Skip to main content
. Author manuscript; available in PMC: 2023 Jan 1.
Published in final edited form as: Curr Opin Nephrol Hypertens. 2022 Jan 1;31(1):109–128. doi: 10.1097/MNH.0000000000000763

Table 2.

Epidemiologic studies of association between physical health status and outcomes in CKD and ESRD.

Author, Publication Year Study Population Mean age, % sex, mean eGFR Country Physical Function Outcome Outcomes
CKD
Hanatani S, et al.40 2018 265 in-hospital heart failure patients with CKD

Age 72.3 ± 9.8
Male 69%
eGFR 43.1 ± 17.2		 Japan Sarcopenia score

(Handgrip strength + calf circumference)		 Cardiovascular events
 (Follow-up: median 725 days)

 High sarcopenia score: adjusted HR 3.04 (1.45–6.38)
Harada K, et al.64 2017 266 CKD patients

Age 71 (62–78)
Male 74%
eGFR 36.7 (26.7–48.1)		 Japan Psoas muscle mass index Major adverse cardiovascular events
 (Follow-up: median 3.2 years)

Low psoas muscle mass: adjusted HR 3.98 (1.65–9.63)
Tsai YC, et al.56 2017 161 CKD patients
(Stage 1–5)

Age 67.2 ± 7.8
Male 54.0%
eGFR 34.5 ± 28.8		 Taiwan 2-minute step test
Handgrip strength
30-second chair-stand		 Follow-up: mean 29.1 months
Commencing dialysis
 2-minute step: adjusted HR 0.04 (0.01–0.95)
 Handgrip strength: adjusted HR 0.89 (0.84–0.96)
 30-second chair-stand adjusted HR 1.02 (0.88–1.17)

Major adverse cardiovascular events
 2-minute step: adjusted HR 0.04 (0.00–30.05)
 Handgrip strength: adjusted HR 0.99 (0.87–1.13)
 30-second chair-stand: adjusted HR 0.65 (0.47–0.89)

All causes hospitalization
 2-minute step: adjusted HR 0.94 (0.04–22.51)
Handgrip strength: adjusted HR 0.96 (0.90–1.02)
30-second chair-stand adjusted HR 0.84 (0.74–0.95)
Pereira RA, et al.27 2015 287 CKD patients
(Stage 3–5)

Age 59.9 ± 10.5
Male 62%
eGFR 25.0 ± 15.8		 Brazil Sarcopenia defined by
① Handgrip strength (HGS) +
 Mid-arm muscle circumference (MAMC)
② HGS
 +
 Subjective global assessment (SGA)
③ HGS
 +
 Skeletal Muscle Index (SMI)		 All-cause mortality
 (Follow-up: up to 40 months)

 HGS+MAMC: adjusted HR 1.62 (0.69–3.82)
 HGS+SGA: adjusted HR 1.80 (0.78–4.17)
 HGS+BIA: adjusted HR 3.02 (1.30–7.05)
Delgado C, et al.52 2015 812 CKD patients
(Stage 3–5)

Age 52 (42 – 61)
Male 60.5%
mGFR 33.1± 11.7		 USA Self-report Frailty

(Frailty: score ≥ 3
Intermediate frail: score 1–2)		 Mortality
 (Follow-up: median 17 years)
  Inter mediate frail: adjusted HR1.43(1.11–1.83)
  Frail: adjusted HR 1.48 (1.08–2.00)
Roshanravan B, et al. 51 2013 385 CKD patients
(Stage 2–4)

Age 61 ± 13
Male 84%
eGFR41.3 ± 19.3		 USA Handgrip strength
(Weak: Sex and BMI specific cut-off)

Gait speed
(Slow: ≤ 0.8m/s)

6 MWD
(Low: <350m)

Timed up and go test
(Slow: ≥12s)		 Mortality (Follow-up: median 3 years)
 Weak HGS: adjusted HR 1.30 (0.71–2.37)
  Per 5-kg decrease: adjusted HR 1.07 (0.92–1.24)

 Slow gait speed: adjusted HR 2.45 (1.09–5.54)
  Per 0.1-m/s slower: adjusted HR1.26(1.09–1.47)

 Low 6MWD: adjusted HR 2.82 (1.17–6.92)
  Per 50-m decrease aHR 1.15 (0.98–1.36)

 Slow TUG: adjusted HR 1.81 (0.92–3.56)
   Per 1-s slower: adjusted HR 1.08 (1.01–1.14)
Roshanravan B, et al.37 2012 336 CKD patients
(Stage 1–4)

Age 58.7 ± 13.0
Male 81%
eGFR 46.4 ± 25.5		 USA Frailty (modified CHS):
Low physical activity
Slow walk
Weak handgrip
Weight loss Exhaustion)		 Death or initiation of dialysis therapy
 (Follow-up: median 967 days)

 Frailty: adjusted HR2.5 (1.4–4.4)
Chang YT, et al.55 2011 128 CKD patients
(Stage 1–5)

Age 60.7 ± 14.8
Male 46.9%
eGFR 46.6 ± 28.2		 Taiwan Handgrip strength
(Low:
Male < 24.65kg
Female < 10.15kg)		 Mortality or ESRD
 High HGS (CKD G1–5): adjusted HR0.90 (0.84–0.97)
  (CKD G3b-5): adjusted HR 0.91 (0.83–0.99)
Wilkinson TJ, et al.53 2021 8767 CKD patients

Age 62.8±5.8
Male 46%
eGFR 54.5 (49.0–57.7)		 UK Sarcopenia defined by EWGSOP2 criteria All-cause mortality
 (Follow-up: median 9.0 years)
  Sarcopenia: adjusted HR1.33 (1.07–1.66)

End stage renal disease
  Sarcopenia: adjusted HR 2.08 (1.53–2.82)
Chao CT, et al.57 2019 165,461 DKD patients

(Numbers of frailty component)

(Zero) Age 58.1 ± 13.7 Male 55.9%

(1): Age 67.1 ± 14.0 Male 53.7%

(2): Age 73.0 ± 11.9 Male 51.5%

(≥ 3): Age 77.5 ± 10.9 Male 53.3%		 Taiwan Numbers of component using FRAIL scale

(Fatigue, Resistance, Ambulation, Illness, Loss of weight)

Zero, 1, 2 or ≥ 3		 Entering chronic dialysis
 Number of component(s)
 1: adjusted HR 1.14 (1.07–1.22)
 2: adjusted HR 1.2 (1.08–1.33)
 ≥ 3: adjusted HR 1.2 (0.91–1.57)

 Every 1 component:
 adjusted HR 1.1 (1.05–1.15)

Mortality

 Number of component(s)
 1: adjusted HR 1.26 (1.22–1.3)
 2: adjusted HR 1.42 (1.36–1.48)
 ≥ 3: adjusted HR 1.35 (1.24–1.47)

 Every 1 component:
 adjusted HR 1.16 (1.14–1.19)

Cardiovascular events
 Number of component(s)
 1: adjusted HR 1.41 (1.36–1.45)
 2: adjusted HR 1.49 (1.43–1.57)
 ≥ 3: adjusted HR 1.56 (1.41–1.74)

 Every 1 component:
 adjusted HR 1.23 (1.2–1.25)

Hospitalization
 Number of component(s)
 1: adjusted HR 1.18 (1.16–1.19)
 2: adjusted HR 1.29 (1.25–1.32)
 ≥ 3: adjusted HR 1.38 (1.28–1.47)

 Every 1 component:
 adjusted HR 1.14 (1.13–1.15)

ICU admission
 Number of component(s)
 1: adjusted HR 1.27 (1.23–1.31)
 2: adjusted HR 1.38 (1.33–1.45)
 ≥ 3: adjusted HR 1.39 (1.26–1.53)

 Every 1 component:
 adjusted HR 1.17 (1.15–1.119)
ESRD
Isoyama N, et al.10 2014 330 incident dialysis patients

Age 53 ±13
Male 61.5%		 Sweden Sarcopenia defined by EWGSOP criteria Mortality
  (Follow-up: median 29 months)
 Low muscle strength alone:
  adjusted HR 1.98 (1.01–3.87)
 Low muscle mass alone
  adjusted HR 1.23 (0.56–2.67)
 Sarcopenia
  adjusted HR 1.93 (1.01–3.71)
Kittiskulnam P, et al.42 2017 645 hemodialysis patients

Age 56.7 ± 14.5
Male 58.6%		 USA Sarcopenia defined by
modified EWGSOP criteria

Muscle mass definition
① muscle mass / height squared
② muscle mass / body weight
③ muscle mass / body surface area
④ muscle mass / body mass index


Handgrip strength
(Low:
male < 26, female < 16kg)

Gait speed
(Slow: ≤ 0.8m/s)		 Mortality
   (Follow-up: mean 1.9 years)

  Low muscle strength
  adjusted HR 1.68(1.01–2.79)
  Slow gait speed
   adjusted HR 2.25 (1.36–3.74)
  Sarcopenia
 ① adjusted HR 2.03 (1.00–4.10)
 ② adjusted HR 0.98 (0.56–1.74)
 ③ adjusted HR 1.06 (0.60–1.86)
 ④ adjusted HR 1.70 (0.94–3.05)
Mori K, et al.13 2019 308 hemodialysis patients

(With Sarcopenia population)
Age 63.5±11.0
Male 55.6%
(Without Sarcopenia)
Age 54.4±11.0
Male 63.0%		 Japan Sarcopenia defined by AWGS Mortality
 (Follow-up: median 90 months)

  Sarcopenia:
  adjusted HR 1.31 (0.81–2.10)
  Diabetes:
  adjusted HR 2.39 (1.51–3.81)
Souweine JS, et al.43 2020 187 hemodialysis patients

Age 65.3 (49.7–82.0)
Male 65%		 France Sarcopenia defined by below criteria;
low muscle strength
(Quadriceps maximal voluntary force < median)
+
Low muscle mass (Creatinine index < median)

Dynapenia
Low muscle strength
+
Normal muscle mass		 Mortality
 (Follow-up: mean 23.7 months)

  Sarcopenia:
  adjusted HR 1.60 (0.76–3.35)
  Dynapenia
  adjusted HR 2.99 (1.18–7.61)
Lin Y L, et al.15 2020 126 hemodialysis patients

Age 63.2±13.0
Male 51.6%		 Taiwan Skeletal mass index (SMI)

Handgrip strength (HGS)

Gait speed

Muscle quality (HGS / mid-arm circumference)		 Mortality or Hospitalization
 (Follow up: up to 3 years)

  Muscle quality:
   adjusted HR 0.42 (0.19–0.93)
  SMI:
  HR 1.04 (0.98–1.10)
  HGS:
  adjusted HR 0.99 (0.97–1.02)
  Gait speed:
   adjusted HR 0.61 (0.31–1.02)
Niu Q, et al.50 2021 1233 hemodialysis patients

by moderate activities limited level
(Patients with limited a lot)
Age:67 (55–77)
Male: 45.2%

(Pateinst with limited a little)
Age: 58 (48–67)
Male: 57.7%

(Patients with not limited at all)

Age: 53 (43–62)
Male 66.3%		 China Questionnaire about ADL and physical function

Moderate activities limited level
(limited a lot, limited a little, not limited at all)

Climbing stairs limited level
(limited a lot, limited a little, not limited at all)		 All-cause mortality
  · Moderate activities limited level
   Limited a little
    adjusted HR 0.652 (0.435–0.977)
    Not limited at all
     adjusted HR 0.472 (0.241–0.927)

  · Climbing stairs limited level
   Limited a little
    adjusted HR 0.574 (0.380–0.865)
    Not limited at all
     adjusted HR 0.472 (0.293–0.762)
McAdams-DeMarco MA, et al.24 2013 146 hemodialysis patients

(Non–frail population)
Age: 55.1±13.4
Male: 57.9%

(Intermediately frail population)
Age: 62.1±13.7
Male: 59.6%

(Frail population)
Age: 62.9 ± 12.9
Male: 45.9%		 USA Frailty defined by CHS criteria

Score
0–1: Non-frail
2: Intermediately frail
3–5: Frail		 All-cause mortality
 Intermediately frail:
  adjusted HR 2.68 (1.02–7.07)
 Frail:
  adjusted HR 2.60 (1.04–6.49)

 Incident rate of hospitalization
 Intermediately frail:
  adjusted HR 0.76 (0.49–1.16)
 Frail:
  adjusted HR 1.43 (1.00–2.03)
Lee SY, et al.65 2017 1658 dialysis patients
(1255 HD, 403 PD)

Age: 55.9±12.9
Male: 55.7%		 Korea Frailty defined by the Short Form of the Kidney Disease Quality of Life questionnaire Korean version Follow-up: median 17.1 months

Mortality
 Prefrail:
  adjusted HR1.01 (0.48–2.12)
 Frail:
  adjusted HR 2.08 (1.04–4.16)


Hospitalization
 Prefrail:
  adjusted HR1.29 (1.00–1.67)
 Frail:
  adjusted HR 1.83 (1.41–2.37)
Matsuzawa R, et al.66 2014 190 hemodialysis patients
Age: 64 (57–72)
Male: 46.8%		 Japan Knee Extensor Strength

(Lower: < 40%)		 Mortality
 (Follow-up: up to 7 years)
 Lower knee extensor strength:
 adjusted HR 2.73 (1.14–6.52)
Abe Y, et al.62 2016 188 hemodialysis patients

Age: 65±10
Male: 47.9%		 Japan Maximum walking speed Cardio-cerebrovascular events
 (Follow-up: up to 7 years)
  Maximum walking speed
   increase 10m/min: adjusted HR 0.77 (0.65–0.92)