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. 2025 Apr 15;7(6):101005.
doi: 10.1016/j.xkme.2025.101005. eCollection 2025 Jun.

Functional Performance Decline Outperforms Sarcopenia and Its Components in Predicting New-Onset Chronic Kidney Disease: A Nationwide Multicenter Study

Liangyu Yin  1 , Furong Li  1 , Tangli Xiao  1 , Jun Zhang  1 , Yan Li  1 , Jicong Luo  1 , Jinghong Zhao  1 , Jiachuan Xiong  1
Affiliations

Functional Performance Decline Outperforms Sarcopenia and Its Components in Predicting New-Onset Chronic Kidney Disease: A Nationwide Multicenter Study

Liangyu Yin et al. Kidney Med. .

Abstract

Background: This study aimed to investigate the associations of functional performance, sarcopenia, and components of sarcopenia with the onset of chronic kidney disease (CKD), while also determining the optimal predictive factor.

Methods: This observational multicenter study included 8,647 community-dwelling adults. Activities of daily living (ADL) scale, physical performance, and sarcopenia were assessed at baseline, and participants were followed to track CKD incidents. The discriminatory performance and cutoffs of ADL and other indices for predicting CKD onset were evaluated. Multivariable-adjusted logistic regression models were employed to analyze the association of ADL with CKD occurrence.

Results: There were 4,681 women and 3,966 men (median age = 57.0 years). Over a 7-year follow-up, 940 CKD incidents occurred. Optimal thresholds for left handgrip strength, right handgrip strength, the 5-time chair stand test, appendicular skeletal muscle index, and ADL to predict CKD onset were established at 35.2 kg, 30.9 kg, 10.4 seconds, 7.3 kg/m,2 and 1 for men; and 16.1 kg, 30.9 kg, 12.8 seconds, 6.3 kg/m,2 and 1 for women, respectively. Among all factors investigated, the ADL score was optimal to predict CKD onset in both men (area under the curve = 0.546; 95% CI, 0.528-0.564) and women (area under the curve = 0.559; 95% CI, 0.538-0.581). Functional performance decline (ADL score ≥1) demonstrated an independent and dose-dependent association with CKD (OR = 1.841; 95% CI, 1.446-2.329; P for trend < 0.001).

Limitations: The use of an anthropometric equation to estimate skeletal muscle mass may not be as precise as other methods. Additionally, the observational nature of the study and reliance on self-reported CKD data may lead to potential confounding, misclassification, and reverse causality, requiring further validation through studies with laboratory-confirmed CKD events and larger, more diverse populations.

Conclusions: The ADL score indicated that functional performance is superior to sarcopenia and its components in predicting the onset of CKD in middle-aged and older Chinese adults. These findings may facilitate the prevention and management of CKD.

Keywords: Activities of daily living; chronic kidney disease; cohort study; functional performance; sarcopenia.

Plain language summary

This study looked at how physical function, sarcopenia (loss of muscle mass and strength), and related factors might predict the development of chronic kidney disease (CKD). This study followed over 8,600 adults for 7 years and found that declines in daily functioning—measured by an activities of daily living score—were linked to an increased risk of CKD. Among several factors studied, the activities of daily living score was the best predictor of CKD onset. The study shows that monitoring physical performance, especially the ability to perform everyday tasks, could help identify people at higher risk for CKD. This insight may improve early detection and prevention strategies, particularly for middle-aged and older adults, helping reduce the burden of CKD in the community.

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Figures

Figure 1
Figure 1
A flowchart of the subject inclusion. CHARLS, the China Health and Retirement Longitudinal Study; CKD, chronic kidney disease.
Figure 2
Figure 2
Subgroup and interaction analysis of the associations of the activities of daily living (ADL)-represented functional performance decline and onset of chronic kidney disease. OR, odds ratio; CI, confidence interval; medians (serum urea nitrogen = 15.10 mg/dL, serum serum creatinine = 0.75 mg/dL, cystatin C = 0.97 mg/L, and uric acid = 4.25 mg/dL).
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