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Risk factors for decreased upper-limb muscle strength and its impact on survival in maintenance hemodialysis patients

  • Nephrology - Original Paper
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Abstract

Purpose

Protein-energy wasting, characterized by decreased muscle mass, is one of the strongest predictors of mortality in patients on maintenance hemodialysis (MHD). As people get older, their muscle strength usually declines faster than muscle mass. However, the association between lower-limb muscle strength and all-cause mortality remains unclear. We aimed to evaluate risk factors for decreased upper-limb muscle strength in MHD patients and its impact on patient survival.

Methods

The cross-sectional part of the study included 174 MHD patients. Subsequently, they were followed up for 52 weeks. Biceps muscle strength, anthropometry, body composition, dietary intake, daily steps, and biochemical indicators of malnutrition and inflammation were evaluated. Risk factors for muscle weakness were screened by multiple linear regression analysis, and patient survival was analyzed by Kaplan–Merier and Cox multivariate analysis.

Results

The 174 MHD patients (93 men; 63.05 ± 12.29 years) were classified as a young (< 65 years, n = 97) group and an elderly group (≥ 65 years, n = 77). Gender, daily steps, muscle mass, 25(OH)D level and IL-6 in young group, and muscle mass, 25(OH)D, daily steps, and NT-proBNP in elderly group were associated with the decreased biceps muscle strength. The survival rate in high muscle strength group was significantly higher than that in low muscle strength group (P = 0.002). The association between low muscle strength and high mortality risk remained strong in the fully adjusted model.

Conclusion

Risk factors of muscle weakness were different between young and elderly MHD patients. There was a strong correlation between strong biceps muscle strength and high patient survival.

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Availability of data and materials

Data that support the findings of this study are available upon request from the corresponding author.

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Acknowledgements

This work was partly presented as a poster at the annual meeting of the American Society of Nephrology, Oct 31–Nov 5, 2017, New Orleans, LA, and has been published in an abstract form (J Am Soc Nephrol 28, 2017:723). Part of this work was also accepted as an oral communication during the XIX International Congress on Nutrition and Metabolism in Renal Disease held in Genoa (Italy) on June 29, 2018.

Funding

This work was supported by the China Natural Science Foundation (81570665, 81400745), State Key Program of National Natural Science Foundation of China (81730017), Program for Outstanding Medical Academic Leader (2019LJ03) and Shanghai Science and Technology Committee (17411950700). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Division of Nephrology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai, 200040, China

    Qian Zhang, Jiaying Zhang, Weichen Zhang, Mengjing Wang, Bihong Huang, Minmin Zhang & Jing Chen

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  1. Qian Zhang
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  2. Jiaying Zhang
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  3. Weichen Zhang
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Contributions

QZ, JZ and WZ collected and interpreted the data; QZ and MW analyzed data and prepared figures; BH and MZ helped with data interpretation; QZ wrote and edited the manuscript. JC designed research and wrote the manuscript. All authors reviewed the manuscript.

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Correspondence to Jing Chen.

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All the authors declared no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (the ethics committee of Huashan Hospital 2016–193) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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11255_2020_2468_MOESM1_ESM.doc

Supplementary Figure 1: Kaplan–Meier curves for non-mortal cardiovascular events according to the presence of high or low biceps muscle strength (A) and in different age groups (B) (DOC 147 kb)

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Zhang, Q., Zhang, J., Zhang, W. et al. Risk factors for decreased upper-limb muscle strength and its impact on survival in maintenance hemodialysis patients. Int Urol Nephrol 52, 1143–1153 (2020). https://doi.org/10.1007/s11255-020-02468-0

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