SUN-256 LOW MUSCLE MASS IN HEMODIALYSIS PATIENT IS ASSOCIATED WITH NON-CORONARY VASCULAR CALCIFICATION AND MAJOR CARDIOVASCULAR OUTCOME

Abstract

Sarcopenia is characterized by age-related decline of skeletal muscle mass with low muscle strength or functional disabilities. According to recent studies, noncoronary vascular calcification was negatively correlated with sarcopenia. We aimed to investigate correlation between sarcopenia and quantified vascular calcification score (VCS) of the arm including vascular access. And also evaluate the relationships between low muscle mass and incidence of vascular intervention and major cardiac and cerebrovascular events (MACCE). Non-contrast arm CT scan including vascular access was taken. Later, VCS was measured by using Aquarius Ver. 4.4.12 simulating the Agatston Method. Skeletal muscle mass was estimated using multi-frequency bioelectrical impedance (BIA, Inbody S10) in supine position checked after a midweek dialysis session. Low muscle mass (LMM) group was defined as patients whose skeletal muscle mass at both lower extremities measured by BIA, normalized to height-squared was less than the median. Vascular Calcification (VC) was assigned to patients with a cut-off value of 500 or higher, which is 40% of highest VC. Data are presented as median (25th to 75th percentile) for continuous variables or a frequency (percentage) for categorical variables. Statistical differences in the clinical characteristics between the two groups were determined using the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Univariate and multivariate logistic regression analyses were used to determine the association between LMM and VC. We enrolled clinically stable 75 adult patients with hemodialysis. In the total 75 patients, there were 42 males (56.0%), and the median age was 64 (58-72) years. All but two patients met the diagnostic criteria for sarcopenia defined by previous study investigated in Koreans. The median vintage of hemodialysis was 49.4 (32.1-99.2) months. When dividing the patients into two groups based on skeletal muscle mass at both legs, there were no differences between the 2 groups in sex, ESRD etiology, and type of vascular access. However, Age and HD vintage were significantly older in LMM group. LMM was significantly associated with VC (Hazard ratio (HR) 3.562, 95% CI 1.341-9.463, p=0.011). After adjusting age, sex, HD vintage, systolic blood pressure and diabetes, LMM was independently associated with VC (HR 10.415, 95% CI 2.357-46.024, p=0.002). Since interventions can occur multiple times in one patient and each intervention is not independent, the Prentice, Williams and Peterson Total Time survival analysis model was used. Vascular intervention was not significantly associated with LMM (HR 1.391, 95% CI 0.746-2.594, p=0.299). In addition, MACCE did not show significant association with LMM (HR 0.989, 95% CI 0.503-1.943, p=0.974). Low muscle mass is associated with vascular calcification in hemodialysis patients. And low muscle mass could be suggested as another potential predictor of vascular calcification.