International urology and nephrology · 2026
Association between muscle-specific strength and disability in instrumental activities of daily living in patients with chronic kidney disease.
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Tang Mengda, Cao Yu, Zhao Jinghong, Yin Liangyu
Аннотация
BACKGROUND: Muscle mass/function loss is common in chronic kidney disease (CKD), often leading to adverse clinical outcomes. This study explores associations between muscle-specific strength (MSS) and instrumental activities of daily living (IADL) in CKD.
METHODS: This cross-sectional study included 693 Chinese CKD patients from a nationwide multicenter survey (2011), with all variables measured at that single time point. Two MSS metrics were used: the upper limb skeletal muscle mass to combined handgrip strength ratio (UCHR), and the lower limb skeletal muscle mass to five-time chair stand test ratio (LFR). Muscle mass was estimated using a validated anthropometric formula. IADL was assessed using a five-task scale, disability = difficulty in ≥1 task. Associations were analyzed using receiver operating characteristic curves, restricted cubic splines (RCS) analysis, and multivariate logistic regression.
RESULTS: Among 693 patients (369 men, 324 women; median age 64 years), 194 (28%) experienced IADL disability. LFR outperformed UCHR in distinguishing IADL disability, particularly in men (AUC: 0.694 [95%CI: 0.630-0.758] vs. 0.563 [0.492-0.634]; DeLong's P=0.006). Optimal LFR cutoffs: 0.578 (men) and 0.647 (women). RCS revealed a linear-like LFR-IADL disability association (men: P<0.001, women: P=0.030), with significant nonlinearity in men (P=0.002). Multivariate analysis: LFR-represented MSS was independently associated with higher odds of IADL disability (men: OR=14.739 [95%CI: 5.903-39.998]; women: OR=3.656 [1.663-8.615]; overall: OR=6.269 [3.508-11.538]).
CONCLUSIONS: LFR outperforms UCHR for assessing MSS in distinguishing IADL disability in CKD patients. Low LFR is independently associated with IADL disability. These findings support clinicians in developing targeted strategies for managing muscle-related functional limitations in CKD patients.
METHODS: This cross-sectional study included 693 Chinese CKD patients from a nationwide multicenter survey (2011), with all variables measured at that single time point. Two MSS metrics were used: the upper limb skeletal muscle mass to combined handgrip strength ratio (UCHR), and the lower limb skeletal muscle mass to five-time chair stand test ratio (LFR). Muscle mass was estimated using a validated anthropometric formula. IADL was assessed using a five-task scale, disability = difficulty in ≥1 task. Associations were analyzed using receiver operating characteristic curves, restricted cubic splines (RCS) analysis, and multivariate logistic regression.
RESULTS: Among 693 patients (369 men, 324 women; median age 64 years), 194 (28%) experienced IADL disability. LFR outperformed UCHR in distinguishing IADL disability, particularly in men (AUC: 0.694 [95%CI: 0.630-0.758] vs. 0.563 [0.492-0.634]; DeLong's P=0.006). Optimal LFR cutoffs: 0.578 (men) and 0.647 (women). RCS revealed a linear-like LFR-IADL disability association (men: P<0.001, women: P=0.030), with significant nonlinearity in men (P=0.002). Multivariate analysis: LFR-represented MSS was independently associated with higher odds of IADL disability (men: OR=14.739 [95%CI: 5.903-39.998]; women: OR=3.656 [1.663-8.615]; overall: OR=6.269 [3.508-11.538]).
CONCLUSIONS: LFR outperforms UCHR for assessing MSS in distinguishing IADL disability in CKD patients. Low LFR is independently associated with IADL disability. These findings support clinicians in developing targeted strategies for managing muscle-related functional limitations in CKD patients.