Sarcopenia, adiposity and large discordance between cystatin C and creatinine-based estimated glomerular filtration rate in patients with cancer
Document Type
Article
Publication Title
Journal of cachexia, sarcopenia and muscle
Abstract
BACKGROUND: Creatinine-based estimated glomerular filtration rate (eGFR) may overestimate kidney function in patients with sarcopenia. While cystatin C-based eGFR (eGFR) is less affected by muscle mass, it may underestimate kidney function in patients with obesity. We sought to evaluate the relationship between body composition defined by computed tomography (CT) scans and discordance between creatinine, eGFR and eGFR in adult patients with cancer. METHODS: This study is a cross-sectional study of consecutive adults with cancer with an abdominal CT scan performed within 90 days of simultaneous eGFR and eGFR measurements between May 2010 and January 2022. Muscle and adipose tissue cross-sectional areas were measured at the level of the third lumbar vertebral body using a validated deep-learning pipeline. CT-defined sarcopenia was defined using independent sex-specific cut-offs for skeletal muscle index (<39 cm/m for women and <55 cm/m for men). High adiposity was defined as the highest sex-specific quartile of the total (visceral plus subcutaneous) adiposity index in the cohort. The primary outcome was eGFR discordance, defined by eGFR > 30% lower than eGFR; the secondary outcome was eGFR > 50% lower than eGFR. The odds of eGFR discordance were estimated using multivariable logistic regression modelling. Unadjusted spline regression was used to evaluate the relationship between skeletal muscle index and the difference between eGFR and eGFR. RESULTS: Of the 545 included patients (mean age 63 ± 14 years, 300 [55%] females, 440 [80.7%] non-Hispanic white), 320 (58.7%) met the criteria for CT-defined sarcopenia, and 136 (25%) had high adiposity. A total of 259 patients (48%) had >30% eGFR discordance, and 122 (22.4%) had >50% eGFR discordance. After adjustment for potential confounders, CT-defined sarcopenia and high adiposity were both associated with >30% eGFR discordance (adjusted odds ratio [aOR] 1.90, 95% confidence interval [CI] 1.12-3.24; aOR 2.01, 95% CI 1.15-3.52, respectively) and >50% eGFR discordance (aOR 2.34, 95% CI 1.21-4.51; aOR 2.23, 95% CI 1.19-4.17, respectively). A spline model demonstrated that as skeletal muscle index decreases, the predicted difference between eGFR and eGFR widens considerably. CONCLUSIONS: CT-defined sarcopenia and high adiposity are both independently associated with large eGFR discordance. Incorporating valuable information from body composition analysis derived from CT scans performed as a part of routine cancer care can impact the interpretation of GFR estimates.
First Page
1187
Last Page
1198
DOI
10.1002/jcsm.13469
Publication Date
6-1-2024
Recommended Citation
Hanna, Paul E.; Ouyang, Tianqi; Tahir, Ismail; Katz-Agranov, Nurit; Wang, Qiyu; Mantz, Lea; Strohbehn, Ian; Moreno, Daiana; Harden, Destiny; Dinulos, James E.; Cosar, Duru; Seethapathy, Harish; Gainor, Justin F.; Shah, Sachin J.; Gupta, Shruti; Leaf, David E.; Fintelmann, Florian J.; and Sise, Meghan E., "Sarcopenia, adiposity and large discordance between cystatin C and creatinine-based estimated glomerular filtration rate in patients with cancer" (2024). Radiology. 1.
https://scholar.bridgeporthospital.org/radiology/1
Identifier
38646842 (pubmed); PMC11154767 (pmc); 10.1002/jcsm.13469 (doi)