Abstract
BackgroundSarcopenia is prevalent in patients with chronic kidney disease (CKD). The indices of physical function, such as grip power and gait speed, decreased according to the decline in the estimated glomerular filtration rate (eGFR).MethodsWe examined the relationships between cystatin C-based GFR (eGFRcys), creatinine-based GFR (eGFRcre), their ratio (eGFRcys/eGFRcre) and sarcopenia in community-dwelling older adults in Japan. This cross-sectional study included 302 men aged 73.9 ± 6.2 years and 647 women aged 72.9 ± 5.8 years from a rural area in Hyogo Prefecture, Japan. eGFRcys and eGFRcre were simultaneously measured, and sarcopenia based on the Asia Working Group for Sarcopenia (AWGS) 2019 criteria was evaluated.ResultseGFRcys and the eGFRcys/eGFRcre ratio were significantly correlated with grip power and gait speed (p < 0.001). The eGFRcys/eGFRcre ratio was also correlated with skeletal muscle mass index (SMI) (p < 0.01). Univariate logistic regression analysis showed eGFRcys and eGFRcys/eGFRcre ratio but not eGFRcre were associated with sarcopenia (p < 0.01). The presence of low eGFRcys (CKDcys) and low eGFRcys/eGFRcre ratio (< 1.0) but not that of low eGFRcre (CKDcre) were associated with sarcopenia (p < 0.01). In the multivariate logistic regression analysis, when the eGFRcys/eGFRcre ratio was added as a covariate to the basic model, it was significantly associated with sarcopenia in women (p < 0.05). Moreover, low eGFRcys/eGFRcre ratio (< 1.0) was associated with a higher risk of sarcopenia in men (p < 0.01).ConclusionIn conclusion, CKDcys but not CKDcre is associated with sarcopenia. A lower eGFRcys/eGFRcre ratio may be a practical screening marker of sarcopenia in community-dwelling older adults.
Highlights
Sarcopenia is a disease characterized by loss of skeletal muscle mass (SMM), and it is an important public health problem
A declined estimated glomerular filtration rate (eGFR) based on Cystatin C (CysC) was associated with a higher prevalence and incidence of frailty, whereas eGFR based on creatinine was not [4]. eGFRcys is related to a higher risk of sarcopenia than eGFRcre, because eGFRcys is not influenced by low muscle mass or quality [5]
The present study showed that, low eGFRcys (CKDcys) was more frequent in participants with sarcopenia than in normal participants (Table 2)
Summary
Sarcopenia is a disease characterized by loss of skeletal muscle mass (SMM), and it is an important public health problem. The muscle strength, for example grip power and physical function such as gait speed, decreased with the decline in the estimated glomerular filtration rate (eGFR) [1]. Cystatin C (CysC) may be a more reliable biomarker that estimates the glomerular filtration rate (eGFR), and it is not influenced by sex, age, or muscle mass. We previously reported that the Cr/CysC ratio was positively correlated to muscle volume and physical function [2]. Another study has reported that the Cr/CysC ratio was associated with high risk of sarcopenia [3]. EGFRcys is related to a higher risk of sarcopenia than eGFRcre, because eGFRcys is not influenced by low muscle mass or quality [5]. The eGFRcys/eGFRcre ratio was independently related to osteoporotic fracture in this study and was correlated to physical function. We hypothesized that eGFRcys is superior to eGFRcre in evaluating muscle mass and physical function, and is more
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