Sarcopenia and mild kidney dysfunction and risk of all-cause and cause-specific mortality in older adults

Gan Wu; Qiong Hu; Zhenhe Huang; Zhihan Lai; Xiaojie Wang; Miao Cai; Hualiang Lin

doi:10.1093/ndt/gfad243

Sarcopenia and mild kidney dysfunction and risk of all-cause and cause-specific mortality in older adults

Nephrol Dial Transplant. 2023 Nov 10:gfad243. doi: 10.1093/ndt/gfad243. Online ahead of print.

Authors

Gan Wu¹, Qiong Hu², Zhenhe Huang³, Zhihan Lai¹, Xiaojie Wang¹, Miao Cai¹, Hualiang Lin¹

Affiliations

¹ Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
² Department of Business Analytics, School of Business, University of Colorado Denver, Denver, CO, USA.
³ Department of Geriatrics, Xiehe Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China.

PMID: 37952094
DOI: 10.1093/ndt/gfad243

Abstract

Background: Sarcopenia has been identified as a risk factor for increased mortality in individuals with CKD. However, when considering individuals with mild kidney dysfunction prior to CKD, the impact of sarcopenia on adverse outcomes, particularly mortality, remains uncertain.

Methods: This study included 323 801 participants from the UK Biobank. Mild kidney dysfunction was defined as eGFR between 60 and 89.9 mL/min/1.73 m2, and sarcopenia was defined according to the criteria of the 2019 European Working Group of Sarcopenia in Older People. Cox proportional hazard models with inverse probability weighting and competing risk models were used for analysis.

Results: During a median follow-up of 11.8 years, 20 146 participants died from all causes. Compared with participants with normal kidney function and without sarcopenia, those with mild kidney dysfunction or sarcopenia had significantly increased risks of all-cause mortality [hazard ratio (HR): 1.16, 95% confidence interval (CI): 1.12 to 1.19; HR: 1.29, 95% CI: 1.20 to 1.37]; those with both mild kidney dysfunction and sarcopenia had an even higher risk of all-cause mortality (HR: 1.61, 95% CI: 1.52 to 1.71), with a significant overall additive interaction (relative risk due to interaction 0.17, 95% CI: 0.05 to 0.29). Further subgroup analyses revealed that the associations of probable sarcopenia with all-cause and cause-specific mortality (non-accidental cause, non-communicable diseases, and cancer) were stronger among participants with mild kidney dysfunction than those with normal kidney function.

Conclusions: The study indicates that sarcopenia and mild kidney dysfunction synergistically increase the risk of all-cause and cause-specific mortality. Early recognition and improvement of mild kidney function or sarcopenia in older people may reduce mortality risk but would require more prospective confirmation.

Keywords: UK Biobank; kidney dysfunction; mortality; sarcopenia.