#2079 The impact of body composition measures on survival and cardiovascular events in patients with chronic kidney disease

Abstract Background and Aims Multimorbidity, frailty and sarcopenia are increasingly prevalent in people with chronic kidney disease (CKD). Creatinine Muscle Index (CMI) has been proposed as a novel surrogate marker of muscle mass, and lower CMI was associated with frailty and increased mortality in the Atherosclerosis Risk in Community Study 1. Waist to hip ratio (WHR) has also been proposed as a surrogate marker of visceral adiposity. In order to investigate the impact of body composition on outcomes, we analysed data collected from a large CKD cohort using CMI and WHR as markers of muscle mass and adiposity respectively to examine their effects on 5-year survival and cardiovascular events. Method 1741 people with CKD stage 3 were recruited from 32 primary care practices. Cystatin C was measured using the Abbott c16000 Analyser (Abbott Diagnostics). eGFR cystatin (eGFRcys) was calculated using the CKD-EPI Cystatin C Equation (2012). CMI was calculated as the product of serum creatinine and eGFRcys (CMI mg/day per 1.73 m2= eGFRcys ml/min per 1.73 m2 × serum creatinine mg/dl × 1 dl/100 ml × 1440 min/day). Cox proportional hazard model was used to examine if CMI and WHR predicted death or cardiovascular events. Results Mean age of the participants was 72.9 ± 9 years. Mean eGFRCr was 53.5 ± 11.8 ml/min/1.73 m2. Mean eGFRcys was 45.1 ± 16.0 ml/min/1.73 m2. Mean CMI was 766.45 ± 239.2 mg/day/1.73 m2. 300 (17.2%) participants died during 5 years of observation. In a Cox proportional hazards model which included CMI, WHR and age, lower CMI per standard deviation change (B = −0.202, HR 0.817, p = 0.007), higher WHR per standard deviation change (B = 0.313, HR 1.37, p 0.001) and age at baseline (B = 0.088, HR 1.09, p 0.001) were independent predictors of mortality at year 5 of follow-up. CMI per standard deviation change also predicted cardiovascular events at 5 years using a univariable cox proportional hazards model, (B = −0.095, HR 0.91, p = 0.03). Conclusion Lower CMI (a surrogate measure of muscle mass) and higher WHR (a surrogate for visceral adiposity) independently predicted 5 year mortality and cardiovascular events in this predominantly elderly population with CKD stage 3. We conclude that body composition has an important impact on mortality and cardiovascular events in patients with CKD and the mechanisms of this merits further investigation. This could inform future interventions that reduce visceral adiposity and improve muscle mass in people with CKD.