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Kidney Week

Abstract: TH-PO133

Association Among Bone Mass, Muscle Mass and Strength, Mortality, and CKD Progression in Older Adults

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Nakano, Yuta, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Mandai, Shintaro, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Naito, Shotaro, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Fujiki, Tamami, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Mori, Yutaro, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Ando, Fumiaki, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Mori, Takayasu, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Susa, Koichiro, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Iimori, Soichiro, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Sohara, Eisei, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
  • Uchida, Shinichi, Tokyo Ika Shika Daigaku, Bunkyo-ku, Tokyo, Japan
Background

Chronic kidney disease (CKD) causes a progressive loss of muscle and bone mass. However, the impact of sarcopenia, low bone mineral density (BMD), and osteosarcopenia on CKD progression is yet to be determined.

Methods

This longitudinal prospective cohort study included 251 (median age 76 years; 35% women) outpatients aged ≥65 years with nondialysis-dependent CKD (NDD-CKD). Sarcopenia was defined according to the 2014 criteria of the Asian Working Group for Sarcopenia (AWGS), and low BMD was defined as a T-score of ≤−1.0. The patients were divided into four groups: normal (no sarcopenia/normal BMD), only low BMD (no sarcopenia/low BMD), only sarcopenia (sarcopenia/normal BMD), and osteosarcopenia (sarcopenia/low BMD).The primary outcome was a composite of all-cause deaths, end-stage kidney disease (ESKD), and admissions owing to major cardiovascular events (MACEs). The secondary outcome was a kidney composite outcome that included a 30% estimated glomerular filtration rate (eGFR) reduction and ESKD. The outcome risk was determined using stratified Cox models adjusted for potential confounders.

Results

During a median follow-up period of 5.2 years, there were 22 deaths, 117 30% eGFR reductions, 48 ESKDs, and 18 admissions owing to MACEs. The osteosarcopenia group rather than the only low BMD or only sarcopenia groups exhibited a higher risk of the primary (hazard ratio [HR]: 2.81, 95% confidence interval [CI]: 1.32–5.99) and kidney composite (HR: 1.90, 95% CI: 1.01–3.57) outcomes. Low handgrip strength (HGS) was associated with a high risk of primary and kidney composite outcomes (HR: 2.38, 95% CI: 1.40–4.05; HR: 1.55, 95% CI: 1.01–2.37, respectively). The increase in HGS but not the body mass index, skeletal muscle mass index, or BMD was associated with a lower risk of primary and kidney composite outcomes (HR: 0.67, 95% CI: 0.52–0.87; HR: 0.76, 95% CI: 0.63–0.93 per 5 kg, respectively).

Conclusion

Osteosarcopenia was associated with poor survival and kidney outcomes. Low HGS was associated with increased mortality risk and kidney function decline. These findings bring insights into the pathogenesis of the kidney–bone–muscle axis and improving muscle strength may mitigate CKD progression.

Funding

  • Government Support – Non-U.S.