Sarcopenia is common and contributes to a high risk of mortality among general population. There is no consensus regarding the cut-off values for sarcopenia in terms of mortality among chronic kidney disease patients. This study aimed to explore and validate cut-off points of handgrip strength (HGS) and lean mass index (LMI) for estimating the risk of mortality in peritoneal dialysis (PD) patients. This single-center prospective cohort study enrolled 1089 incident PD patients between October 2002 and July 2019. All patients were followed until death, transfer to hemodialysis, receiving renal transplantation or the end date of study (December 2019). All participants were randomly sampled to development cohort (70% participants) and validation cohort (30% participants), matched by gender and diabetes. Lean body mass was calculated by using the equation published by our center. Cubic spline regression analysis was used to examine the relationship between HGS or LMI values and mortality, and explore the cut-off points after adjusting for age, diabetes, cardiovascular disease and serum albumin in the development cohort. The derived cut-off values were verified by the agreement rate for predicting mortality and then compared with cut-off values from various clinical guidelines in the validation cohort. All 1089 patients were followed up with the median of 36.0 (18.0, 71.0) months. In the development cohort, cut-off points for predicting the higher mortality were derived as 24.5 kg and 14 kg of HGS for males and females, 16.7 kg/m2 and 13.8 kg/m2 of LMI for males and females respectively. In the validation cohort, these cut-off values significantly predicted worse outcomes, with HR 1.96 (1.35, 2.84) of HGS and HR 1.76 (1.26, 2.47) of LMI for all-cause mortality after multivariate adjustment. The newly derived cut-off points of HGS have numerically higher prognostic values in all-cause mortality compared with those from current clinical guidelines, and agreement rates of HGS were 65.2 versus 62.5–64.6 respectively. The derived cut-off values of HGS and LMI have sufficient and better prognostic value in predicting all-cause mortality in PD patients compared with the cut-off values in the existing guidelines. These cut-off values are only validated in a single population, thus limiting the generalizability.

中文翻译：

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腹膜透析患者肌肉减少症握力和瘦体重指数的临界值

肌肉减少症很常见，并导致普通人群的高死亡率风险。在慢性肾脏病患者的死亡率方面，肌肉减少症的临界值尚未达成共识。本研究旨在探索和验证握力 (HGS) 和瘦体重指数 (LMI) 的截止点，以评估腹膜透析 (PD) 患者的死亡风险。这项单中心前瞻性队列研究在 2002 年 10 月至 2019 年 7 月期间招募了 1089 名 PD 患者。所有患者均被随访至死亡、转入血液透析、接受肾移植或研究结束日期（2019 年 12 月）。所有参与者被随机抽样到发展队列（70% 参与者）和验证队列（30% 参与者），按性别和糖尿病进行匹配。瘦体重是使用我们中心发布的公式计算的。三次样条回归分析用于检查 HGS 或 LMI 值与死亡率之间的关系，并探索在调整发展队列中的年龄、糖尿病、心血管疾病和血清白蛋白后的截止点。派生的临界值通过预测死亡率的一致率进行验证，然后与验证队列中各种临床指南的临界值进行比较。所有 1089 名患者均得到随访，中位数为 36.0（18.0，71.0）个月。在发育队列中，预测较高死亡率的截止点是男性和女性的 HGS 为 24.5 公斤和 14 公斤，男性和女性的 LMI 分别为 16.7 公斤/平方米和 13.8 公斤/平方米。在验证队列中，这些临界值显着预测更差的结果，在多变量调整后，HGS 的 HR 为 1.96 (1.35, 2.84)，LMI 的全因死亡率为 1.76 (1.26, 2.47)。与当前临床指南相比，新得出的 HGS 截止点在全因死亡率方面具有更高的预后价值，HGS 的一致率分别为 65.2 和 62.5-64.6。与现有指南中的临界值相比，得出的 HGS 和 LMI 临界值在预测 PD 患者全因死亡率方面具有充分和更好的预后价值。这些截止值仅在单个群体中验证，因此限制了普遍性。与当前临床指南相比，新得出的 HGS 截止点在全因死亡率方面具有更高的预后价值，HGS 的一致率分别为 65.2 和 62.5-64.6。与现有指南中的临界值相比，得出的 HGS 和 LMI 临界值在预测 PD 患者全因死亡率方面具有充分和更好的预后价值。这些截止值仅在单个群体中验证，因此限制了普遍性。与当前临床指南相比，新得出的 HGS 截止点在全因死亡率方面具有更高的预后价值，HGS 的一致率分别为 65.2 和 62.5-64.6。与现有指南中的临界值相比，得出的 HGS 和 LMI 临界值在预测 PD 患者全因死亡率方面具有充分和更好的预后价值。这些截止值仅在单个群体中验证，因此限制了普遍性。与现有指南中的临界值相比，得出的 HGS 和 LMI 临界值在预测 PD 患者全因死亡率方面具有充分和更好的预后价值。这些截止值仅在单个群体中验证，因此限制了普遍性。与现有指南中的临界值相比，得出的 HGS 和 LMI 临界值在预测 PD 患者全因死亡率方面具有充分和更好的预后价值。这些截止值仅在单个群体中验证，因此限制了普遍性。