Diagnosis, prevalence, and outcomes of sarcopenia in kidney transplantation recipients: A systematic review and meta‐analysis

Abstract

The prevalence of sarcopenia and its clinical predictors and clinical impact vary among kidney transplant recipients (KTRs), in part because of different diagnostic criteria. This study aimed to assess the reported diagnosis criteria of sarcopenia and compare them in terms of prevalence, clinical predictors, and impact of sarcopenia. The Medline, Embase, and Cochrane Library were searched for the full-length reports published until 28 January 2022. The subgroup analysis, meta-regression, and sensitivity analysis were performed and heterogeneity was assessed using the I 2 . A total of 681 studies were retrieved, among which only 23 studies (including 2535 subjects, 59.7% men, mean age 49.8 years) were eventually included in the final analysis. The pooled prevalence in these included studies was 26% [95% confidence interval (95% CI): 20-34%, I 2 = 93.45%], including 22% (95% CI: 14-32%, I 2 = 88.76%) in men and 27% (95% CI: 14-41%, I 2 = 90.56%) in women (P = 0.554 between subgroups). The prevalence of sarcopenia diagnosed using low muscle mass was 34% (95% CI: 21-48%, I 2 = 95.28%), and the prevalence of using low muscle mass in combination with low muscle strength and/or low physical performance was 21% (95% CI: 15-28%, I 2 = 90.37%) (P = 0.08 between subgroups). In meta-regression analyses, the mean age (regression coefficient: 1.001, 95% CI: 0.991-1.011) and percentage male (regression coefficient: 0.846, 95% CI: 0.367-1.950) could not predict the effect size. Lower body mass index (odds ratio (OR): 0.57, 95% CI: 0.39-0.84, I 2 = 61.5%), female sex (OR: 0.31, 95% CI: 0.16-0.61, I 2 = 0.0%), and higher age (OR: 1.08, 95% CI: 1.05-1.10, I 2 = 10.1%) were significantly associated with a higher risk for sarcopenia in KTRs, but phase angle (OR: 0.81, 95% CI: 0.16-4.26, I 2 = 84.5%) was not associated with sarcopenia in KTRs. Sarcopenia was not associated with rejections (risk ratio (RR): 0.67, 95% CI: 0.23-1.92, I 2 = 12.1%), infections (RR: 1.03, 95% CI: 0.34-3.12, I 2 = 87.4%), delayed graft functions (RR: 0.81, 95% CI: 0.46-1.43, I 2 = 0.0%), and death (RR: 0.95, 95% CI: 0.32-2.82, I 2 = 0.0%) in KRTs. Sarcopenia was found to be very common in KRTs. However, we have not found that sarcopenia had a negative impact on clinical health after kidney transplantation. Large study cohorts and multicentre longitudinal studies in the future are urgently needed to explore the prevalence and prognosis of sarcopenia in kidney transplant patients.

Coexistence of Low Muscle Mass and Osteoporosis as a Predictor of Fragility Fractures in Long-Term Kidney Transplant Recipients

“…At baseline, the number of KTRs with LMM was 109 (31.9%), similar to a previous meta-analysis on sarcopenia in KTRs; the prevalence of sarcopenia defined based on LMM was 34% [30]. There were 93 KTRs with osteoporosis (27.2%) in our study, which was also similar to the prevalence of osteoporosis reported in a previous study regarding KTRs (11-56%) [24].…”

Nutrition support management of organ transplant recipients in the acute posttransplant phase

“…Rates of malnutrition vary among patients requiring kidney transplantation, depending on patient age, sex, duration of dialysis, type of dialysis, and presence of other comorbidities, as well as the nutrition assessment parameters chosen. Sarcopenia, as a marker of reduced muscle mass, has been found to be prevalent (34%) among kidney transplant recipients; however, no consistent association has been found between sarcopenia and rejection, infection, graft function, hospital length of stay, or mortality 24,25 . Conversely, in kidney transplant recipients >60 years old, low skeletal muscle index (<42 cm 2 /m 2 , not adjusted for sex) was associated with prolonged length of stay, increased wound complications, and reduced graft/patient survival, but only in male patients 26 .…”

“…Sarcopenia, as a marker of reduced muscle mass, has been found to be prevalent (34%) among kidney transplant recipients; however, no consistent association has been found between sarcopenia and rejection, infection, graft function, hospital length of stay, or mortality. 24,25 Conversely, in kidney transplant recipients >60 years old, low skeletal muscle index (<42 cm 2 /m 2 , not adjusted for sex) was associated with prolonged length of stay, increased wound complications, and reduced graft/patient survival, but only in male patients. 26 Myosteatosis (fat infiltration of muscle, signifying poor muscle quality) has been independently associated with posttransplant mortality in kidney recipients.…”

Comment on “Sarcopenia and cardiovascular diseases: A systematic review and meta‐analysis” by Zuo et al.

“…The results found that average age had no impact on the sarcopenia prevalence among CVDs and general population, with the results of regression coefficient being 0.00078 [(95% CI: À0.0048 to 0.006), P = 0.775] for CVD and regression coefficient being 0.0045 [(95% CI: À0.003 to 0.0046), P = 0.817] for general population, which was consistent with previous of meta-analysis for pooling the prevalence sarcopenia among patients with mechanical ventilation 2 or kidney transplantation recipients. 3 To conclude, the authors did a great systematic review and meta-analysis which focusing the important CVDs population. Their study brings great attention of sarcopenia for CVDs, given the high prevalence of sarcopenia among this special population.…”