Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation · 2025
Longitudinal Muscle Mass Trajectories and Their Prognostic Implications in Hemodialysis Patients.
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Kim Sung Gyun, Jang Jinha, Lee Sion, Min Sei Hong, Yoon Hojoong, Kim Insoo, An Jung Nam, Kim Jwa-Kyung
Аннотация
OBJECTIVES: Muscle wasting is a critical concern in hemodialysis patients and is closely linked to adverse outcomes. While cross-sectional associations between low muscle mass and poor prognosis are well documented, the longitudinal trajectories of muscle mass and their predictive value for clinical outcomes remain incompletely characterized.
METHODS: In this prospective cohort study, 283 hemodialysis patients undergoing at least three body composition assessments at 6-month intervals were included. We applied latent class trajectory modeling to identify distinct longitudinal trajectories of muscle mass change. The primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalization and cardiovascular (CV) mortality; however, CV mortality was evaluated descriptively because of the limited number of events (no adjusted modeling).
RESULTS: Muscle mass trajectories were modeled over a mean duration of 24.5 ± 9.2 months, and three distinct patterns were identified: increasing (17.0%), mild decline (56.5%), and progressive decline (26.5%), with annual appendicular skeletal muscle mass/m2 changes of +10.2%, -2.3%, and -12.5%., respectively. Patients in the progressive decline group were older, had lower geriatric nutritional risk index, higher inflammatory markers, and a higher prevalence of cardiovascular disease. Multivariate analysis revealed that each 1-point decrease in geriatric nutritional risk index (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07-1.18), pre-existing cardiovascular disease (OR, 2.99; 95% CI, 1.57-5.69), and elevated systolic blood pressure (OR, 1.02; 95% CI, 1.002-1.03) independently predicted progressive muscle decline. During a median follow-up of 24 months, this group exhibited significantly increased risks of all-cause mortality (hazard ratio, 7.63; 95% CI, 2.78-20.90) and hospitalization (hazard ratio, 4.04; 95% CI, 2.01-8.10). CV deaths occurred in 1/48 (2.1%), 15/160 (9.4%), and 20/75 (26.7%) in the respective trajectory groups.
CONCLUSIONS: Distinct muscle mass trajectories were shown to stratify the risk of all-cause mortality and hospitalization. Therefore, incorporating repeated body composition assessments into routine care may facilitate early identification and targeted management.
METHODS: In this prospective cohort study, 283 hemodialysis patients undergoing at least three body composition assessments at 6-month intervals were included. We applied latent class trajectory modeling to identify distinct longitudinal trajectories of muscle mass change. The primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalization and cardiovascular (CV) mortality; however, CV mortality was evaluated descriptively because of the limited number of events (no adjusted modeling).
RESULTS: Muscle mass trajectories were modeled over a mean duration of 24.5 ± 9.2 months, and three distinct patterns were identified: increasing (17.0%), mild decline (56.5%), and progressive decline (26.5%), with annual appendicular skeletal muscle mass/m2 changes of +10.2%, -2.3%, and -12.5%., respectively. Patients in the progressive decline group were older, had lower geriatric nutritional risk index, higher inflammatory markers, and a higher prevalence of cardiovascular disease. Multivariate analysis revealed that each 1-point decrease in geriatric nutritional risk index (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07-1.18), pre-existing cardiovascular disease (OR, 2.99; 95% CI, 1.57-5.69), and elevated systolic blood pressure (OR, 1.02; 95% CI, 1.002-1.03) independently predicted progressive muscle decline. During a median follow-up of 24 months, this group exhibited significantly increased risks of all-cause mortality (hazard ratio, 7.63; 95% CI, 2.78-20.90) and hospitalization (hazard ratio, 4.04; 95% CI, 2.01-8.10). CV deaths occurred in 1/48 (2.1%), 15/160 (9.4%), and 20/75 (26.7%) in the respective trajectory groups.
CONCLUSIONS: Distinct muscle mass trajectories were shown to stratify the risk of all-cause mortality and hospitalization. Therefore, incorporating repeated body composition assessments into routine care may facilitate early identification and targeted management.