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The association of muscle size, strength and exercise capacity with all‐cause mortality in non‐dialysis‐dependent CKD patients
Author(s) -
Watson Emma L.,
Major Rupert W.,
Wilkinson Thomas J.,
Greening Neil J.,
Gould Douglas W.,
Barratt Jonathan,
Smith Alice C.
Publication year - 2020
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12655
Subject(s) - medicine , wasting , kidney disease , dialysis , cohort , cohort study , prospective cohort study , end stage renal disease , cardiology , disease , physical therapy
Background/Objective Patients with chronic kidney disease (CKD) are commonly reported to exhibit skeletal muscle wasting, reduced strength and exercise capacity. Evidence from patients with end‐stage renal disease (ESRD) demonstrates these factors are associated with mortality, but it is unclear whether this relationship exists earlier in the illness. Our objective was to determine whether muscle size, strength or exercise capacity was associated with all‐cause mortality, unscheduled hospital admissions or time to ESRD in patients not requiring dialysis. Methods This is a prospective cohort study of 89 patients with CKD stages 3b‐5 not requiring renal replacement therapy with a mean follow‐up period of 3.3 years in which the contribution of predictors of rectus femoris muscle size, muscle strength, exercise capacity to all‐cause mortality rates, progression to ESRD and time to first hospitalization were investigated. Results Unadjusted analysis suggested each 1 cm 2 increase in quadriceps muscle size (measured by ultrasonography cross‐sectional area) was associated with a 38% reduced risk for death ( p = .006), and a 10 m improvement on the incremental shuttle walk test was associated with a 3% reduced risk for death ( p = .04). However, this relationship was not present in analysis adjusted for age, gender and eGFR. No association was seen between any factor for the development of ESRD or time to first hospitalization. Conclusion These results suggest that in this small cohort, muscle size and exercise capacity are associated with mortality when considered alone, but this relationship was not present in adjusted analyses. Further investigation in a larger patient group is warranted.