Relationships between cystatin C- and creatinine-based eGFR in Japanese rural community- dwelling older adults with sarcopenia

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Abstract

Background

Sarcopenia is prevalent in patients with chronic kidney disease (CKD). The indices of physical function, such as grip power and gait speed, decreased according to the decline in the estimated glomerular filtration rate (eGFR).

Methods

We examined the relationships between cystatin C-based GFR (eGFRcys), creatinine-based GFR (eGFRcre), their ratio (eGFRcys/eGFRcre) and sarcopenia in community-dwelling older adults in Japan. This cross-sectional study included 302 men aged 73.9 ± 6.2 years and 647 women aged 72.9 ± 5.8 years from a rural area in Hyogo Prefecture, Japan. eGFRcys and eGFRcre were simultaneously measured, and sarcopenia based on the Asia Working Group for Sarcopenia (AWGS) 2019 criteria was evaluated.

Results

eGFRcys and the eGFRcys/eGFRcre ratio were significantly correlated with grip power and gait speed ( p < 0.001). The eGFRcys/eGFRcre ratio was also correlated with skeletal muscle mass index (SMI) ( p < 0.01). Univariate logistic regression analysis showed eGFRcys and eGFRcys/eGFRcre ratio but not eGFRcre were associated with sarcopenia ( p < 0.01). The presence of low eGFRcys (CKDcys) and low eGFRcys/eGFRcre ratio (< 1.0) but not that of low eGFRcre (CKDcre) were associated with sarcopenia ( p < 0.01). In the multivariate logistic regression analysis, when the eGFRcys/eGFRcre ratio was added as a covariate to the basic model, it was significantly associated with sarcopenia in women ( p < 0.05). Moreover, low eGFRcys/eGFRcre ratio (< 1.0) was associated with a higher risk of sarcopenia in men ( p < 0.01).

Conclusion

In conclusion, CKDcys but not CKDcre is associated with sarcopenia. A lower eGFRcys/eGFRcre ratio may be a practical screening marker of sarcopenia in community-dwelling older adults.

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Most cited references 27

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Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Liang-Kung Chen, Jean Woo, Prasert Assantachai … (2020)

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.

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Revised equations for estimated GFR from serum creatinine in Japan.

Seiichi Matsuo, Enyu Imai, Masaru Horio … (2009)

Estimation of glomerular filtration rate (GFR) is limited by differences in creatinine generation among ethnicities. Our previously reported GFR-estimating equations for Japanese had limitations because all participants had a GFR less than 90 mL/min/1.73 m2 and serum creatinine was assayed in different laboratories. Diagnostic test study using a prospective cross-sectional design. New equations were developed in 413 participants and validated in 350 participants. All samples were assayed in a central laboratory. Hospitalized Japanese patients in 80 medical centers. Patients had not participated in the previous study. Measured GFR (mGFR) computed from inulin clearance. Estimated GFR (eGFR) by using the modified isotope dilution mass spectrometry (IDMS)-traceable 4-variable Modification of Diet in Renal Disease (MDRD) Study equation using the previous Japanese Society of Nephrology Chronic Kidney Disease Initiative (JSN-CKDI) coefficient of 0.741 (equation 1), the previous JSN-CKDI equation (equation 2), and new equations derived in the development data set: modified MDRD Study using a new Japanese coefficient (equation 3), and a 3-variable Japanese equation (equation 4). Performance of equations was assessed by means of bias (eGFR - mGFR), accuracy (percentage of estimates within 15% or 30% of mGFR), root mean squared error, and correlation coefficient. In the development data set, the new Japanese coefficient was 0.808 (95% confidence interval, 0.728 to 0.829) for the IDMS-MDRD Study equation (equation 3), and the 3-variable Japanese equation (equation 4) was eGFR (mL/min/1.73 m2) = 194 x Serum creatinine(-1.094) x Age(-0.287) x 0.739 (if female). In the validation data set, bias was -1.3 +/- 19.4 versus -5.9 +/- 19.0 mL/min/1.73 m2 (P = 0.002), and accuracy within 30% of mGFR was 73% versus 72% (P = 0.6) for equation 3 versus equation 1 and -2.1 +/- 19.0 versus -7.9 +/- 18.7 mL/min/1.73 m(2) (P < 0.001) and 75% versus 73% (P = 0.06) for equation 4 versus equation 2 (P = 0.06), respectively. Most study participants had chronic kidney disease, and some may have had changing GFRs. The new Japanese coefficient for the modified IDMS-MDRD Study equation and the new Japanese equation are more accurate for the Japanese population than the previously reported equations.

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K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.

(2002)

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Author and article information

Contributors

Ken Shinmura: ke-shimmura@hyo-med.ac.jp

Journal

Journal ID (nlm-ta): Clin Exp Nephrol

Journal ID (iso-abbrev): Clin Exp Nephrol

Title: Clinical and Experimental Nephrology

Publisher: Springer Singapore (Singapore )

ISSN (Print): 1342-1751

ISSN (Electronic): 1437-7799

Publication date (Electronic): 22 October 2020

Publication date PMC-release: 22 October 2020

Publication date (Print): 2021

Volume: 25

Issue: 3

Pages: 231-239

Affiliations

[1 ]GRID grid.272264.7, ISNI 0000 0000 9142 153X, Division of General Medicine, Department of Internal Medicine, , Hyogo College of Medicine, ; 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan

[2 ]GRID grid.272264.7, ISNI 0000 0000 9142 153X, Department of Orthopaedic Surgery, , Hyogo College of Medicine, ; Nishinomiya, Hyogo Japan

[3 ]GRID grid.272264.7, ISNI 0000 0000 9142 153X, Department of General Medicine and Community Health Science, , Sasayama Medical Center Hyogo College of Medicine, ; Sasayama, Hyogo Japan

[4 ]GRID grid.272264.7, ISNI 0000 0000 9142 153X, Department of Rehabilitation Medicine, , Sasayama Medical Center Hyogo College of Medicine, ; Sasayama, Hyogo Japan

[5 ]GRID grid.411532.0, ISNI 0000 0004 1808 0272, School of Rehabilitation, , Hyogo University of Health Sciences, ; Kobe, Hyogo Japan

[6 ]GRID grid.411532.0, ISNI 0000 0004 1808 0272, School of Pharmacy, , Hyogo University of Health Sciences, ; Kobe, Hyogo Japan

[7 ]GRID grid.272264.7, ISNI 0000 0000 9142 153X, Department of Dentistry and Oral Surgery, , Hyogo College of Medicine, ; Nishinomiya, Hyogo Japan

[8 ]GRID grid.260975.f, ISNI 0000 0001 0671 5144, Division of Comprehensive Prosthodontics, , Niigata University Graduate School of Medical and Dental Sciences, ; Niigata, Niigata Japan

Article

Publisher ID: 1981

DOI: 10.1007/s10157-020-01981-x

PMC ID: 7925493

PubMed ID: 33090338

SO-VID: cec6fe3d-166c-4300-8f53-0fba353ead17

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 8 April 2020

Date accepted : 5 October 2020

Funding

Funded by: JSPS KAKENHI

Award ID: grant number: 16KT0012, (2016–2018)

Award Recipient : Ken Shinmura

Custom metadata

ScienceOpen disciplines: Nephrology

Keywords: sarcopenia,egfr,awgs,cystatin c,skeletal muscle mass index (smi)

Data availability:

ScienceOpen disciplines: Nephrology

Keywords: sarcopenia, egfr, awgs, cystatin c, skeletal muscle mass index (smi)

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Relationships between cystatin C- and creatinine-based eGFR in Japanese rural community- dwelling older adults with sarcopenia

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Abstract

Background

Methods

Results

Conclusion

Related collections

Karger: Nephrology

Most cited references 27

Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Revised equations for estimated GFR from serum creatinine in Japan.

K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.

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Cited by 12

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