Relationship between lower extremity muscle strength and all-cause mortality in Japanese patients undergoing dialysis

• Published in: Physical therapy 2014-07, Vol.94 (7), p.947-956
• Main Authors: Matsuzawa, Ryota, Matsunaga, Atsuhiko, Wang, Guoqin, Yamamoto, Shuhei, Kutsuna, Toshiki, Ishii, Akira, Abe, Yoshifumi, Yoneki, Kei, Yoshida, Atsushi, Takahira, Naonobu
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angina pectoris; Area Under Curve; Cause of Death; Comorbidity; Complications and side effects; Diabetes; Disease; Exercise Test; Female; Hemodialysis; Hemodialysis patients; Humans; Japan - epidemiology; Kaplan-Meier Estimate; Knee; Lower Extremity - physiopathology; Male; Measurement; Middle Aged; Mortality; Muscle strength; Muscle Strength - physiology; Muscle Strength Dynamometer; Muscle weakness; Muscle, Skeletal - physiopathology; Muscular system; Nutrition research; Older people; Patients; Physical therapists; Physiological aspects; Proportional Hazards Models; Prospective Studies; Renal Dialysis - mortality; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - therapy; Risk factors; ROC Curve; Studies; Survival analysis; Survival Rate
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20130270

Skeletal muscle wasting is common and insidious in patients who are undergoing hemodialysis. However, the association between lower extremity muscle strength and all-cause mortality remains unclear in this population. The purpose of this study was to investigate the prognostic significance of lower extremity muscle strength on 7-year survival in a cohort of patients who were clinically stable and undergoing hemodialysis. A prospective cohort study was conducted. A total of 190 Japanese outpatients who were undergoing maintenance hemodialysis 3 times per week at a hemodialysis center were followed for up to 7 years. Lower extremity muscle strength was evaluated using a handheld dynamometer at the time of patient enrollment in the study. Muscle strength data were divided by dry weight and expressed as a percentage. A Cox proportional hazards regression model was used to assess the contribution of lower extremity muscle strength to all-cause mortality. The median age (25th and 75th percentiles) of this study population was 64 years (57 and 72 years), 53.2% of the patients were women, and the time on hemodialysis was 39.0 months (15.9 and 110.5 months) at baseline. During a median follow-up of 36.0 months, there were 30 deaths. With a multivariate Cox model, the hazard ratio in the group with a knee extensor strength of