Frequency and Characteristics of Overestimated Renal Function in Japanese Patients with Chronic Liver Disease and Its Relation to Sarcopenia

Abstract

Renal dysfunction and sarcopenia are important prognostic factors in patients with chronic liver disease (CLD). Muscle atrophy can cause the overestimation of renal function based on serum creatinine. However, the frequency of overestimated renal function in Japanese patients with CLD and its relationship with sarcopenia are unclear. In present study, we evaluated the frequency of overestimated renal function, defined as a >20% higher eGFR using creatinine than using cystatin C, in 307 patients with CLD as well as its relationship with indicators of sarcopenia. In total, 24.8% of patients had overestimated renal function. In a multivariate regression analysis, liver cirrhosis (p = 0.004) and psoas muscle mass index (p = 0.049) were significantly associated with overestimated renal function. Loss of skeletal muscle mass was significantly more frequent in both male and female patients with overestimated renal function than without. In males, the loss of muscle strength and rate of sarcopenia, defined as loss of muscle mass and strength, were significantly higher in patients with than without overestimated renal function. The high frequency of overestimated renal function in Japanese patients suggests that indicators of renal function should be carefully considered; furthermore, monitoring and interventions for both renal function and sarcopenia are needed in patients with CLD.

Overestimated renal function in patients with liver cirrhosis predicts poor prognosis

“…However, several hypotheses have been proposed in this regard. Previous reports have revealed that overestimated renal function in patients with LC is associated with loss of skeletal muscle mass, 9 and we reported that overestimated renal function is significantly associated with the presence of sarcopenia 11 . Loss of skeletal muscle mass and sarcopenia are reported to be significant poor prognostic factors in patients with LC and/or HCC 1,8,13,25–27 .…”

“…In this study, skeletal muscle mass was evaluated using the psoas muscle mass index (PMI) estimated based on CT imaging. The PMI was calculated according to previous reports 11,20–23 as follows: the sum of the L3 level cross‐sectional areas of the right and left psoas muscle mass was calculated by manual tracing and subsequently divided by height squared (cm 2 /m 2 ). Muscle atrophy was also defined according to our previous report 24 as follows: PMI values <3.74 cm 2 /m 2 for men and <2.29 cm 2 /m 2 for women.…”

“…Therefore, cystatin C‐based eGFR (eGFRcys) accurately reflects renal function in patients with LC 9 . Recently, we and other groups revealed that the prevalence of overestimated renal function is high in patients with LC (30%–47%) 9,11 . Additionally, the actual renal function is worse than that estimated based on serum creatinine among patients with LC with overestimated renal function; furthermore, these patients also exhibited a deteriorated liver functional reserve and high rate of loss of skeletal muscle mass 11 .…”

“…9 Recently, we and other groups revealed that the prevalence of overestimated renal function is high in patients with LC (30%-47%). 9,11 Additionally, the actual renal function is worse than that estimated based on serum creatinine among patients with LC with overestimated renal function; furthermore, these patients also exhibited a deteriorated liver functional reserve and high rate of loss of skeletal muscle mass. 11 Importantly, in patients with LC, the presence of renal dysfunction 5,12 and sarcopenia [13][14][15] is associated with a poor prognosis.…”

“…9,11 Additionally, the actual renal function is worse than that estimated based on serum creatinine among patients with LC with overestimated renal function; furthermore, these patients also exhibited a deteriorated liver functional reserve and high rate of loss of skeletal muscle mass. 11 Importantly, in patients with LC, the presence of renal dysfunction 5,12 and sarcopenia [13][14][15] is associated with a poor prognosis. Thus, the presence of overestimated renal function in patients with LC might cause poor prognosis; however, this aspect has not been adequately clarified.…”