title: Lower thigh muscle mass is associated with all-cause and cardiovascular mortality in elderly hemodialysis patients.
abstract: Higher body mass index appears protective in hemodialysis patients, although it remains to be determined which component of muscle or fat mass is primarily associated with this survival advantage.
  
  
  
  Eighty-one hemodialysis patients in our institution were prospectively followed from July 2011 to August 2015. Muscle and fat mass were evaluated by measuring the cross-sectional areas of the thigh and abdomen using computed tomography. The relationship between muscle and fat mass, and all-cause and cardiovascular mortality was studied using the Kaplan-Meier analyses and multivariate Cox proportional hazard models.
  
  
  
  During more than 4 years of follow-up, 26 patients (32%) died. In the Kaplan-Meier curve analyses, lower thigh muscle mass was significantly associated with all-cause and cardiovascular mortality (log-rank test, P<0.01 and P<0.001, respectively), but there was no such association with thigh fat, abdominal muscle and fat mass levels. In multivariate Cox proportional hazard models, each 0.1 cm2/kg increase in the thigh muscle area adjusted by dry weight was associated with an estimated 22% lower risk of all-cause mortality (95% confidence interval (95% CI), 0.64-0.95, P<0.05) and a 30% lower risk of cardiovascular mortality (95% CI, 0.54-0.90, P<0.01).
  
  
  
  Lower thigh muscle mass is significantly associated with all-cause and cardiovascular mortality in hemodialysis patients. Our findings indicate the importance of focusing on the muscle mass of lower extremities to predict the clinical outcomes of hemodialysis patients.
authors.affiliation: Renal Division, Department of Internal Medicine, Iwata City Hospital, Iwata, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Fukasawa
authors.affiliation: Renal Division, Department of Internal Medicine, Iwata City Hospital, Iwata, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kaneko
authors.affiliation: Renal Division, Department of Internal Medicine, Iwata City Hospital, Iwata, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Niwa
authors.affiliation: Renal Division, Department of Internal Medicine, Iwata City Hospital, Iwata, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Matsuyama
authors.affiliation: First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yasuda
authors.affiliation: The Department of Clinical Nutrition, School of Food and Nutritional Sciences, University of Shizuoka, Shizuoka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kumagai
authors.affiliation: Renal Division, Department of Internal Medicine, Iwata City Hospital, Iwata, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Furuya
mesh_terms: D000009:Abdominal Muscles / Q000033:anatomy & histology; D034861:Abdominal Wall / Q000033:anatomy & histology; D050154:Adiposity; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018482:Muscle, Skeletal / Q000503:physiopathology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D013848:Thigh / Q000033:anatomy & histology*