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Adverse Muscle Composition Is an Early Feature of Chronic Kidney Disease and Associates With Poor Function and Comorbidities

Indurain, Ainhoa ; Karlsson, Markus ; Fernström, Anders ; Uhlin, Fredrik LU ; Linge, Jennifer ; Petersson, Mikael LU ; Leinhard, Olof Dahlqvist and Segelmark, Mårten LU orcid (2025) In Kidney Medicine 8(1).
Abstract

Rational & Objective: Sarcopenia is linked to increased morbidity and mortality in chronic kidney disease (CKD), but its definition and assessment vary considerably across studies. This study evaluated the technical feasibility of magnetic resonance imaging (MRI)–based assessment of adverse muscle composition (AMC)—defined as low muscle volume and high fat infiltration—and its associations with comorbidity, functional performance, and risk for coronary heart disease (CHD) in CKD. Study Design: This is a cross-sectional and prospective study. Settings & Participants: Participants included 11 patients from a single-center hemodialysis (HD) cohort and 903 individuals with CKD from the UK Biobank, along with matched controls without... (More)

Rational & Objective: Sarcopenia is linked to increased morbidity and mortality in chronic kidney disease (CKD), but its definition and assessment vary considerably across studies. This study evaluated the technical feasibility of magnetic resonance imaging (MRI)–based assessment of adverse muscle composition (AMC)—defined as low muscle volume and high fat infiltration—and its associations with comorbidity, functional performance, and risk for coronary heart disease (CHD) in CKD. Study Design: This is a cross-sectional and prospective study. Settings & Participants: Participants included 11 patients from a single-center hemodialysis (HD) cohort and 903 individuals with CKD from the UK Biobank, along with matched controls without CKD. For each participant, a personalized muscle volume z-score (sex-specific and body size–specific) was calculated and combined with muscle fat infiltration for AMC evaluation. Predictor(s): Adverse muscle composition. Outcomes: Comorbidity index, functional performance (handgrip strength, walking pace, stair climbing, and falls), and new CHD events. Analytical Approach: In the HD cohort, Spearman rank correlations and Cox proportional-hazards model were used. In the UK Biobank cohort, linear/logistic regression models and Cox proportional-hazards model were used. Results: AMC was present in 45% of the HD cohort and associated with higher comorbidity index. In the UK Biobank, AMC prevalence was greater in CKD versus no CKD (32% vs 25%, P < 0.001). Participants with AMC had worse functional performance (P < 0.001), higher comorbidity index (P < 0.001), and 2-fold increased CHD incidence (P = 0.01). Limitations: Blood samples defining CKD were taken 7-9 years before MRI, and self-reported data on walking pace, falls, stair climbing, and type 2 diabetes. Conclusions: The AMC, assessed by MRI, is a prevalent muscle composition phenotype in CKD and is associated with high prevalence of comorbidity, poor function, and increased risk for CHD. Plain-language Summary: Sarcopenia is a common and clinically significant complication in chronic kidney disease (CKD), but its definition and assessment remain variable. This study investigated the use of magnetic resonance imaging to identify adverse muscle composition—defined by low muscle volume and increased fat infiltration within muscle tissue. Using data from a hemodialysis cohort and the UK Biobank, we found that adverse muscle composition is more common in individuals with CKD and is significantly associated with increased comorbidity, poor physical performance, and a 2-fold higher risk of new coronary heart disease events. These findings suggest that magnetic resonance imaging–based muscle assessment may help identify high-risk CKD patients earlier and more accurately.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adverse muscle composition, CKD, functional performance, metabolic comorbidity, MRI
in
Kidney Medicine
volume
8
issue
1
article number
101164
publisher
Elsevier
external identifiers
  • pmid:41503193
  • scopus:105024726662
ISSN
2590-0595
DOI
10.1016/j.xkme.2025.101164
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Authors
id
b3e42538-f990-4825-b436-4b4c5566970e
date added to LUP
2026-03-30 14:53:03
date last changed
2026-03-31 03:00:02
@article{b3e42538-f990-4825-b436-4b4c5566970e,
  abstract     = {{<p>Rational &amp; Objective: Sarcopenia is linked to increased morbidity and mortality in chronic kidney disease (CKD), but its definition and assessment vary considerably across studies. This study evaluated the technical feasibility of magnetic resonance imaging (MRI)–based assessment of adverse muscle composition (AMC)—defined as low muscle volume and high fat infiltration—and its associations with comorbidity, functional performance, and risk for coronary heart disease (CHD) in CKD. Study Design: This is a cross-sectional and prospective study. Settings &amp; Participants: Participants included 11 patients from a single-center hemodialysis (HD) cohort and 903 individuals with CKD from the UK Biobank, along with matched controls without CKD. For each participant, a personalized muscle volume z-score (sex-specific and body size–specific) was calculated and combined with muscle fat infiltration for AMC evaluation. Predictor(s): Adverse muscle composition. Outcomes: Comorbidity index, functional performance (handgrip strength, walking pace, stair climbing, and falls), and new CHD events. Analytical Approach: In the HD cohort, Spearman rank correlations and Cox proportional-hazards model were used. In the UK Biobank cohort, linear/logistic regression models and Cox proportional-hazards model were used. Results: AMC was present in 45% of the HD cohort and associated with higher comorbidity index. In the UK Biobank, AMC prevalence was greater in CKD versus no CKD (32% vs 25%, P &lt; 0.001). Participants with AMC had worse functional performance (P &lt; 0.001), higher comorbidity index (P &lt; 0.001), and 2-fold increased CHD incidence (P = 0.01). Limitations: Blood samples defining CKD were taken 7-9 years before MRI, and self-reported data on walking pace, falls, stair climbing, and type 2 diabetes. Conclusions: The AMC, assessed by MRI, is a prevalent muscle composition phenotype in CKD and is associated with high prevalence of comorbidity, poor function, and increased risk for CHD. Plain-language Summary: Sarcopenia is a common and clinically significant complication in chronic kidney disease (CKD), but its definition and assessment remain variable. This study investigated the use of magnetic resonance imaging to identify adverse muscle composition—defined by low muscle volume and increased fat infiltration within muscle tissue. Using data from a hemodialysis cohort and the UK Biobank, we found that adverse muscle composition is more common in individuals with CKD and is significantly associated with increased comorbidity, poor physical performance, and a 2-fold higher risk of new coronary heart disease events. These findings suggest that magnetic resonance imaging–based muscle assessment may help identify high-risk CKD patients earlier and more accurately.</p>}},
  author       = {{Indurain, Ainhoa and Karlsson, Markus and Fernström, Anders and Uhlin, Fredrik and Linge, Jennifer and Petersson, Mikael and Leinhard, Olof Dahlqvist and Segelmark, Mårten}},
  issn         = {{2590-0595}},
  keywords     = {{Adverse muscle composition; CKD; functional performance; metabolic comorbidity; MRI}},
  language     = {{eng}},
  month        = {{10}},
  number       = {{1}},
  publisher    = {{Elsevier}},
  series       = {{Kidney Medicine}},
  title        = {{Adverse Muscle Composition Is an Early Feature of Chronic Kidney Disease and Associates With Poor Function and Comorbidities}},
  url          = {{http://dx.doi.org/10.1016/j.xkme.2025.101164}},
  doi          = {{10.1016/j.xkme.2025.101164}},
  volume       = {{8}},
  year         = {{2025}},
}