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. 2025 Apr 16;5(1):118.
doi: 10.1038/s43856-025-00821-x.

Associations between skeletal muscle strength and chronic kidney disease in patients with MASLD

Xin-Lei Zhang #  1   2 , Yeqing Gu #  3 , Jing Zhao  4   5 , Pei-Wu Zhu  6 , Wen-Ying Chen  1 , Gang Li  1   7 , Wen-Yue Liu  8 , Wen Zheng  1 , Ni Zhang  1 , Li-Li Chen  1 , Giovanni Targher  9   10 , Christopher D Byrne  11 , Kaijun Niu  12   13   14 , Dan-Qin Sun  15   16 , Ming-Hua Zheng  17   18
Affiliations

Associations between skeletal muscle strength and chronic kidney disease in patients with MASLD

Xin-Lei Zhang et al. Commun Med (Lond). .

Abstract

Background: A skeletal muscle strength (SMS) decline is associated with metabolic diseases, but whether SMS also declines with chronic kidney disease (CKD) in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) is uncertain. This study examined the associations between SMS and the risk of CKD in MASLD population.

Method: We performed a large-scale study with four cohorts: PERSONS and NHANES 2011-2014 cohorts for the cross-sectional investigation, and TCLSIH and UK Biobank cohorts for the longitudinal investigation. A handgrip dynamometer measured handgrip strength as a proxy for overall SMS. Participants were stratified according to CKD status [non-CKD vs. CKD (stages 1-5) groups].

Results: In the PERSONS cohort, the CKD group has a lower handgrip strength than the non-CKD group (27.14 ± 9.19 vs. 33.59 ± 11.92 kg, P < 0.001). Higher handgrip strength is associated with lower odds of abnormal albuminuria or CKD (OR: 0.96, 95%CI:0.92-0.99 and OR:0.95, 95%CI: 0.91-0.99 respectively). The highest handgrip strength tertile is associated with the lowest risk of having abnormal albuminuria or CKD (compared with the lowest or middle tertile). Results are similar in NHANES cohort. Furthermore, the highest handgrip strength is independently associated with the lowest risk of incident CKD in MASLD (HR: 0.95, 95%CI: 0.92-0.99 and HR:0.99, 95%CI: 0.98-0.99 in TCLSIH and UK Biobank cohorts). In Kaplan-Meier curve analysis, the cumulative incidence of CKD is lowest in the highest handgrip strength tertile compared to the lowest or the middle tertile.

Conclusions: Higher handgrip/muscle strength is independently associated with a lower risk of CKD and abnormal albuminuria in MASLD population.

Plain language summary

Metabolic dysfunction-associated steatotic liver disease (MASLD) occurs when there is too much fat in the liver. People with MASLD have an increased risk of developing chronic kidney disease (CKD). Skeletal muscles are responsible for voluntary movements and are crucial for movement and health. We investigated whether skeletal muscle strength (SMS), assessed using handgrip strength, was associated with the risk of CKD in individuals with MASLD. Based on data from over 14,000 participants we found that higher SMS was associated with a lower risk of CKD. These findings suggest that preserving skeletal muscle strength may help prevent people with MASLD developing kidney disease.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram showing how the four cohorts were involved in the study design.
Fig. 2
Fig. 2. Associations between handgrip strength and the risk of abnormal albuminuria in cross-sectional analyses (n = 460 in the PERSONS cohort and n = 1414 in the NHANES cohort).
a Risk of abnormal albuminuria according to handgrip strength in Chinese patients with biopsy-proven MASLD in the hospital-based cohort. b Risk of abnormal albuminuria according to handgrip strength in the NHANES cohort. c Logistic regression models showing the risk of abnormal albuminuria according to handgrip strength tertiles.
Fig. 3
Fig. 3. Associations between handgrip strength and the risk of prevalent CKD (stage 1–5) in cross-sectional analyses (n = 460 in the PERSONS cohort and n = 1414 in the NHANES cohort).
a Risk of CKD according to handgrip strength in Chinese patients with biopsy-proven MASLD in the hospital-based cohort. b Risk of CKD according to handgrip strength in the NHANES cohort. c Logistic regression models showing the risk of prevalent CKD according to handgrip strength tertiles.
Fig. 4
Fig. 4. Diagnostic performance of non-invasive assessment of CKD in people with MASLD.
a The AUROC of the non-invasive model for screening CKD in MASLD subjects was 0.74 (95% CI: 0.66–0.80) in the PERSONS cohort. b The AUROC of the non-invasive model was 0.72 (95% CI: 0.68–0.75) in the NHANES cohort.
Fig. 5
Fig. 5. Kaplan-Meier survival curves for the analysis between handgrip strength and the risk of developing incident CKD in MASLD.
a, b Cumulative incidence rates of CKD. c, d Cumulative incidence rates of CKD according to handgrip strength tertiles in the TCLSIH and UK Biobank cohorts.
See this image and copyright information in PMC

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