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Low skeletal muscle mass index is independently associated with low bone mineral density in kidney transplant recipients: a retrospective observational cohort study

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Abstract

Background

Osteoporosis and osteopenia are more frequent in patients who have received kidney transplants than in healthy individuals. Although osteoporosis and sarcopenia are closely related, only few studies have considered them in the post-transplantation period. We aimed to investigate the relationship between lower bone mineral density and skeletal muscle in kidney transplant recipients.

Methods

We included 371 patients in the maintenance phase of kidney transplantation (> 6 months after transplantation) followed-up at our institution from January to December 2019. The primary endpoint was the association between bone mineral density and skeletal muscle mass index. As secondary endpoints, in addition to skeletal muscle mass index, we investigated other factors associated with low bone mineral density, including kidney function and 25-hydroxy vitamin D (25(OH)D) concentration. Considering the possibility that factors affecting bone mineral density differ between men and women, we explored these factors separately for both sexes.

Results

Of the 371 participants, 243 (65.4%) were men. The median age and time after transplantation were 52 and 14 years, respectively. Univariate analysis showed that age, female sex, time since transplantation, cystatin C-based estimated glomerular filtration rate (eGFRcysC), 25(OH)D, and skeletal muscle mass index were associated with bone mineral density. Multivariate analysis showed associations of bone mineral density with eGFRcysC, 25(OH)D, and skeletal muscle mass index. Multivariate analysis by sex showed significant associations with eGFRcysC, hemoglobin, and skeletal muscle mass index in men and with age, eGFRcysC, albumin, and skeletal muscle mass index in women. Bone mineral density was not associated with history of dialysis prior to transplantation or time since transplantation.

Conclusions

In kidney transplant recipients, an independent association between lower bone mineral density and skeletal muscle mass index was observed in both sexes.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgments

We would like to express our sincere thanks to the staff of Masuko Memorial Hospital for their cooperation in this study. We would also like to thank Takako Yamagami, the kidney transplant coordinator.

Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Nephrology, Yuuai Medical Center, 50-5 Yone, Tomigusuku City, Okinawa, 901-0224, Japan

    Morikuni Nishihira

  2. Department of Transplantation, Masuko Memorial Hospital, 35-28 Takehashi-Cho, Nakamura-Ku, Nagoya, Aichi, 453-8566, Japan

    Yutaka Matsuoka & Kazuharu Uchida

  3. Department of Nephrology, Masuko Memorial Hospital, 35-28 Takehashi-Cho, Nakamura-Ku, Nagoya, Aichi, 453-8566, Japan

    Mayuko Hori, Makoto Tsujita, Kaoru Yasuda & Kunio Morozumi

  4. Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan

    Morikuni Nishihira, Satoshi Ashimine, Kohei Ishiyama & Takaaki Kobayashi

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  1. Morikuni Nishihira
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Contributions

M.N. participated in study design, data collection and analysis, and writing of the article. Y.M., M.H., M.T., and K.Y. participated in data collection and writing of the article. S.A., K.I., K.M., and T.K. participated in the writing and review of the article. K.U. participated in the data collection, writing, and review of the article. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Morikuni Nishihira.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Research involving human participants and/or animals

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Masuko Memorial Hospital Ethics Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Masuko Memorial Hospital Ethics Committee (approval no. Masuko MR1-22).

Ethics approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Masuko Memorial Hospital Ethics Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Masuko Memorial Hospital Ethics Committee (approval no. Masuko MR1-22).

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The need for informed consent was waived due to the retrospective nature of this study.

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The need for informed consent was waived due to the retrospective nature of this study.

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Nishihira, M., Matsuoka, Y., Hori, M. et al. Low skeletal muscle mass index is independently associated with low bone mineral density in kidney transplant recipients: a retrospective observational cohort study. J Nephrol (2024). https://doi.org/10.1007/s40620-024-01931-w

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