Diagnostic performance of the creatinine-to-cystatin C based eGFR ratio for predicting sarcopenia in chronic kidney disease patients

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Abstract Title *

Diagnostic performance of the creatinine-to-cystatin C based eGFR ratio for predicting sarcopenia in chronic kidney disease patients

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Co-author 1

Nobuhiro Hashimoto bosuhiro2005@yahoo.co.jp Osaka General Medical Center Department of Kidney Disease and Hypertension Osaka Japan *

Co-author 2

Miyu Tuchida tsuchida.miyu9903@gmail.com Osaka General Medical Center Department of Kidney Disease and Hypertension Osaka Japan -

Co-author 3

Syuzo Makino 05a14078@gmail.com Osaka General Medical Center Department of Kidney Disease and Hypertension Osaka Japan -

Co-author 4

Akito Takashima aki65han@gmail.com Osaka General Medical Center Department of Kidney Disease and Hypertension Osaka Japan -

Co-author 5

Hiromitsu Miyakawa mi8kawa1009@gmail.com Osaka General Medical Center Department of Kidney Disease and Hypertension Osaka Japan -

Co-author 6

Hiroki Okusima okuringo@hotmail.co.jp Osaka General Medical Center Department of Kidney Disease and Hypertension Osaka Japan -

Co-author 7

Terumasa Hayashi t-hayashi@abelia.ocn.ne.jp Osaka General Medical Center Department of Kidney Disease and Hypertension Osaka Japan -

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

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Introduction

Sarcopenia, defined as a decrease in muscle mass and strength, is prevalent among patients with chronic kidney disease (CKD) and is associated with adverse clinical outcomes. The ratio of creatinine- to cystatin C-based eGFR (eGFRcre/eGFRcys) and the serum creatinine-to-cystatin C ratio (sCre/sCys), which account for the influence of muscle mass, have been reported to be associated with sarcopenia. However, data concerning advanced CKD are limited, and no study has specifically examined this association in Japanese patients with CKD. We aimed to investigate the relationship between these indices and sarcopenia in Japanese patients with CKD.

Methods

This was a cross-sectional study of 119 outpatients with CKD treated at our department. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Physical performance was assessed using the Short Physical Performance Battery (SPPB), and skeletal muscle mass was measured by bioelectrical impedance analysis (InBody). Receiver operating characteristic (ROC) curves were constructed to calculate the area under the curve (AUC) for eGFRcre/eGFRcys and sCre/sCys in predicting sarcopenia.

Results

The mean age of participants was 70 years, and the mean eGFR was 30 ml/min/1.73m². Sarcopenia was identified in 19 patients. The AUC for sarcopenia prediction was 0.71 for eGFRcre/eGFRcys and 0.70 for sCre/sCys. Among patients aged ≥65 years, the predictive performance of eGFRcre/eGFRcys improved, with an AUC of 0.77. Using a cutoff value of 1.0 for eGFRcre/eGFRcys, sensitivity was 86%, specificity was 68%, and the negative predictive value was 96%. These findings indicate that values ≤1 reliably exclude sarcopenia.

Conclusion

The eGFRcre/eGFRcys ratio is a simple and practical predictor of sarcopenia in patients with CKD, particularly among those aged ≥65 years. This index may serve as a useful screening tool to rule out sarcopenia in clinical practice.

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