Journal Mobile Options
Table of Contents
Vol. 27, No. 3, 2007
Issue release date: May 2007
Am J Nephrol 2007;27:279–286

Kidney Function and Sarcopenia in the United States General Population: NHANES III

Foley R.N. · Wang C. · Ishani A. · Collins A.J. · Murray A.M.
aUnited States Renal Data System Coordinating Center, bDepartment of Medicine, University of Minnesota, and cDepartment of Medicine, Hennepin County Medical Center, Minneapolis, Minn., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background/Aims: It is not known whether sarcopenia is associated with levels of kidney function in community-dwelling adults. Methods: Subjects were adult Third National Health and Nutrition Examination Survey participants in whom bioimpedance was performed (n = 13,770). Class I sarcopenia was defined as a skeletal mass index of 1–2 standard deviations below and class II sarcopenia as <2 standard deviations below young adult values. Results: A monotonic association existed between increasing sarcopenia prevalence and declining glomerular filtration rate: ≧90 ml/min/1.73 m2, 22.8% class I, 3.8% class II sarcopenia; 60–89 ml/min/1.73 m2, 33.6% class I, 5.3% class II sarcopenia, and <60 ml/min/1.73 m2, 50.7% class I, 9.4% class II sarcopenia (p < 0.0001). This association dissipated when adjustment was made for older age and more comorbidity. Multivariate associations (p < 0.05) of sarcopenia and chronic kidney disease included: older age; low income-to-poverty ratio; overweight; lack of exercise; low carbohydrate, fat and protein intake; hypercalcemia; low 25-hydroxy-vitamin D3; higher diastolic blood pressure, and insulin resistance. Conclusion: Sarcopenia is common in community-dwelling adults with chronic kidney disease. Although causality cannot be assumed, several associations may be susceptible to intervention.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. Am J Kidney Dis 2002;39:S1–S246.
  2. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS: Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;41:1–12.
  3. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al: National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137–147.
  4. Fried LF, Shlipak MG, Crump C, Bleyer AJ, Gottdiener JS, Kronmal RA, et al: Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals. J Am Coll Cardiol 2003;41:1364–1372.
  5. Henry RM, Kostense PJ, Bos G, Dekker JM, Nijpels G, Heine RJ, et al: Mild renal insufficiency is associated with increased cardiovascular mortality: the Hoorn Study. Kidney Int 2002;62:1402–1407.
  6. Muntner P, He J, Hamm L, Loria C, Whelton PK: Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 2002;13:745–753.
  7. Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, et al: Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004;351:1285–1295.
  8. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–1305.
  9. Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, et al: Chronic kidney disease awareness, prevalence, and trends among US adults, 1999 to 2000. J Am Soc Nephrol 2005;16:180–188.
  10. Janssen I, Heymsfield SB, Ross R: Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002;50:889–896.
  11. Metter EJ, Talbot LA, Schrager M, Conwit R: Skeletal muscle strength as a predictor of all-cause mortality in healthy men. J Gerontol A Biol Sci Med Sci 2002;57:B359–B365.
  12. Roubenoff R, Parise H, Payette HA, Abad LW, D’Agostino R, Jacques PF, et al: Cytokines, insulin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: the Framingham Heart Study. Am J Med 2003;115:429–435.
  13. Krakauer JC, Franklin B, Kleerekoper M, Karlsson M, Levine JA: Body composition profiles derived from dual-energy X-ray absorptiometry, total body scan, and mortality. Prev Cardiol 2004;7:109–115.
  14. Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, et al: Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 2006;61:72–77.
  15. Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B, et al: Factors predicting malnutrition in hemodialysis patients: a cross-sectional study. Kidney Int 1998;53:773–782.
  16. Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI: Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr 1985;41:810–817.
  17. Janssen I, Heymsfield SB, Baumgartner RN, Ross R: Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 2000;89:465–471.
  18. Coresh J, Astor BC, McQuillan G, Kusek J, Greene T, Van Lente F, et al: Calibration and random variation of the serum creatinine assay as critical elements of using equations to estimate glomerular filtration rate. Am J Kidney Dis 2002;39:920–929.
  19. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–470.
  20. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. Am J Kidney Dis 2002;39:S1–S246.
  21. Bennett PH, Haffner S, Kasiske BL, Keane WF, Mogensen CE, Parving HH, et al: Screening and management of microalbuminuria in patients with diabetes mellitus: recommendations to the Scientific Advisory Board of the National Kidney Foundation from an ad hoc committee of the Council on Diabetes Mellitus of the National Kidney Foundation. Am J Kidney Dis 1995;25:107–112.
  22. Keane WF, Eknoyan G: Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation. Am J Kidney Dis 1999;33:1004–1010.
  23. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–419.
  24. National Center for Health Statistics: National Health and Nutrition Examination Survey. 2006.
  25. Kehayias JJ, Fiatarone MA, Zhuang H, Roubenoff R: Total body potassium and body fat: relevance to aging. Am J Clin Nutr 1997;66:904–910.
  26. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al: Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998;147:755–763.
  27. Janssen I, Baumgartner RN, Ross R, Rosenberg IH, Roubenoff R: Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol 2004;159:413–421.
  28. Melton LJ III, Khosla S, Crowson CS, O’Connor MK, O’Fallon WM, Riggs BL: Epidemiology of sarcopenia. J Am Geriatr Soc 2000;48:625–630.
  29. Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R: The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc 2004;52:80–85.
  30. Roubenoff R: Sarcopenia: effects on body composition and function. J Gerontol A Biol Sci Med Sci 2003;58:1012–1017.
  31. Ikizler TA, Hakim RM: Nutrition in end-stage renal disease. Kidney Int 1996;50:343–357.
  32. Pupim LB, Heimburger O, Qureshi AR, Ikizler TA, Stenvinkel P: Accelerated lean body mass loss in incident chronic dialysis patients with diabetes mellitus. Kidney Int 2005;68:2368–2374.
  33. Desmet C, Beguin C, Swine C, Jadoul M: Falls in hemodialysis patients: prospective study of incidence, risk factors, and complications. Am J Kidney Dis 2005;45:148–153.
  34. Ball AM, Gillen DL, Sherrard D, Weiss NS, Emerson SS, Seliger SL, et al: Risk of hip fracture among dialysis and renal transplant recipients. JAMA 2002;288:3014–3018.
  35. Ikizler TA, Greene JH, Wingard RL, Parker RA, Hakim RM: Spontaneous dietary protein intake during progression of chronic renal failure. J Am Soc Nephrol 1995;6:1386–1391.
  36. Roubenoff R, Hughes VA: Sarcopenia: current concepts. J Gerontol A Biol Sci Med Sci 2000;55:M716–M724.
  37. Castaneda C, Charnley JM, Evans WJ, Crim MC: Elderly women accommodate to a low-protein diet with losses of body cell mass, muscle function, and immune response. Am J Clin Nutr 1995;62:30–39.
  38. Melichna J, Zauner CW, Havlickova L, Novak J, Hill DW, Colman RJ: Morphologic differences in skeletal muscle with age in normally active human males and their well-trained counterparts. Hum Biol 1990;62:205–220.
  39. Meredith CN, Frontera WR, O’Reilly KP, Evans WJ: Body composition in elderly men: effect of dietary modification during strength training. J Am Geriatr Soc 1992;40:155–162.
  40. Castaneda C, Gordon PL, Uhlin KL, Levey AS, Kehayias JJ, Dwyer JT, et al: Resistance training to counteract the catabolism of a low-protein diet in patients with chronic renal insufficiency. A randomized, controlled trial. Ann Intern Med 2001;135:965–976.
  41. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR: Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002;347:1557–1565.
  42. Iannuzzi-Sucich M, Prestwood KM, Kenny AM: Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. J Gerontol A Biol Sci Med Sci 2002;57:M772–M777.
  43. Visser M, Deeg DJ, Lips P: Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 2003;88:5766–5772.
  44. Rasmussen BB, Fujita S, Wolfe RR, Mittendorfer B, Roy M, Rowe VL, et al: Insulin resistance of muscle protein metabolism in aging. FASEB J 2006;20:768–769.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50