Diabetic Kidney Disease Progression Associated With Changes in Muscle, Fat Amounts

A study published in Frontiers in Endocrinology found that diabetic kidney disease (DKD) progression in patients with type 2 diabetes (T2D) was associated with reduced rectus femoris cross-sectional area (RFCSA) and increased visceral fat area (VFA), which may make them valuable markers of DKD progression.

RFCSA, which is a measure of the muscle mass around the hip, and VFA, which measures the fat stored deep in the body around the organs, have an unknown association between each other and with the risk of DKD. VFA has been associated with insulin resistance and is a risk factor for T2D development. RFCSA measurement has been used to assess sarcopenia, characterized by loss of skeletal muscle strength, which is a complication of T2D. The present study aimed to define the relationships among RFCSA, VFA, and the prognostic risk of DKD.

The controlled, open-label, cross-sectional trial included patients who were older than 18 years and had a diagnosis of T2D. Patients were excluded if they had acute complications of diabetes, nondiabetic nephropathy, myasthenia or muscular atrophy, malignant tumors, chronic heart failure, severe liver disease, or uncontrolled hypertension, or were pregnant.

Clinical data were recorded for all participants. Estimated glomerular filtration rate was calculated with CKD-EPI. Laboratory measurements for blood urea nitrogen, creatinine, cystatin C, serum uric acid, and hemoglobin A_1c (HbA_1c) were collected. RFCSA was measured with ultrasonography and VFA was estimated with the Omron DUALSCAN BIA machine.

There were 879 patients included in the study, of whom 270 (30.72%) had a diagnosis of DKD. The patients were separated into 4 groups based on their risk classification: low risk, moderate risk, high risk, and very high risk. Male and female participants were split into 2 groups: the high- to very high-risk group and the low- to moderate-risk group. RFCSA was lower in the high to very high-risk group compared with the low- to moderate-risk group; VFA was higher in the high- to very high-risk group compared with the low- to moderate-risk group.

Spearman’s correlation was used to find the relationship between the prognostic risk of DKD and the clinical parameters of male and female patients. The prognostic risk of DKD was negatively correlated with RFCSA (male r, –0.138; female r, –0.194) and positively correlated with age (male r, 0.210; female r, 0.223), duration (male r, 0.291; female r, 0.212), triglycerides (male r, 0.103; female r, 0.124), and VFA (male r, 0.139; female r, 0.144); no significant association was found between HbA_1c and risk of DKD.

A multivariable logistic regression found that duration (b, 1.11; 95% CI, 1.07-1.16), RFCSA (b, 0.69; 95% CI, 0.57-0.83), and VFA (b, 1.01; 95% CI, 1.00-1.02) were found to be associated with high- to very high-risk prognosis of DKD in men with T2D. Women with T2D with a high- to very high-risk prognosis of DKD were also found to have a link to duration (b, 1.04; 95% CI, 1.01-1.07), RFCSA (b, 0.73; 95% CI, 0.59-0.91), and VFA (b, 1.01; 95% CI, 1.00-1.02).

There were some limitations to this study. Confounding factors like physical activity and use of antidiabetes medication could influence the results of this study. A cross-sectional trial was the source of the summarized conclusion. VFA was measured with a device that has seen limited validation.

The researchers concluded that decreased muscle mass in the lower limbs and increased VFA among patients with T2D were associated with the progression of DKD.

“Based on the conclusion of this study, for patients who have not yet developed DKD or are in the early stage of DKD, individualized lifestyle guidance…and reasonable hypoglycemic medicine selection should be given to increase muscle content and reduce abdominal fat, which may delay the occurrence and progress of DKD,” the authors wrote.

Reference

Lin X, Chen Z, Huang H, Zhong J, Xu L. Diabetic kidney disease progression is associated with decreased lower-limb muscle mass and increased visceral fat area in T2DM patients. Front Endocrinol. 2022;13:1002118. doi:10.3389/fendo.2022.1002118