Functional Performance Decline Outperforms Sarcopenia and Its Components in Predicting New-Onset Chronic Kidney...

This study aimed to investigate the associations of functional performance, sarcopenia, and components of sarcopenia with the onset of chronic kidney disease (CKD), while also determining the optimal predictive factor.

This observational multicenter study included 8,647 community-dwelling adults. Activities of daily living (ADL) scale, physical performance, and sarcopenia were assessed at baseline, and participants were followed to track CKD incidents. The discriminatory performance and cutoffs of ADL and other indices for predicting CKD onset were evaluated. Multivariable-adjusted logistic regression models were employed to analyze the association of ADL with CKD occurrence.

There were 4,681 women and 3,966 men (median age = 57.0 years). Over a 7-year follow-up, 940 CKD incidents occurred. Optimal thresholds for left handgrip strength, right handgrip strength, the 5-time chair stand test, appendicular skeletal muscle index, and ADL to predict CKD onset were established at 35.2 kg, 30.9 kg, 10.4 seconds, 7.3 kg/m,² and 1 for men; and 16.1 kg, 30.9 kg, 12.8 seconds, 6.3 kg/m,² and 1 for women, respectively. Among all factors investigated, the ADL score was optimal to predict CKD onset in both men (area under the curve = 0.546; 95% CI, 0.528-0.564) and women (area under the curve = 0.559; 95% CI, 0.538-0.581). Functional performance decline (ADL score ≥1) demonstrated an independent and dose-dependent association with CKD (OR = 1.841; 95% CI, 1.446-2.329; P for trend < 0.001).

The use of an anthropometric equation to estimate skeletal muscle mass may not be as precise as other methods. Additionally, the observational nature of the study and reliance on self-reported CKD data may lead to potential confounding, misclassification, and reverse causality, requiring further validation through studies with laboratory-confirmed CKD events and larger, more diverse populations.

The ADL score indicated that functional performance is superior to sarcopenia and its components in predicting the onset of CKD in middle-aged and older Chinese adults. These findings may facilitate the prevention and management of CKD.