title: Low glomerular filtration rate as an associated risk factor for sarcopenic muscle strength: is creatinine or cystatin C-based estimation more relevant?
abstract: BACKGROUND
  We aimed to evaluate the association of a decreased glomerular-filtration-rate (GFR <60 ml/min/1.73 m2), estimated using Modification of Diet in Renal Disease (MDRD), creatinine- and cystatin C-based (CKDEPI-CR and CKDEPI-CC) Chronic Kidney Disease Epidemiology Collaboration equations with handgrip strength (HGS).
  
  
  METHODS
  Community-dwelling males aged ≥60 years admitted to outpatient clinic were included. We used MDRD, CKDEPI-CR, and CKDEPI-CC formulas for GFR estimation and corrected these for body surface area. Muscle strength was assessed by HGS.
  
  
  RESULTS
  209 men (mean age 67.8 ± 6.4) were enrolled. Sixty-two patients (29.7%) had sarcopenic HGS. Subjects with sarcopenic HGS were older, had higher rate of a GFR < 60 ml/min/1.73 m2, had lower mid-upper arm circumference; tended to have lower creatine kinase, albumin, CKDEPI-CC-GFR levels; and higher BUN/creatinine ratio and cystatin C. Multivariate logistic regression analysis revealed a CKDEPI-CC lower than 60 ml/min/1.73 m2as the only independent factor underlying sarcopenic HGS. Higher age tended to have an independent association. Only higher age was independently associated with low HGS when other estimations were used (p = 0.013 and p = 0.021 when MDRD and CKDEPI-CR were used, respectively).
  
  
  CONCLUSIONS
  There is a strong association of a GFR level of <60 ml/min/1.73 m2with sarcopenic HGS, when CKDEPI-CC formula is used.
authors.affiliation: a Department of Internal Medicine , Division of Geriatrics, Marmara University Hospital , Istanbul , Turkey.
authors.forename: Asli
authors.initials: A
authors.lastname: Tufan
authors.affiliation: b Department of Internal Medicine , Istanbul Faculty of Medicine, Division of Geriatrics, Istanbul University , Istanbul , Turkey , and.
authors.forename: Fatih
authors.initials: F
authors.lastname: Tufan
authors.affiliation: c Department of Internal Medicine , Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey.
authors.forename: Timur Selcuk
authors.initials: TS
authors.lastname: Akpinar
authors.affiliation: b Department of Internal Medicine , Istanbul Faculty of Medicine, Division of Geriatrics, Istanbul University , Istanbul , Turkey , and.
authors.forename: Birkan
authors.initials: B
authors.lastname: Ilhan
authors.affiliation: b Department of Internal Medicine , Istanbul Faculty of Medicine, Division of Geriatrics, Istanbul University , Istanbul , Turkey , and.
authors.forename: Gulistan
authors.initials: G
authors.lastname: Bahat
authors.affiliation: b Department of Internal Medicine , Istanbul Faculty of Medicine, Division of Geriatrics, Istanbul University , Istanbul , Turkey , and.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Karan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood*; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood*; D005919:Glomerular Filtration Rate; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications / Q000503:physiopathology*; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine
keywords: Male; extracorporeal shock-wave therapy; sarcopenia