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Preprint / Version 1

Quality matters: chronic kidney disease progressively impacts muscle strength independently of changes in skeletal muscle mass


  • Antoine Chatrenet APCoSS – Institute of Physical Education and Sports Sciences (IFEPSA), UCO, Angers, France
  • Pierre-Yves de Müllenheim APCoSS - Institute of Physical Education and Sports Sciences (IFEPSA), UCO Angers, France.



kidney cachexia, skeletal muscle, nutritional status, sarcopenia, muscle force, musculoskeletal health


Background. Chronic kidney disease (CKD) is commonly associated with multifactorial neuromuscular impairment. Few studies have investigated CKD-induced changes in maximal voluntary force (MVF), and even fewer have longitudinal follow-up. The aim of this study is to investigate whether CKD progression modifies the relationship between skeletal muscle mass and force and the prevalence of sarcopenia and sarcopenic obesity.

Methods. The data used were prospectively gathered during routine check-ups in a network of nutritional centres in Mexico. From a dataset of 5430 patients, we selected 1098 patients with available anthropometric, kidney function, handgrip and bioimpedance data. The relationship between appendicular skeletal mass (ASM) and MVF was investigated in the different CKD stages using mixed models, while sarcopenia and sarcopenic obesity were compared using the Chi-2 test. Longitudinal analysis, considering individuals with at least two visits (n=516), was performed via regression models using the linear slopes with time of MVF, ASM and kidney function.

Results. After normalization with ASM, MVF was higher in CKD G1-G3 compared to G4 and G5 (p≤0.001, Cohen’s d=0.270-0.576). Slopes between MVF and ASM were lower in CKD G3, G4 and G5 than in CKD G1-G2 (-1.131 [-2.067,-0.195], p=0.019; -1.728 [-2.809,-0.647], p=0.002; -1.744 [-2.876,-0.613], p=0.003, respectively). The prevalence of sarcopenia and sarcopenic obesity did not differ across CKD stages, but recovery was most commonly observed in CKD G1-G2. Longitudinal analysis showed an independent association between the slopes of MVF, kidney function and ASM. 

Conclusions. CKD negatively, progressively and independently affects the neuromuscular system, and force production is reduced for any given muscle mass as CKD progresses. While no association was found between CKD stage and prevalence of sarcopenia, recovery was more frequent in the early CKD stages. These results suggest the importance of early rehabilitation programs to improve musculoskeletal health, quality of life and survival in CKD patients.


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