Difference between kidney function by cystatin C versus creatinine and association with muscle mass and frailty

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-05-31 DOI:10.1111/jgs.19014

Julia H. Yuan MD, Dena E. Rifkin MD, MS, Charles Ginsberg MD, MAS, Peggy M. Cawthon PhD, MPH, Deborah M. Kado MD, MS, Scott R. Bauer MD, ScM, Kristine E. Ensrud MD, MPH, Andrew R. Hoffman MD, O. Alison Potok MD

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Abstract

Background

A higher difference in estimated glomerular filtration rate by cystatin C versus creatinine (eGFRDiff = eGFRCys – eGFRCreat) is associated with decreased frailty risk. Since eGFRCreat is influenced by muscle more than eGFRCys, muscle mass may explain this association. Previous work could not account for this when considering regional muscle measures by imaging. Deuterated creatine (D₃Cr) dilution measures whole body muscle mass (kilograms). We aimed to determine whether eGFRDiff is associated with D₃Cr muscle mass and whether muscle mass explains the association between eGFRDiff and frailty.

Methods

Cross-sectional analysis within the multicenter MrOS Study at Year 14 (visit 4). 490 men of the original cohort of 5994 MrOS participants (aged ≥65 at enrollment) were included. Exposure was eGFRDiff (= eGFRCys – eGFRCreat), calculated using CKD-EPI equations 2012/2021. Primary outcome was D₃Cr muscle mass. Secondary outcome was phenotypic pre-frailty (one or two criteria) and frailty (≥three criteria) including the following: weight loss, weakness, slow gait, physical activity, poor energy. The association of eGFRDiff with D₃Cr muscle mass was examined by linear regression, that with prefrailty / frailty by multinomial logistic regression.

Results

Mean ± SD age was 84 ± 4 years, eGFRCreat 68 ± 16, eGFRCys 52 ± 16, eGFRDiff −15 ± 12 mL/min/1.73 m² and D₃Cr muscle mass 24 ± 4 kg. For each SD increment in eGFRDiff, D3Cr muscle mass was 1.4 kg higher on average, p < 0.0001 (fully adjusted). Higher eGFRDiff was associated with lower odds of frailty (OR = 0.63 95% CI [0.45;0.89]), but this was partially attenuated and insignificant after additionally adjusting for D₃Cr muscle mass (OR = 0.85 95% CI [0.58; 1.24]).

Conclusions

Higher eGFRDiff is associated with lower odds of frailty among late-life men. D₃Cr muscle mass accounts for some of this association. This suggests that non-GFR determinants of creatinine and cystatin C, such as muscle mass, play a role in explaining the association of eGFRDiff with frailty. Future studies are needed to confirm.

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肾功能胱抑素 C 与肌酐之间的差异以及与肌肉质量和虚弱的关系。

背景：胱抑素 C 估算肾小球滤过率与肌酐估算肾小球滤过率之差（eGFRDiff = eGFRCys - eGFRCreat）越大，虚弱风险越低。由于 eGFRCreat 比 eGFRCys 更受肌肉的影响，因此肌肉质量可能是这种关联的原因。以前的研究在考虑通过成像测量区域肌肉时无法解释这一点。氘化肌酸（D3Cr）稀释可测量全身肌肉质量（公斤）。我们旨在确定 eGFRDiff 是否与 D3Cr 肌肉质量相关，以及肌肉质量是否能解释 eGFRDiff 与虚弱之间的关联：多中心 MrOS 研究第 14 年（第 4 次访问）的横断面分析。从最初的 5994 名 MrOS 参与者（入组时年龄≥65 岁）中选取 490 名男性作为研究对象。暴露量为 eGFRDiff（= eGFRCys - eGFRCreat），采用 2012/2021 年 CKD-EPI 方程计算。主要结果为 D3Cr 肌肉质量。次要结果是虚弱前表型（一个或两个标准）和虚弱（≥三个标准），包括：体重减轻、虚弱、步态缓慢、体力活动少、体力差。eGFRDiff 与 D3Cr 肌肉质量的关系通过线性回归进行检验，与虚弱前/虚弱的关系通过多项式逻辑回归进行检验：平均（±SD）年龄为 84 ± 4 岁，eGFRCreat 68 ± 16，eGFRCys 52 ± 16，eGFRDiff -15 ± 12 mL/min/1.73 m2，D3Cr 肌肉质量 24 ± 4 kg。eGFRDiff 每增加一个标准差，D3Cr 肌肉质量平均增加 1.4 千克，P 3Cr 肌肉质量（OR = 0.85 95% CI [0.58; 1.24]）：结论：较高的 eGFRDiff 与晚年男性较低的虚弱几率相关。结论：较高的 eGFRDiff 与晚年男性较低的虚弱几率有关，D3Cr 肌肉质量在一定程度上与此相关。这表明，肌酐和胱抑素 C 的非肾小球滤过率决定因素（如肌肉质量）在解释 eGFRDiff 与虚弱的关联方面发挥了作用。这需要今后的研究加以证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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