Cardiometabolic index (CMI) and sarcopenia as predictors of all-cause and cardiovascular mortality in chronic kidney disease: a NHANES-based cohort study.
Elevated CMI and sarcopenia are associated with increased mortality risk in CKD patients, particularly when both are present.
Where it sits
this study against the rest of the ace-031 (acvr2b-fc) corpusSummary and findings
This study investigated the impact of Cardiometabolic Index (CMI) and sarcopenia on all-cause and cardiovascular mortality in chronic kidney disease (CKD) patients using NHANES data from 1999-2006 and 2011-2018. A total of 1,886 CKD patients were analyzed, revealing that high CMI and sarcopenia were associated with increased mortality risks. The highest risk was observed in patients with both conditions.
Abstract
The Cardiometabolic Index (CMI) reflects visceral adiposity and lipid dysregulation, while sarcopenia indicates skeletal muscle depletion, both representing metabolic and functional decline in chronic kidney disease (CKD). This study aimed to investigate the impact of CMI and sarcopenia, as well as their integration into a metabolico-muscular composite risk model, on all-cause and cardiovascular mortality in CKD patients. Based on data from the National Health and Nutrition Examination Survey spanning 1999-2006 and 2011-2018, a total of 1,886 CKD patients were included. Kaplan-Meier survival analysis, multivariable Cox proportional hazards models, restricted cubic spline regression, and subgroup analyses were employed for assessment, while time-dependent receiver operating characteristic analysis was used to evaluate predictive performance. Results showed that patients with both high CMI and sarcopenia had the lowest survival rate. After multivariable adjustment, Cox regression demonstrated that patients in the highest CMI quartile had significantly increased risks of all-cause mortality (HR = 2.25, 95% CI: 1.35-3.73) and cardiovascular mortality (HR = 4.03, 95% CI: 1.52-10.70). Sarcopenia was also associated with increased risks of both mortality types (all-cause: HR = 1.27, 95% CI: 1.10-2.49; cardiovascular: HR = 1.12, 95% CI: 1.06-2.21). Further analysis identified nonlinear relationships between CMI and both all-cause and cardiovascular mortality, regardless of sarcopenia status. This longitudinal cohort study demonstrates that elevated CMI and sarcopenia are independently associated with increased mortality risk in CKD patients, with the highest risk observed when both conditions coexist. Therefore, this study positions CMI and sarcopenia as prognostic biomarkers for mortality risk stratification in CKD.
Background
Chronic kidney disease (CKD) is associated with increased risk of mortality, and understanding predictors of this risk is crucial for patient management. The Cardiometabolic Index (CMI) and sarcopenia are potential indicators of metabolic and functional decline in CKD. This study aims to evaluate the prognostic value of these indicators for mortality in CKD patients, which could aid in risk stratification and management.
Methods
This was a cohort study using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2006 and 2011-2018. A total of 1,886 CKD patients were included. The study employed Kaplan-Meier survival analysis, multivariable Cox proportional hazards models, restricted cubic spline regression, and subgroup analyses. Time-dependent receiver operating characteristic analysis was used to evaluate predictive performance.
Results
The study found that patients with high CMI and sarcopenia had the lowest survival rates. After multivariable adjustment, the highest CMI quartile was associated with significantly increased risks of all-cause mortality (HR = 2.25, 95% CI: 1.35-3.73) and cardiovascular mortality (HR = 4.03, 95% CI: 1.52-10.70). Sarcopenia was also associated with increased risks of all-cause mortality (HR = 1.27, 95% CI: 1.10-2.49) and cardiovascular mortality (HR = 1.12, 95% CI: 1.06-2.21). Nonlinear relationships between CMI and mortality were identified.
Interpretation
The findings suggest that CMI and sarcopenia are independent predictors of mortality in CKD patients, with the highest risks observed when both conditions are present. The effect sizes are statistically significant, but the clinical significance, particularly for sarcopenia, may be modest given the hazard ratios. The study's observational nature and reliance on NHANES data limit causal conclusions and may introduce bias.
Key findings
- HR = 2.25 for all-cause mortality in highest CMI quartile, 95% CI: 1.35-3.73
- HR = 4.03 for cardiovascular mortality in highest CMI quartile, 95% CI: 1.52-10.70
- HR = 1.27 for all-cause mortality with sarcopenia, 95% CI: 1.10-2.49
- HR = 1.12 for cardiovascular mortality with sarcopenia, 95% CI: 1.06-2.21
- Nonlinear relationships between CMI and mortality observed
Limitations
- observational study design
- potential selection bias from NHANES data
- limited causal inference
- nonlinear relationships complicate interpretation