SMI could help nephrologists recommend appropriate rehabilitation and nutritional management for candidates with presarcopenia on the kidney transplant waiting list to improve post-transplant outcomes.

A low skeletal muscle index (SMI) as assessed by computed tomography (CT) independently predicts increased risks for morbidity and mortality after kidney transplantation among men aged 60 years or older, according to a recent study.

“SMI, which can be easily calculated by routine CT scan, is a reliable tool to measure muscle mass in kidney transplantation candidates and could help nephrologists recommend appropriate rehabilitation and nutritional management for candidates with presarcopenia on the kidney transplant wait-list in order to improve post-transplant outcomes,” Pierre-Guillaume Deliège, MD, of Hôpital Maison Blanch in Reims, France, and colleagues reported in the Journal of Renal Nutrition.

The study included 122 patients (71 men and 51 women) aged 60 years or older at the time of kidney transplantation (mean age of 66 years). On multivariate analysis, a low SMI, defined as less than 42 cm2/m2, was significantly associated with 12.1-fold and 3.4-fold increased odds of wound complications and a combined endpoint of graft loss or death, respectively, in men compared with an SMI of 42 cm2/m2 or higher. In addition, a low SMI was significantly associated with longer immediate post-transplant hospitalization and longer total hospitalization during the first-year after transplant. SMI was not associated with length of hospitalization or adverse outcomes after transplantation in women, according to the investigators.

The average length of hospitalization was 20.5 days. Overall patient survival at 1 year was 89.7%, with cardiac etiologies and severe infections the most common causes of death.

Compared with women, men had a significantly higher serum creatinine level (836 vs 693 µmol/L), skeletal muscle mass (151.0 vs 96.5 cm2), and SMI (50.9 vs 37.8 cm2/m2). They were also significantly more likely to have hypertension as a cause of end-stage kidney disease (25.4% vs 7.8%), the investigators reported.

Reference

Deliège PG, Braconnier A, Chaix F, et al. Skeletal muscle index as a prognostic marker for kidney transplantation in older patients. J Ren Nutr. 2021;1:286-295. doi:10.1053/j.jrn.2020.08.014

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