Research Paper Volume 12, Issue 21 pp 21023—21036

Association of skeletal muscle mass, kidney disease and mortality in older men and women: the cardiovascular health study

Nicholas T. Kruse1, , Petra Buzkova2, , Joshua I. Barzilay3, , Rodrigo J. Valderrabano4, , John A. Robbins5, , Howard A. Fink6, , Diana I. Jalal1, ,

  • 1 Division of Nephrology, Department of Internal Medicine, Carver College of Medicine, Iowa City, IA 52242, USA
  • 2 Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
  • 3 Division of Endocrinology, Kaiser Permanente of Georgia, Emory University School of Medicine, Atlanta, GA 30322, USA
  • 4 University of Miami Miller School of Medicine, Miami, FL 33136, USA
  • 5 Department of Medicine, University of California, Davis, Modesto, CA 95350, USA
  • 6 Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN 55417, USA

Received: February 17, 2020       Accepted: October 8, 2020       Published: November 2, 2020
How to Cite

Copyright: © 2020 Kruse et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Low muscle mass (sarcopenia) is a prevalent and major concern in the aging population as well as in patients with chronic kidney disease (CKD). We hypothesized that sarcopenia is an independent predictor of incident and progressive CKD and increased mortality in older men and women (≥65 years) from the Cardiovascular Health Study. Sarcopenia was defined by bioimpedance-estimated skeletal muscle mass index (SMI) as a continuous variable and categorically (normal, class I, and class II). Cox regression hazard ratios (HRs) estimated the risk of incident and prevalent CKD and mortality in individuals with and without CKD. Low SMI was associated with increased prevalence of CKD in men (p<0.001), but lower prevalence of CKD in women (p=0.03). Low muscle mass was not associated with incident CKD or rapid CKD progression (>3 ml/minute/1.73m2/year decline in eGFR) in men, but was associated with lower risk of incident CKD in women ([adjusted RR=0.69, 95% (0.51,0.94)]. Low muscle mass (class II) was independently associated with higher mortality only in men [(adjusted HR=1.26, 95% (1.05,1.50)]. Neither definition of sarcopenia was associated with mortality in men or women with CKD. Further studies are needed to understand the mechanisms by which sarcopenia contributes to higher mortality in aging men.


BIA: bioelectrical impedance; CHS: Cardiovascular Health Study; CKD: chronic kidney disease; CVD: cardiovascular disease; DBP: diastolic blood pressure; DXA: dual x-ray absorptiometry; eGFR: estimated glomerular filtration rate; HDL: high density lipoprotein; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance; LDL: low density lipoprotein; NHANES: National Health and Nutrition Examination Survey; RR: relative risk; SBP: systolic blood pressure; SMI: skeletal muscle mass index.