Sarcopenia in kidney transplant recipients: prevalence, predictors, and prognosis

Article: Diagnosis, prevalence, and outcomes of sarcopenia in kidney transplantation recipients: A systematic review and meta-analysis

Patients with end-stage kidney disease (ESKD) are recommended to consider kidney transplantation (KT), a procedure known for improving survival and quality of life a smaller cost than dialysis. Current studies in kidney transplant recipients (KTRs) note heterogenous prevalence rates for sarcopenia, which ranges from 3.7% to 72.1%. This heterogeneity could be attributed to differences in diagnostic criteria and/or sample sizes. Ultimately, however, it contributes to the uncertainty surrounding sarcopenia’s clinical predictors and its impact on outcomes in KTRs.

The aim of this study was to investigate the literature on KTRs to determine the most common reported diagnostic criteria of sarcopenia, its prevalence, clinical predictors, and its impact on KTRs’ outcomes.

Key learnings:

The prevalence of sarcopenia in KTRs was found to be 26%. Patients with chronic kidney disease and those on dialysis were found to possess a lower sarcopenia prevalence, hypothesised to be due to improved kidney function and a reduction in uraemic toxins.

A larger proportion of the studies analysed (13 out of the total 23) used low muscle mass (LMM) in combination with low muscle strength and/or performance to diagnose sarcopenia. However, 10 out of the total 23 studies used LMM as the sole diagnostic criterion for sarcopenia. Studies estimating sarcopenia’s prevalence using LMM alone found a higher positive rate but a lower diagnostic accuracy compared to those using combined criteria.

Furthermore, mean age and male gender were not found to be associated with the prevalence of sarcopenia, which highlights the importance of assessing for sarcopenia in younger and in male KTRs. Lastly, compared to those without sarcopenia, KTRs with sarcopenia were found to possess lower quality of life and physical activity levels. However, despite this, sarcopenia was not found to negatively impact clinical health (rejections, infections, delayed graft functions, and death) after kidney transplantation. These findings should be urgently explored by large multicentre longitudinal studies.

Reviewed by: S. Duarte

Authors: Zhang JZ, Shi W, Zou M et al.

Published in: JCSM 2022