Associations of Skeletal Muscle Mass and Body Mass Index With Clinical Outcomes in Autosomal Dominant Polycystic Kidney Disease: An Observational Study.
Authors
Affiliations (14)
Affiliations (14)
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea.
- Department of Biostatistics, Dongguk University College of Medicine, Goyang, South Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea; Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, South Korea.
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea.
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea; Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea.
- Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea. Electronic address: [email protected].
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. Electronic address: [email protected].
Abstract
Low muscle mass is a risk factor for chronic kidney disease. In this study, we examined the relationship between muscle mass and mortality, as well as end-stage kidney disease (ESKD), in patients with autosomal dominant polycystic kidney disease (ADPKD). Retrospective cohort study. 1,443 patients with ADPKD from eight tertiary-care hospitals in Korea between 2006 and 2020. Computed tomography images were obtained at the third lumbar vertebra to measure the skeletal muscle area (SMA) using an artificial intelligence system. SMA indexed for w a height<sup>2</sup> s classified as low-attenuation muscle area (LAMA) or normal-attenuation muscle area (NAMA) based on muscle quality. All-cause mortality and ESKD. Cox proportional hazards regression, adjusted for sex, age, creatinine, glucose, and height-adjusted total kidney volume, was used to investigate the associations of muscle indices with all-cause mortality and ESKD. Subgroup analyses were conducted based on body mass index categories: low or normal (<25 kg/m<sup>2</sup>) and overweight or obese (≥25 kg/m<sup>2</sup>). The study population included more than half female patients, and the mean estimated glomerular filtration rate was 68.4 ml/min/1.73m<sup>2</sup>. Mean follow-up was 5.14 years. Greater SMA/height<sup>2</sup> and NAMA/height<sup>2</sup> were associated with a lower risk of mortality (HRs 0.58 (95% CI 0.39-0.88) and 0.55 (95% CI, 0.39-0.79), respectively). Greater NAMA/height<sup>2</sup> was associated with a 26% lower ESKD incidence (0.74 (0.59,0.92), but a greater LAMA/height<sup>2</sup> was associated with a lower ESKD incidence (HR 1.18, 95% CI 1.01-1.37). A higher NAMA/LAMA ratio was associated with a lower ESKD incidence (HR 0.74, 95% CI 0.60-0.92). Greater muscle mass was associated with a lower risk of mortality among overweight individuals and a lower risk of ESKD in underweight individuals. Lack of details about muscle strength and performance. Among individuals with ADPKD, greater and higher-quality muscle mass were associated with lower risk of mortality and progression of CKD to ESKD.