TOPLINE:

Among patients with stage 3 chronic kidney disease (CKD), lower muscle mass — measured using the creatinine muscle index (CMI) — was associated with increased risks for all-cause mortality and progression of CKD, and a higher waist-hip ratio (WHR), a marker of visceral adiposity, was linked to increased odds of cardiovascular events over 5 years.

METHODOLOGY:

• Researchers conducted a prospective observational cohort study to determine whether the CMI — a surrogate marker of muscle mass — and the WHR — a surrogate marker of visceral adiposity — were associated with all-cause mortality, cardiovascular events, and progression of CKD over 5 years.
• They included 1732 patients (mean age, 72.9 years; 60.4% women) with CKD category G3 (estimated glomerular filtration rate [eGFR], 30-59 mL/min/1.73 m²) recruited from 32 primary care clinics in Derbyshire, England. Individuals who were terminally ill (expected survival < 1 year) or had undergone a solid organ transplant were excluded.
• The CMI was calculated as the product of serum creatinine and cystatin C-based eGFR, and the WHR was calculated by dividing the waist circumference at the level of the umbilicus by the widest hip (buttocks) circumference.
• Co-primary outcomes were the time to cardiovascular events (including myocardial infarction, need for coronary or peripheral revascularisation or amputation for peripheral vascular disease, transient ischaemic attack, cerebrovascular accident, death due to peripheral vascular disease, or sudden cardiac death) and all-cause mortality over 5 years.
• The secondary outcome was the progression of CKD, defined as a 25% decline in the eGFR coupled with worsening of the GFR category or an increase in the albuminuria category according to Kidney Disease: Improving Global Outcomes criteria.

TAKEAWAY:

• Over 5 years, 248 patients died. Each one SD decrease in the CMI was independently associated with a 28% increased risk for all-cause mortality at 5 years (hazard ratio [HR], 1.28; P = .003).
• By year 5, 605 patients had experienced a hospital admission for cardiovascular events. Each one SD increase in the WHR was independently associated with a 16% increased risk for cardiovascular events at 5 years (HR, 1.16; P = .009).
• A lower CMI (per SD decrease) was also independently associated with 23% increased odds of the progression of CKD at 5 years (odds ratio, 1.23; P = .024).
• Higher age, male sex, higher urine albumin:creatinine ratio (uACR), and lower levels of serum albumin were also independently associated with increased risks for both mortality and cardiovascular events. Greater age, male sex, higher uACR, lower haemoglobin levels, and presence of diabetes were associated with an increased risk for the progression of CKD.

IN PRACTICE:

"The use of these simple and inexpensive surrogate markers of body composition may enhance risk stratification in people with CKD and inform future therapeutic strategies to improve outcomes in this high-risk population," the authors wrote.

SOURCE:

This study was led by Ashveer Randhay, Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, England. It was published online on June 02, 2026, in the American Journal of Nephrology.

LIMITATIONS:

The study did not perform direct measures of muscle mass or visceral adiposity. The cohort consisted primarily of older patients with CKD from the UK, which may have limited generalisability. Additionally, the study relied exclusively on office blood pressure readings rather than ambulatory measurements.

DISCLOSURES:

This study did not receive any specific funding. One author reported receiving consulting fees, honoraria, support to attend conferences, and royalties and holding other ties with various pharmaceutical companies and organisations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.