Abstract
BackgroundSarcopenia is common and contributes to a high risk of mortality among general population. There is no consensus regarding the cut-off values for sarcopenia in terms of mortality among chronic kidney disease patients. This study aimed to explore and validate cut-off points of handgrip strength (HGS) and lean mass index (LMI) for estimating the risk of mortality in peritoneal dialysis (PD) patients.MethodsThis single-center prospective cohort study enrolled 1089 incident PD patients between October 2002 and July 2019. All patients were followed until death, transfer to hemodialysis, receiving renal transplantation or the end date of study (December 2019). All participants were randomly sampled to development cohort (70% participants) and validation cohort (30% participants), matched by gender and diabetes. Lean body mass was calculated by using the equation published by our center. Cubic spline regression analysis was used to examine the relationship between HGS or LMI values and mortality, and explore the cut-off points after adjusting for age, diabetes, cardiovascular disease and serum albumin in the development cohort. The derived cut-off values were verified by the agreement rate for predicting mortality and then compared with cut-off values from various clinical guidelines in the validation cohort.ResultsAll 1089 patients were followed up with the median of 36.0 (18.0, 71.0) months. In the development cohort, cut-off points for predicting the higher mortality were derived as 24.5 kg and 14 kg of HGS for males and females, 16.7 kg/m2 and 13.8 kg/m2 of LMI for males and females respectively. In the validation cohort, these cut-off values significantly predicted worse outcomes, with HR 1.96 (1.35, 2.84) of HGS and HR 1.76 (1.26, 2.47) of LMI for all-cause mortality after multivariate adjustment. The newly derived cut-off points of HGS have numerically higher prognostic values in all-cause mortality compared with those from current clinical guidelines, and agreement rates of HGS were 65.2 versus 62.5–64.6 respectively.ConclusionsThe derived cut-off values of HGS and LMI have sufficient and better prognostic value in predicting all-cause mortality in PD patients compared with the cut-off values in the existing guidelines. These cut-off values are only validated in a single population, thus limiting the generalizability.
Highlights
Sarcopenia, which is defined as age-associated loss of skeletal muscle mass and function [1,2,3,4] is associated with progressive worsening of nutritional and clinical conditions, as well as a high risk for morbidity and mortality [1, 5,6,7]
The whole cohort was randomly divided into development cohort (n = 762) and validation cohort (n = 327)
There was a research that found muscle mass lack of association with mortality [25]. Consistent with these studies, we found the predictive effect of handgrip strength (HGS) to be better than that of lean mass index (LMI) with regard to mortality in dialysis patients
Summary
Sarcopenia, which is defined as age-associated loss of skeletal muscle mass and function [1,2,3,4] is associated with progressive worsening of nutritional and clinical conditions, as well as a high risk for morbidity and mortality [1, 5,6,7]. Several guidelines have published the cut-off value of hand grip strength (HGS) and lean mass index (LMI) to determine the sarcopenia [2,3,4, 18]. Several studies performed in dialysis patients have used the cut-off values recommended by these guidelines to report the prevalence of sarcopenia, 11–41% [16, 19,20,21,22], and indicated close associations between sarcopenia and hospitalization [19], cardiovascular disease (CVD) [23, 24] and mortality [19, 25]. This study aimed to explore and validate cut-off points of handgrip strength (HGS) and lean mass index (LMI) for estimating the risk of mortality in peritoneal dialysis (PD) patients
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