Table 3.
Summary of studies on sarcopenia prevalence in non-dialyzed CKD, dialysis, and kidney transplanted patients, and methods and criteria used for establishing presence of sarcopenia
| Author | Population | Sample size | Age (years)* | Muscle mass assessment | Strength and/or performance | Sarcopenia Prevalence | Operational criteria used | Observation |
|---|---|---|---|---|---|---|---|---|
| CKD Stage 2–5 not on dialysis | ||||||||
| Pereira, NDT 2015 [57] | CKD 3–5 | 287 |
59.9 (10.5) 53% > 60 years |
MAMC: < 90% reference value SGA—physical exam for low muscle mass BIA: SMMI (< 6.76 kg/m2 for women and < 10.76 kg/m2 for men) |
Strength: HGS (< 30th percentile for sex and age) |
MAMC: 9.8% SGA: 9.4% SMMI -BIA: 5.9% |
EWGSOP 1 | Only SMMI by BIA predicted mortality |
| De Souza, Plos One 2017 [65] | CKD 2–5 | 100 | 73.6 (9.22) |
DXA: ASMI (< 7.26 kg/m2 for men and < 5.5 kg/m2 for women) ASM/BMI (< 0.789 for men and < 0.512 for women) |
Strength: HGS (EWGSOP 1: < 30 kg for men and < 20 kg for women; FNIH: < 26 kg for men and < 16 kg for women) Performance: Gait speed (< 0.8 m/s) |
FNIH: 28.7% EWGSOP 1: 11.9% |
EWGSOP 1 and FNIH | |
| Ishikawa, Plos One 2018 [171] | CKD 3–5 | 260 | 76 (69–80) |
DXA: ASMI (< 7.0 kg/m2 in males and < 5.4 kg/m2 in females) |
Strength: HGS (< 26 kg in males and < 18 kg in females) Performance: Gait speed (< 0.8 m/s) |
25% | AWGS | Low mass + low strength and/or performance |
| Hanatani, IJC 2018 [70] | In-hospital CKD | 265 | 72.3 (9.8) | Calf circumference (according to sex and age) | Strength: HGS (according to score chart) | 62.6% | Scoring Sarcopenia (sarcopenia score ≥ 105 in men and ≥ 120 in women) by Ishii 2014 [172] | |
| D’Alessandro, Nutrients 2018 [52] | CKD 3b-4 | 80 (40 ≥ 75 years, 40 > 60 and < 75 years) |
73.7 (7.2) Older: 79.8 (3.3) Younger: 67.5 (4.3) |
BIA: SMMI (< 10.75 kg/m2) |
Strength: HGS (< 30 kg) |
Older: 55% Younger: 12% |
EWGSOP 1 | Only included male patients > 60 years |
| Vettoretti, Nutrients 2019 [173] | CKD 3b-5 | 113 | 80 (6) | Anthropometry: MAMC reduction > 10% of ref population |
Strength: HGS (< 26 kg men, < 17 kg women) Performance: Gait speed (severity) (< 0.8 m/s) |
24% | EWGSOP 2 | Only included patients ≥ 65 years |
| Fernandes, Nutrition 2019 [64] | CKD 3b-4 | 73 | 62.9 (1.1) |
DXA: ASMI (< 7.26 kg/m2 in men and < 5.5 kg/m2 in women) |
Strength: HGS (< 30 kg men, < 20 kg women) Performance: Gait speed (< 1 m/s) |
12.3% | EWGSOP 1 | Sarcopenia defined as low mass + low strength and/or performance |
| Sharma, CJASN 2014 [54] | CKS 2–4 | 5192 (CKD 2: 4086, CKD 3a: 775, CKD 3b: 254, CKD 4: 77) |
CKD 2: 54.6 (0.4) CKD 3a: 71 (0.6) CKD 3b: 74.5 (1) CKD 4: 73.2 (1.4) |
DXA: ASMI (< 7.26 kg/m2 in men and < 5.45 kg/m2 in women) |
NA |
CKD 2: < 15% CKD 3a: > 20% CKD 3b: > 20% CKD 4: 34.1% |
EWGSOP 1 for low muscle mass | Did not assess strength or performance |
| Androga, KIRep 2017 [67] | CKD 2–4 | 1101 | 70–77 |
DXA: ASMI (< 7.26 kg/m2 in men and < 5.45 kg/m2 in women) |
NA | 22% (12.5% only sarcopenia and 9.7% obesity sarcopenia) | EWGSOP 1 for low muscle mass | Did not assess strength or performance |
| Zou, NDT 2017 [66] | CKD 3–5 | 148 | 66 (19–87) | NA | Strength: HGS (< 30 kg men, < 20 kg women) | 14% | EWGSOP 1 | Did not assess muscle mass |
| Harada, AJC 2017 [68] | CKD | 266 | 71 (62–78) | CT scan: PSOAS area—PSOAS index (< 7.17 cm2/m2 for man and < 5.13 cm2/m2 for women) | NA | 41.3% | No consensus used to identify sarcopenia | Assessed only muscle mass. Cut-offs defined based on the study area under the ROC curve results |
| Renal replacement therapy (hemodialysis, peritoneal dialysis and kidney transplantation) | ||||||||
| Kim, CN 2013 [56] | HD | 95 | 63.9 (10) |
BIS: LTI (2 standard deviations (SD) or more below the normal gender-specific means for young persons) |
Strength: HGS (< 30 kg men, < 20 kg women) |
37% in men 29.3% women |
EWGSOP 1 | |
| Lamarca, JNHA 2014 [55] | HD | 102 (n = 49 for DXA + HGS) | 70.7 (7) |
DXA: ASMI (< 8.12 kg/m2 for men; < 6.08 kg/m2 for women; < 6.95 kg/m2 for men; < 5.16 kg/m2 for women) BIA: LBMI (< 18.1 kg/m2 for men; < 14.6 kg/m2; < 15.9 kg/m2 for men; < 12.8 kg/m2 for women) SKF: LBMI (same as LBMI by BIA) MAMC (< 90% standard values) Calf circumference (< 31 cm) |
Strength: HGS (< 10th percentile of young individuals according to gender) | From 3.9 to 63.3% depending on the method used to assess muscle mass | EWGSOP 1 and International working group in sarcopenia |
Cutoffs: ALMI and LBMI: < 20th percentile of young individuals; < 2 SD below means of young individuals |
| Isoyama, CJASN 2014 [58] | HD | 330 | 53 (13) |
DXA ASMI (< 7.3 kg/m2 in men and < 5.5 kg/m2 in women) |
Strength: HGS (< 30 kg men, < 20 kg women) | 20% | EWGSOP 1 | ASMI cutoff: two SDs below the sex-specific mean from a young reference population |
| Kittiskulnam, JCSM 2016 [174] | HD | 645 | 56.7 (14.5) |
BIS: SMM and SMMI and SMM/BMI (2SD or more below sex specific means of healthy young adults (18–49 years) |
Strength: HGS (< 26 kg for men and < 16 kg for women) Performance: gait speed (< 0.8 m/s) |
Using SMMI: 3.9% Using SMM/BMI: 14% |
FNIH (for muscle strength and performance) | Reference populations and cutoff points of BIS-derived whole-body muscle mass were obtained from the National Health and Nutrition Examination Survey (NHANES) 2003–2004 |
| Slee, JRN 2019 [59] | HD | 87 | 65.9 (13) |
BIA: SMI (< 10.76 kg/m2 for men and < 6.76 kg/m2 for women) ASMI (< 7.26 kg/m2 for men and < 5.45 kg/m2 for women) Anthropometry: MAMC (< 23.8 cm for men and < 18.4 cm for women) |
Strength: HGS (< 30 kg for men and < 20 kg for women; < 26 kg for men and < 16 kg for women; categorized by BMI and sex based on the Fried criteria [175]) |
Females EWGSOP: SMMI – 13% ASMI – 17% FNIH: 8% Males EWGSOP: SMMI – 56% ASMI – 30% FNIH: SMMI – 40% ASMI – 22% |
EWGSOP 1 and FNIH | Janssen equation for SMM and Sergi equation for ASM calculation |
| Giglio, JRN 2019 [30] | HD | 170 | 70.6 (7.2) | Baumgartner equation for ASM (previously validated in 47 patients), ASMI calculated (< 7.26 kg/m2 for men and < 5.45 kg/m2 for women) | Strength: HGS (< 30 kg for men and < 20 kg for women) | 36.5% | EWGSOP 1 | Sarcopenia defined as low mass + low strength |
| Kamijo, PDI 2018 [176] | PD | 119 | 66.8 (13.2) |
BIS SMI (< 7 kg/m2 in men, < 5.7 kg/m2 in women) |
Strength: HGS (< 26 men, < 18 women) Performance: gait speed (< 0.8 m/s) |
11% | AWGS | For diagnosis strength or performance were considered together with muscle mass |
| Abro, EJCN 2018 [177] | PD | 155 | 63 (14.9) |
BIA: ASM derived from segmental BIA (FNIH: < 19.75 kg in men, < 15.02 kg in women) ASM/BMI (FNIH: < 0.789 men, < 0.512 women) ASMI (EWGSOP: < 7.23 kg/m2 in men, < 5.67 kg/m2 in women; AWGS: < 7 kg/m2 in men, < 5.7 kg/m2 in women) |
Strength: HGS (FNIH: < 26 kg men, < 16 kg women; EWGSOP: < 30 kg men, < 20 kg women; AWGS: < 26 kg men, < 18 kg women) | 11–15.5% depending on the criteria |
FNIH EWGSOP AWGS |
|
| Hung, NCP 2017 [69] | PD | 325 | 56.7 (16.5) |
DXA: ASM (< 2 SD from young population; < 19.75 kg in men and < 15 kg in women) ASMI (< 7.26/ < 7.25/ < 8.5/ < 6.95 kg/m2 in men and < 5.75/ < 5.67/ < 5.45/ < 5.16 kg/m2 in women ASM/BMI (< 0.789 men; < 0.512 women) |
NA | 2.2–31.3% for women and 25.1–75.6% for men depending on cutoff used | EWGSOP 1 | Only muscle mass evaluation |
| Da Silva, EJCN 2019 [178] | PD | 50 | 55.7 (16.2) | ASMI (EWGSOP: < 7.26 kg/m2 in men, < 5.5 kg/m2 in women; EWGSOP 2: < 7 kg/m2 in men and < 5.5 kg/m2 in women) |
Strenght: HGS (EWGSOP: < 30 kg in men, < 20 kg in women; EWGSOP 2: < 27 kg in men, < 16 kg in women) Performance: Gait speed (< 0.8 m/s) |
EWGSOP 1: 4% (ASMI + HGS); 4% (ASMI + GS) EWGSOP 2: 4% |
EWGSOP 1 and EWGSOP 2 | |
| Yanishi, TP 2016 [179] | KTR | 51 | 46.2 (12.8) |
DXA: ASMI (< 7 kg/m2 in men, < 5.4 kg/m2 in women) |
Strenght: HGS (< 27 kg in men, < 18 kg in women) Performance: Gait speed (< 0.8 m/s) |
11.8% | AWGS | |
| Studies including non-dialysis CKD, dialysis and kidney transplanted patients | ||||||||
| Dierkes, BMC 2018 [63] |
CKD 3–5 HD KTR |
CKD: 112 HD: 24 KTR: 72 |
CKD: 66 (51–76) HD: 63 (50–76) KTR: 60 (49–67) |
BIA: ASMI (≤ 8.87 kg/m2 in men and ≤ 6.42 kg/m2 in women) |
Strength: HGS (< 30 kg men, < 20 kg women) |
35% (CKD: 37%, HD: 42%, KTR: 32%) | EWGSOP 1 | ALM calculated using MacDonald equation [180] |
| Wilkinson, Nephrology 2019 [181] |
CKD HD KTR |
26 CKD 11 HD 35 KTR |
55.7 (14.4) CKD: 58.8 (17.8) HD: 61.6 (7.7) KTR: 51.6 (12.2) |
DXA: ASM (< 19.75 kg in men and < 15.02 kg in women) ASMI (< 7.26 kg/m2 in men and < 5.45 kg/m2 in women) ASM/BMI (< 0.789 in men and < 0.512 in women) |
Strength: HGS Performance: SPPB (no information regarding cut-offs) | 26–35% depending on the muscle mass assessment method | EWGSOP 1 and FNIH | |
| Lai, Nutrition 2019 [62] |
CKD 3–5 Dialysis (HD + PD) KTR |
77 (CKD: 26, Dialysis: 37, KTR: 14) | 69.6 (9.85) |
BIA: SMMI (≤ 10.75 kg/m2 in men and ≤ 6.75 kg/m2 in women) |
Strength: HGS (< 30 kg in men and < 20 kg in women) | 49.4% | EWGSOP 1 | SMM calculated using Janssen equation [18] |
ALM appendicular lean mass, ASM appendicular skeletal muscle, ASMI appendicular skeletal muscle index, AWGS Asian working group on sarcopenia, BIA bioelectric impedance analysis, BIS bioelectric impedance spectroscopy, BMI body mass index, CKD chronic kidney disease, DXA dual energy X-ray absorptiometry, EWGSOP European working group on sarcopenia in older people, FNIH Foundation for the National Institute of Health, HD hemodialysis, HGS handgrip strength, KTR kidney transplant recipients, MAMC mid-arm muscle circumference, SMMI skeletal muscle mass index, SMM skeletal muscle mass.
*Values in parenthesis describes standard deviation