Modified Creatinine Index and Clinical Outcomes of Hemodialysis Patients: An Indicator of Sarcopenia?
| Autor: | Atsushi Yoshida, Manae Harada, Atsuhiko Matsunaga, Keika Hoshi, Yuta Suzuki, Shohei Yamamoto, Takaaki Watanabe, Kentaro Kamiya, Ryota Matsuzawa, Shiwori Osada, Yusuke Isobe, Keigo Imamura |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Sarcopenia medicine.medical_treatment 030232 urology & nephrology Medicine (miscellaneous) 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Interquartile range Renal Dialysis Internal medicine medicine Risk of mortality Humans Dialysis Aged Retrospective Studies Creatinine 030109 nutrition & dietetics Nutrition and Dietetics Hand Strength business.industry Surrogate endpoint Mortality rate medicine.disease chemistry Nephrology Cardiology Female Hemodialysis business human activities |
| Zdroj: | Epub 2020 Sep 18 |
| ISSN: | 1051-2276 |
| Popis: | Objective Sarcopenia (especially muscle mass assessed using gold standard techniques) has been suggested as a poorer predictor of mortality than muscle function in patients undergoing hemodialysis. Appropriate methods to estimate muscle mass for use as a good predictor of clinical outcomes remain to be established. We investigated whether the modified creatinine index (mCI), which is a surrogate marker of muscle mass, could predict mortality and cardiovascular (CV) hospitalizations independent of muscle function and other confounders in patients on hemodialysis. Design and Methods In this retrospective study, outpatients (n = 542; mean age, 65.3 years; 60% men; median dialysis vintage, 29 months; mean BMI, 22.0 kg/m2) undergoing hemodialysis were investigated. The mCI, handgrip strength, and gait speed were assessed and related to all-cause mortality and a composite of CV hospitalizations and all-cause mortality. Cox proportional and mixed-effects negative binomial models were fit for mortality and the composite outcomes. Results Patients were followed up for a median 3 years (interquartile range: 1.5-5.7). Each per SD increase of mCI (HR:0.63, 95% CI:0.62-0.65), handgrip strength (HR:0.51, 95% CI:0.48-0.54), and gait speed (HR:0.60, 95% CI:0.56-0.64) were significantly associated with lower all-cause mortality rates after adjusting for covariates. The mCI was consistently found to be an independent predictor of mortality after additional adjustment for handgrip strength or gait speed. Furthermore, sarcopenic conditions [i.e., lower mCI, and lower handgrip strength (HR:3.79, 95% CI:2.09-6.87) or slower gait speed (HR:4.20, 95% CI:2.38-7.41)] were significantly associated with a higher risk of mortality after adjusting for covariates. Associations of mCI with multiple CV hospitalizations and mortality were similar to those between mCI and mortality. Conclusion The mCI was a good predictor of clinical outcomes and was comparable to muscle function, including handgrip strength and gait speed. The mCI is likely to provide additional diagnostic and prognostic values for sarcopenia in patients on hemodialysis. |
| Databáze: | OpenAIRE |
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