength, low muscle mass alone, low muscle strength alone, or both (sarcopenia).
See this image and copyright information in PMC

References

    1. US Renal Data System : USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2012
    1. Carrero JJ, Chmielewski M, Axelsson J, Snaedal S, Heimbürger O, Bárány P, Suliman ME, Lindholm B, Stenvinkel P, Qureshi AR: Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients. Clin Nutr 27: 557–564, 2008 - PubMed
    1. Heimbürger O, Qureshi AR, Blaner WS, Berglund L, Stenvinkel P: Hand-grip muscle strength, lean body mass, and plasma proteins as markers of nutritional status in patients with chronic renal failure close to start of dialysis therapy. Am J Kidney Dis 36: 1213–1225, 2000 - PubMed
    1. Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, Mitch WE, Price SR, Wanner C, Wang AY, ter Wee P, Franch HA: Etiology of the protein-energy wasting syndrome in chronic kidney disease: A consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr 23: 77–90, 2013 - PubMed
    1. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, De Meynard C, Donini L, Harris T, Kannt A, Keime Guibert F, Onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C, Souhami E, Verlaan S, Zamboni M: Sarcopenia: An undiagnosed condition in older adults. Current consensus definition: Prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 12: 249–256, 2011 - PMC - PubMed

Publication types

MeSH terms