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Abstract: SA-PO933

Indoxyl Sulfate Levels Are a Predictor for Sarcopenia but Myostatin Levels Are an Indicator for Muscle Mass in Patients With CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials


  • Lee, Su mi, Dong-A University, Busan, Korea (the Republic of)
  • An, Won Suk, Dong-A University, Busan, Korea (the Republic of)

Serum myostatin and indoxyl sulfate (IS) levels are increased according to renal function decline and are the main mediators of chronic kidney disease (CKD)-related sarcopenia. However, a recent report showed that myostatin levels were increased in balance-trained CKD patients associated with increased lean mass. The aim of this study was to assess the association between serum myostatin and IS levels and sarcopenia in CKD patients. We performed a post-hoc analysis of data extracted from a RECOVERY study ( NCT03788252).


Baseline data from the RECOVERY study were analyzed in 150 CKD patients (mean CKD-EPI eGFR: 33.8±12.5). A Six-meter gait speed test and handgrip strength (HGS) were assessed. Skeletal muscle index (SMI) was measured by an InBody S10 based on bioelectrical impedance analysis. Low muscle mass was defined as an SMI <7.0 kg/m2 in men and <5.7 kg/m2 in women. Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019. Serum myostatin and IS levels were measured. We classified patients into two groups according to the median value of myostatin: patients with high myostatin levels (≥4.5 ng/mL) and those with low myostatin levels (<4.5 ng/mL). In addition, IS levels were divided into high (≥0.365 pg/mL) and low (<0.365 pg/mL) groups.


The proportion of patients with sarcopenia was higher in patients with high IS levels but was lower in patients with high myostatin levels. SMI and HGS were significantly lower in patients with high IS levels but were significantly higher in patients with high myostatin levels. IS levels showed a negative correlation with eGFR, SMI, and HGS but myostatin levels showed a positive correlation with SMI, and HGS. Myostatin/SMI ratio reflected muscle mass was negatively associated with eGFR and was not associated with SMI and HGS. The ROC curve of IS levels for presarcopenia was 0.67 (95% CI, 0.51–0.84; P=0.022). The sensitivity and specificity for predicting presarcopenia were 64.7% and 64.4%. Sarcopenia and presarcopenia were independently associated with age and IS levels after adjustment for gender, diabetes mellitus, creatinine, and myostatin/SMI.


Serum IS levels are an important predictor for sarcopenia but serum myostatin levels are indicator muscle mass in CKD patients with lower eGFR.