https://doi.org/10.4081/aiua.2026.15532
Correlates of appendicular skeletal muscle mass in non-dialysis dependent chronic kidney disease men and the control group
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Published: 22 June 2026
Introduction: Skeletal muscle wasting is a serious complication of chronic kidney disease (CKD) and is associated with increased mortality. However, the main determinants of muscle atrophy in CKD are not yet well known and may differ in the general and CKD populations. The aim of this study was to investigate the relationships between appendicular skeletal muscle mass (ASM) and anthropometric measurements, body composition parameters as well as laboratory results, and compare these associations in patients with estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and participants with eGFR ≥ 60 ml/min/1.73 m2.
Methods: Two groups of male participants were included: 33 patients with eGFR < 60 ml/min/1.73 m2 and 38 individuals with eGFR ≥ 60 ml/min/1.73 m2. Muscle mass and body composition variables, including ASM, were assessed by bioimpedance spectroscopy (BIS). Blood samples were taken to evaluate serum creatinine, urea, haemoglobin, C-reactive protein (CRP) and albumin.
Results: In both groups of patients ASM positively correlated with body mass, body mass index (BMI), lean tissue mass (LTM) and lean tissue indx (LTI) (p < 0.05 for all parameters). ASM positively correlated with height in individuals with eGFR ≥ 60 ml/min/1.73 m2 (p = 0.001). There was no statistically significant correlations between laboratory parameters and ASM in both groups.
Conclusions: ASM is associated significantly and positively with anthropometric and body composition parameters such as body mass, BMI, LTM and LTI both in patients with eGFR < 60 ml/min/1.73 m2 and in those with eGFR ≥ 60 ml/min/1.73 m2 which suggests that the determinants of ASM are similar in CKD and in the general population.
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1. Frontera WR, Ochala J. Skeletal muscle: a brief review of structure and function. Calcif Tissue Int. 2015;96:183-195.
2. Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84:475-482.
3. Troutman AD, Arroyo E, Sheridan EM, et al. Skeletal muscle atrophy in clinical and preclinical models of chronic kidney disease: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2024;15:21-35.
4. Wang XH, Mitch WE, Price SR. Pathophysiological mechanisms leading to muscle loss in chronic kidney disease. Nat Rev Nephrol. 2022;18:138-152.
5. Wang K, Liu Q, Tang M, et al. Chronic kidney disease-induced muscle atrophy: molecular mechanisms and promising therapies. Biochem Pharmacol. 2023;208:115407.
6. Bataille S, Chauveau P, Fouque D, et al. Myostatin and muscle atrophy during chronic kidney disease. Nephrol Dial Transplant. 2021;36:1986-1993.
7. Stenvinkel P, Carrero JJ, von Walden F, et al. Muscle wasting in end-stage renal disease promulgates premature death: established, emerging and potential novel treatment strategies. Nephrol Dial Transplant. 2016;31:1070-1077.
8. Antunes AC, Araújo DA, Veríssimo MT, Amaral TF. Sarcopenia and hospitalisation costs in older adults: a cross-sectional study. Nutr Diet. 2017;74:46-50.
9. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16-31.
10. Romejko K, Szamotulska K, Rymarz A, et al. The association of appendicular skeletal muscle mass with anthropometric, body composition, nutritional, inflammatory, and metabolic variables in non-dialysis-dependent chronic kidney disease men. Front Med (Lausanne). 2024;11:1380026.
11. Romejko K, Szamotulska K, Rymarz A, Niemczyk S. Muscle mass and muscle strength in non-dialysis-dependent chronic kidney disease patients. J Clin Med. 2024;13:6448.
12. Lin TY, Wu MY, Chen HS, et al. Development and validation of a multifrequency bioimpedance spectroscopy equation to predict appendicular skeletal muscle mass in hemodialysis patients. Clin Nutr. 2021;40:3288-3295.
13. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii,1-253.
14. Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju S, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388:776-786.
15. Yamamoto T, Nakayama M, Miyazaki M, et al. Impact of lower body mass index on risk of all-cause mortality and infection-related death in Japanese chronic kidney disease patients. BMC Nephrol. 2020;21:244.
16. Navaneethan SD, Schold JD, Arrigain S, et al. Body mass index and causes of death in chronic kidney disease. Kidney Int. 2016;89:675-682.
17. Rahimlu M, Shab-Bidar S, Djafarian K. Body mass index and all-cause mortality in chronic kidney disease: a dose-response meta-analysis of observational studies. J Ren Nutr. 2017;27:225-232.
18. Park J, Ahmadi SF, Streja E, et al. Obesity paradox in end-stage kidney disease patients. Prog Cardiovasc Dis. 2014;56:415-425.
19. Gracia-Iguacel C, Qureshi AR, Avesani CM, et al. Subclinical versus overt obesity in dialysis patients: more than meets the eye. Nephrol Dial Transplant. 2013;28 Suppl 4:iv175-iv181.
20. Bellafronte NT, de Queirós Mattoso Ono A, Chiarello PG. Sarcopenic obesity in chronic kidney disease: challenges in diagnosis using different diagnostic criteria. Med Princ Pract. 2021;30:477-486.
21. Lafortuna CL, Maffiuletti NA, Agosti F, Sartorio A. Gender variations of body composition, muscle strength and power output in morbid obesity. Int J Obes (Lond). 2005;29:833-841.
22. Sergi G, Coin A, Enzi G, et al. Role of visceral proteins in detecting malnutrition in the elderly. Eur J Clin Nutr. 2006;60:203-209.
23. Visser M, Kritchevsky SB, Newman AB, et al. Lower serum albumin concentration and change in muscle mass: the Health, Aging and Body Composition Study. Am J Clin Nutr. 2005;82:531-537.
24. Snyder CK, Lapidus JA, Cawthon PM, et al. Serum albumin in relation to change in muscle mass, muscle strength, and muscle power in older men. J Am Geriatr Soc. 2012;60:1663-1672.
25. Heimbürger O, Qureshi AR, Blaner WS, et al. Hand-grip muscle strength, lean body mass, and plasma proteins as markers of nutritional status in patients with chronic renal failure close to start of dialysis therapy. Am J Kidney Dis. 2000;36:1213-1225.
26. Tessari P. Protein metabolism in liver cirrhosis: from albumin to muscle myofibrils. Curr Opin Clin Nutr Metab Care. 2003;6:79-85.
27. Takeda H, Ishihama K, Fukui T, et al. Significance of rapid turnover proteins in protein-losing gastroenteropathy. Hepatogastroenterology. 2003;50:1963-1965.
28. Gil HW, Yang JO, Lee EY, et al. The effect of dialysis membrane flux on amino acid loss in hemodialysis patients. J Korean Med Sci. 2007;22:598-603.
29. Aparicio M, Chauveau P, de Précigout V, et al. Nutrition and outcome on renal replacement therapy of patients with chronic renal failure treated by a supplemented very low protein diet. J Am Soc Nephrol. 2000;11:708-716.
30. Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif. 2015;39:84-92.
31. Mihai S, Codrici E, Popescu ID, et al. Inflammation-related mechanisms in chronic kidney disease prediction, progression, and outcome. J Immunol Res. 2018;2018:2180373.
32. Lin R, Chen Y, Liu K. Association between serum C-reactive protein and low muscle mass among US adults: results from NHANES 1999 to 2006. Clinics (Sao Paulo). 2025;80:100588.
33. Wong TC, Su HY, Chen YT, et al. Ratio of C-reactive protein to albumin predicts muscle mass in adult patients undergoing hemodialysis. PLoS One. 2016;11:e0165403.
34. Hanna RM, Streja E, Kalantar-Zadeh K. Burden of anemia in chronic kidney disease: beyond erythropoietin. Adv Ther. 2021;38:52-75.
35. Vinke JSJ, Wouters HJCM, Stam SP, et al. Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients. J Cachexia Sarcopenia Muscle. 2022;13:2044-2053.
36. Nankivell BJ, Nankivell LFJ, Elder GJ, Gruenewald SM. How unmeasured muscle mass affects estimated GFR and diagnostic inaccuracy. EClinicalMedicine. 2020;29-30:100662.
37. Groothof D, Post A, Polinder-Bos HA, et al. Muscle mass and estimates of renal function: a longitudinal cohort study. J Cachexia Sarcopenia Muscle. 2022;13:2031-2043.
38. Tsai PH, Yang HC, Lin C, et al. Association of serum phosphate with low handgrip strength in patients with advanced chronic kidney disease. Nutrients. 2021;13:3605.
39. Hamer M, Molloy GJ. Association of C-reactive protein and muscle strength in the English Longitudinal Study of Ageing. Age (Dordr). 2009;31:171-177.
40. Chatrenet A, de Müllenheim PY, Torreggiani M, et al. Quality matters: chronic kidney disease progression is associated with reduced muscle strength independently of changes in skeletal muscle mass: an observational study. Clin Kidney J. 2025;18:sfaf036.
Ethics Approval
CRediT authorship contribution
Conceptualization, K.R. and K.S.; data curation, K.R.; formal analysis, K.S.; funding acquisition, S.N.; investigation, K.R. and A.R; methodology, K.R. and K.S.; project administration, A.R. and S.N.; resources, S.N.; supervision, S.N.; visualization, K.S.; writing - original draft preparation, K.R.; writing - review and editing, K.R.; K.S.; and S.N. All authors have approved the final version of the manuscript.
Supporting Agencies
Data Availability Statement
The original dataset is available from the corresponding author upon reasonable request.
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