Open medicine (Warsaw, Poland) · 2026
The role of sarcopenia in all-cause mortality prediction among community-dwelling adults with eGFR 15-89 mL/min/1.73 m2.
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Chang Kaili, Zhu Bowen, Ding Xiaoqiang, Wang Weiming, Dai Yan
Аннотация
OBJECTIVES: Sarcopenia is common among individuals with impaired kidney function and is associated with poor quality of life and adverse clinical outcomes. This study aimed to investigate the association between sarcopenia and all-cause mortality among Chinese community-dwelling middle-aged and older adults with an estimated glomerular filtration rate (eGFR) of 15-89 mL/min/1.73 m2.
METHODS: Using data from the China Health and Retirement Longitudinal Study (CHARLS), we included 2,526 participants aged 45-85 years with an eGFR of 15-89 mL/min/1.73 m2 who were followed from 2011 to 2018. Because albuminuria and other markers of kidney damage were unavailable, the study population was operationally defined according to eGFR criteria. Cox proportional hazards regression models were used to evaluate the association between sarcopenia and all-cause mortality. Exploratory analyses assessed the incremental prognostic value of sarcopenia using 5-year time-dependent area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and continuous net reclassification improvement (NRI).
RESULTS: Among the 2,526 participants included in the final analysis, the prevalence of sarcopenia was 28.1 % (335/1,194) in men and 41.4 % (551/1,332) in women. After adjustment for potential confounders, sarcopenia was associated with a significantly higher risk of all-cause mortality in women (HR, 1.82; 95 % CI, 1.26-2.63). In exploratory analyses, the addition of sarcopenia to the clinical variable-based model modestly improved 5-year mortality risk discrimination in women, increasing the time-dependent AUC from 0.615 (95 % CI, 0.561-0.670) to 0.650 (95 % CI, 0.599-0.700). The IDI was 0.008 (95 % CI, 0.003-0.014; p=0.006), whereas the continuous NRI was 0.236 (95 % CI, -0.055-0.417; p=0.090).
CONCLUSIONS: Sarcopenia was associated with an increased risk of all-cause mortality among women with an eGFR of 15-89 mL/min/1.73 m2. Sarcopenia may provide additional prognostic information beyond conventional clinical risk factors, although the incremental prognostic findings were exploratory and require further validation. The clinical utility of sarcopenia assessment for mortality risk stratification remains to be established.
METHODS: Using data from the China Health and Retirement Longitudinal Study (CHARLS), we included 2,526 participants aged 45-85 years with an eGFR of 15-89 mL/min/1.73 m2 who were followed from 2011 to 2018. Because albuminuria and other markers of kidney damage were unavailable, the study population was operationally defined according to eGFR criteria. Cox proportional hazards regression models were used to evaluate the association between sarcopenia and all-cause mortality. Exploratory analyses assessed the incremental prognostic value of sarcopenia using 5-year time-dependent area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and continuous net reclassification improvement (NRI).
RESULTS: Among the 2,526 participants included in the final analysis, the prevalence of sarcopenia was 28.1 % (335/1,194) in men and 41.4 % (551/1,332) in women. After adjustment for potential confounders, sarcopenia was associated with a significantly higher risk of all-cause mortality in women (HR, 1.82; 95 % CI, 1.26-2.63). In exploratory analyses, the addition of sarcopenia to the clinical variable-based model modestly improved 5-year mortality risk discrimination in women, increasing the time-dependent AUC from 0.615 (95 % CI, 0.561-0.670) to 0.650 (95 % CI, 0.599-0.700). The IDI was 0.008 (95 % CI, 0.003-0.014; p=0.006), whereas the continuous NRI was 0.236 (95 % CI, -0.055-0.417; p=0.090).
CONCLUSIONS: Sarcopenia was associated with an increased risk of all-cause mortality among women with an eGFR of 15-89 mL/min/1.73 m2. Sarcopenia may provide additional prognostic information beyond conventional clinical risk factors, although the incremental prognostic findings were exploratory and require further validation. The clinical utility of sarcopenia assessment for mortality risk stratification remains to be established.