Alice Sabatino1,2, Giuseppe Regolisti3,4,5, Giuseppe Benigno3,4, Francesca Di Mario3,4, Carla Maria Avesani6, Enrico Fiaccadori3,4. 1. UO Nefrologia, Azienda Ospedaliera- Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy. alice.sabatino86@gmail.com. 2. Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy. alice.sabatino86@gmail.com. 3. UO Nefrologia, Azienda Ospedaliera- Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy. 4. Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy. 5. UO Clinica e Immunologia Medica, Azienda Ospedaliero-Universitaria Parma, Parma, Italy. 6. Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden.
Abstract
BACKGROUND AND AIMS: Skeletal muscle (SM) area, as measured by abdominal CT at the level of the third lumbar vertebra (L3), has been proposed as a proxy of whole body muscle mass. However, population-specific reference values are lacking. In the present study we aimed at: (1) detecting low SM area on abdominal CT images in patients on hemodialysis by applying cut-offs derived from a group of healthy subjects, and (2) estimating the independent risk of all-cause mortality associated with low SM area. METHODS: We retrospectively enrolled 212 adult patients on hemodialysis, undergoing abdominal CT scan (study group), and 87 healthy kidney donors (reference group). We obtained the gender-specific 5th percentile values of the abdominal SM area distribution from both the whole control group and the subgroup of younger (29-60 years) subjects, which we used as reference cut-offs. Then we applied those cut-offs in the study group to identify patients with low SM area. We used survival and Cox regression analysis to evaluate the risk of all-cause mortality associated with low abdominal SM area. RESULTS: In the fully adjusted Cox regression analysis, the patients with low abdominal SM area had a higher risk of death than the patients with values above the reference cut-off derived in the subgroup of younger controls (adjHR = 1.79 (1.21; 2.67), P = 0.004). CONCLUSIONS: Abdominal CT imaging can be used to detect low abdominal SM area in patients on hemodialysis by applying cut-offs derived from healthy subjects sharing a similar ethnic background. Low SM area as assessed by CT is independently associated with all-cause mortality in ESKD patients on hemodialysis.
BACKGROUND AND AIMS: Skeletal muscle (SM) area, as measured by abdominal CT at the level of the third lumbar vertebra (L3), has been proposed as a proxy of whole body muscle mass. However, population-specific reference values are lacking. In the present study we aimed at: (1) detecting low SM area on abdominal CT images in patients on hemodialysis by applying cut-offs derived from a group of healthy subjects, and (2) estimating the independent risk of all-cause mortality associated with low SM area. METHODS: We retrospectively enrolled 212 adult patients on hemodialysis, undergoing abdominal CT scan (study group), and 87 healthy kidney donors (reference group). We obtained the gender-specific 5th percentile values of the abdominal SM area distribution from both the whole control group and the subgroup of younger (29-60 years) subjects, which we used as reference cut-offs. Then we applied those cut-offs in the study group to identify patients with low SM area. We used survival and Cox regression analysis to evaluate the risk of all-cause mortality associated with low abdominal SM area. RESULTS: In the fully adjusted Cox regression analysis, the patients with low abdominal SM area had a higher risk of death than the patients with values above the reference cut-off derived in the subgroup of younger controls (adjHR = 1.79 (1.21; 2.67), P = 0.004). CONCLUSIONS: Abdominal CT imaging can be used to detect low abdominal SM area in patients on hemodialysis by applying cut-offs derived from healthy subjects sharing a similar ethnic background. Low SM area as assessed by CT is independently associated with all-cause mortality in ESKD patients on hemodialysis.
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Authors: A Sabatino; G Regolisti; T Karupaiah; S Sahathevan; B K Sadu Singh; B H Khor; N Salhab; M Karavetian; A Cupisti; E Fiaccadori Journal: Clin Nutr Date: 2016-06-18 Impact factor: 7.324