Kidney Week

Abstract: FR-PO1114

Muscle Density Changes in CKD and Clinical Outcomes

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Schrauben, Sarah J., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Sarah J. Schrauben, MD, MS

• Zemel, Babette, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Babette Zemel

• Long, Jin, Stanford University, Stanford, California, United States

Jin Long, PhD

• Wilson, Francis Perry, Yale University School of Medicine, New Haven, Connecticut, United States

Francis Perry Wilson, MD, MS

• Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Michelle Denburg, MD

• Mostoufi-Moab, Sogol, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Sogol Mostoufi-Moab, MD

• Baker, Joshua F., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Joshua F. Baker, MD

Background

Low muscle density associates with muscle impairment and poor outcomes. We measured muscle density annually over 2 years in CKD participants, compared with controls to determine predictors of muscle density decline, and associations with cardiovascular disease (CVD) and death.

Methods

Adults with CKD were recruited as an ancillary to the CRIC Study. Healthy adults, ages 21-78 years were enrolled as controls. Muscle and fat cross-sectional area (CSA, cm²) in the calf were obtained by peripheral quantitative CT (pQCT). pQCT muscle density (mg/cm³) was used as a composite index of intra- and extra-myocellular fat content. pQCT measures were converted to age- and sex-specific Z-Scores based on distributions in controls. Linear regression analyses evaluated group differences and changes in muscle density over time in CKD. Cox proportional hazards models evaluated associations of muscle density with CVD and death over mean 8 years.

Results

Included were 501 controls and 277 with CKD. Muscle density was lower in CKD [β: -0.60, 95% CI: -0.75, -0.45]; difference was attenuated when adjusted for BMI. Deficits were most notable among those with sarcopenia (low muscle CSA) (Figure). Diabetes and low calf CSA also predicted greater muscle density 2 yr decline [diabetes β: -0.09, 95% CI: -0.18, -0.01, calf CSA Z-score < -1 β -0.17, 95% CI: -0.30, -0.04]. Lower muscle density was associated with a higher risk of death and CVD, but not independently of age, race, sex, diabetes, smoking, CVD, and eGFR [HR per SD: 1.27 (0.92, 1.72); HR: 1.25 (0.97, 1.61), respectively].

Conclusion

Low muscle density was observed among CKD patients with diabetes, greater adiposity, low calf CSA, low BMI, and more advanced CKD. Greater declines in muscle density were associated with baseline diabetes and low muscle mass. These observations suggest loss of muscle density in CKD occurs in the context of metabolic obesity as well as sarcopenia.

Funding

• NIDDK Support