Publication: Sarcopenia predicts mortality in renal transplant candidates
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Date
2022-05-01
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Abstract
BACKGROUND AND AIMS: Sarcopenia is common in chronic kidney disease
(CKD) and is associated with increased mortality and morbidity. Sarcopenia in CKD
can be defined as a decreased muscle mass, mainly due to the catabolic state caused
by the uremic environment. Malnutrition and inflammation are also common in
sarcopenic patients. In this study, we aimed to investigate the prevalence of sarcopenia
defined as low muscle mass determined by Psoas Muscle Index (PMI) in waitlisted
end-stage renal disease (ESRD) patients and its association between ‘Prognostic
Nutritional Index (PNI)’, ‘C-reactive protein (CRP) to Albumin Ratio (CAR)’ and
mortality.
METHOD: ESRD patients registered to national kidney transplant waiting list and had
abdomen CT at admission were included in the study. Kidney donor candidates were
constituted as healthy controls. PMI (cm2/m2) were calculated by proportioning the
psoas muscle area detected in the abdomen CT with the square of the height. The PMI
of the controls at the fifth percentile according to gender was accepted as the limit
value for sarcopenia. PNI and CAR were calculated using albumin, CRP and absolute
lymphocyte count. The associations between PMI, PNI, CAR and all-cause mortality
were investigated.
RESULTS: A total of 162 ESRD patients and 87 age matched healthy controls were
included in the study. The mean age of the patients was 44.7 ± 14.2 years and followup time was 3.37 (0.35–9.60) years. The mean PMI were similar between the groups
(5.24 ± 1.71 versus 5.48 ± 1.87 cm2/m2, P = 0.302). While prevalence of sarcopenia
(16.7% versus 3.4%, P = 0.002) and CAR [1.47 (0.12–37.10) versus 0.74 (0.21–10.20),
P < 0.001] was higher; PNI [40 (20.4–52.2) versus 44 (36.1–53.0), P < 0.001] was
lower in ESRD patients than controls. When ESRD patients compared according to
sarcopenia PMI [3.45 ± 0.9 versus 5.59 ± 1.6, P < 0.001] and PNI [39 (20.4–51)
versus 41 (23–52.2), P = 0.005] was significantly lower and CAR [2.03 (0.28–34.65)
versus 1.28 (0.12–37.1), P = 0.041] was higher in sarcopenic ESRD group than nonsarcopenic ESRD group (Table 1). In the correlation analysis, PMI was positively
correlated with PNI (r = 0.246, P = 0.002), no correlated with CAR (r = −0.061,
P = 0.445). In the follow-up, 67 waitlisted patients had been transplanted. In the
five-year survival analysis, the non-sarcopenic transplant group [95% CI: 4.612–5.123
versus 95% CI: 2.721–5.413, P = 0.001] had better survival than sarcopenic transplant
group (Figure 1). Mortality rates were similar in both sarcopenic transplant group and
non-sarcopenic-non-transplant group. Multivariate regression analysis showed that
sarcopenia (HR: 10.277, 95% CI: 3.912–27.000, P < 0.001), not having a transplant
(HR: 3.949, 95% CI: 1.301–11.993, P = 0.015), low PNI (HR: 3.532, 95% CI: 1.303–
9.574, P = 0.013) and duration of renal replacement therapy (HR: 1.009, 95% CI:
1.002–1.015, P = 0.008) were independent risk factors for mortality in all ESRD group.
CONCLUSION: In this study we observed that sarcopenia, as defined by low muscle
mass, is almost seen five times more frequent in ESRD patients than controls and
positively correlated wit
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Keywords
Tıp, Dahili Tıp Bilimleri, İç Hastalıkları, Nefroloji, Sağlık Bilimleri, Medicine, Internal Medicine Sciences, Internal Diseases, Nephrology, Health Sciences, TRANSPLANTASYON, Klinik Tıp, Klinik Tıp (MED), ÜROLOJİ VE NEFROLOJİ, TRANSPLANTATION, CLINICAL MEDICINE, Clinical Medicine (MED), UROLOGY & NEPHROLOGY, Üroloji, Transplantasyon, Urology, Transplantation
Citation
ÇOBAN H., BARUTÇU ATAŞ D., KURŞUN M., TUĞCU M., AŞICIOĞLU E., ARIKAN İ. H., Cimsit C., TUĞLULAR Z. S., VELİOĞLU A., "SARCOPENIA PREDICTS MORTALITY IN RENAL TRANSPLANT CANDIDATES", NEPHROLOGY DIALYSIS TRANSPLANTATION, cilt.37, 2022