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Protein, malnutrition and wasting disorders

Lower thigh muscle mass is associated with all-cause and cardiovascular mortality in elderly hemodialysis patients



Higher body mass index appears protective in hemodialysis patients, although it remains to be determined which component of muscle or fat mass is primarily associated with this survival advantage.


Eighty-one hemodialysis patients in our institution were prospectively followed from July 2011 to August 2015. Muscle and fat mass were evaluated by measuring the cross-sectional areas of the thigh and abdomen using computed tomography. The relationship between muscle and fat mass, and all-cause and cardiovascular mortality was studied using the Kaplan–Meier analyses and multivariate Cox proportional hazard models.


During more than 4 years of follow-up, 26 patients (32%) died. In the Kaplan–Meier curve analyses, lower thigh muscle mass was significantly associated with all-cause and cardiovascular mortality (log-rank test, P<0.01 and P<0.001, respectively), but there was no such association with thigh fat, abdominal muscle and fat mass levels. In multivariate Cox proportional hazard models, each 0.1 cm2/kg increase in the thigh muscle area adjusted by dry weight was associated with an estimated 22% lower risk of all-cause mortality (95% confidence interval (95% CI), 0.64–0.95, P<0.05) and a 30% lower risk of cardiovascular mortality (95% CI, 0.54–0.90, P<0.01).


Lower thigh muscle mass is significantly associated with all-cause and cardiovascular mortality in hemodialysis patients. Our findings indicate the importance of focusing on the muscle mass of lower extremities to predict the clinical outcomes of hemodialysis patients.

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We thank Dr Kazuhiro Saisu (Juzen hospital, Hamamatsu, Japan) for providing the clinical advice and information. This work was supported by grants from The Kidney Foundation, Japan (JKFB 15–19).

Author contributions

HF, HY, HK and RF designed the study. MK, HN and TM were involved in the data acquisition. HF, HK and RF carried out the statistical analysis and drafted the manuscript. All authors read, revised and approved the final version of manuscript.

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Correspondence to H Fukasawa.

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Fukasawa, H., Kaneko, M., Niwa, H. et al. Lower thigh muscle mass is associated with all-cause and cardiovascular mortality in elderly hemodialysis patients. Eur J Clin Nutr 71, 64–69 (2017).

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