Kidney Week

Abstract: FR-OR123

Intramuscle Fat Infiltration in Non-Dialysis CKD: Clinical Determinants and Association with Mortality

Session Information

• Translational Advances in Nutrition and Metabolism
  October 26, 2018 | Location: 7B, San Diego Convention Center
  Abstract Time: 04:42 PM - 04:54 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

• Avesani, Carla Maria, Rio de Janeiro State University, Rio de Janeiro, Brazil

Carla Maria Avesani, PhD



Guest researcher at Karolinska Institute, Department of Clinical Science, Intervention and Technology, Division of baxter Novum. Associate Professor, Rio de Janeiro State University, Nutrition Institute, Department of Applied Nutrition.

• Giglio, Juliana, Rio de Janeiro State University, Rio de Janeiro, Brazil

Juliana Giglio,

• Qureshi, Abdul Rashid Tony, Karolinska Institutet, Huddinge, Stockholm, Sweden

Abdul Rashid Tony Qureshi,

• Kamimura, Maria A., Federal University of São Paulo, São Paulo, Brazil

Maria A. Kamimura,

• Bichels, André Valente, Unifesp, São Paulo, Brazil

André Valente Bichels,

• Stenvinkel, Peter, Karolinska University Hospital Huddinge, Stockholm, Sweden

Peter Stenvinkel,

• Lindholm, Bengt, Karolinska Institutet, Huddinge, Stockholm, Sweden

Bengt Lindholm,

• Carrero, Juan Jesus, Karolinska Institutet, Huddinge, Stockholm, Sweden

Juan Jesus Carrero,

• Cordeiro, Antonio C., Dante Pazzanese Institute of Cardiology, Sao Caetano do Sul, Brazil

Antonio C. Cordeiro,

Background

Intramuscle fat infiltration (IFI) is an important feature of aging currently understood as a cause of muscle weakness in elderly. Compared to healthy controls, IFI has been reported elevated in chronic kidney disease (CKD) patients. Its determinants and consequences, however, are unknown.

Methods

Cross-sectional study with mortality follow-up of 195 nephrology-referred patients with non-dialysis CKD stages 3-5. Mean age was 60±11 years, 61% were men and glomerular filtration rate (creatinine clearance) was 25±12 ml/min/1.73 m². We used computed tomography (CT) scan (Slice-O-Matic software version 5.0) of the third lumbar vertebra to quantify the degree of IFI (reported as % of fat within muscle area). Muscles evaluated by CT were psoas, transversus abdominis, rectus abdominis, external and internal obliques, erector spinae and quadratus lumborum. Coronary artery calcification score (CAC) was evaluated by CT, muscle strength by dynamometry (handgrip strength, HGS) and shown as standard values to normative tables.

Results

IFI was higher in women than in men (9.7±6 vs 6.3±4%, P<0.05), and was positively correlated (Spearman test) with age (rho =0.37), Charlson comorbidity score (rho=0.19), CAC (r=0.16) and CT-derived visceral (rho=0.37) and subcutaneous fat (rho =0.57). IFI was negatively associated with HGS (rho=-0.25) and CT-derived skeletal muscle mass (rho=-0.37). In multiple linear regression analysis, male sex (ß=-0.66; P<0.01), older age (ß=0.40 per 1-SD increase; P<0.01), higher muscle mass (ß=0.48 per cm/m² increase; P<0.01) but lower muscle strength (ß=-0.15 per % decrease in HGS) were independent predictors of IFI% (r²=0.33). During 40±13 months of follow-up, 57 patients died. Increased IFI was associated with the risk of death (adjusted hazard ratio 1.60 per 1-SD increase, 95% CI: 1.21 to 2.11) independently of sex, age, diabetes, CKD stage, CAC, subjective global assessment and standard HGS.

Conclusion

IFI is associated with lower muscle strength in non-dialysis CKD patients and predicts the risk of death, regardless of muscle stores. These data are consistent with the notion that intramuscle fat infiltration worsens muscle quality.