Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients

Joanna Sophia J Vinke, Hanneke J C M Wouters, Suzanne P Stam, Rianne M Douwes, Adrian Post, Antonio W Gomes-Neto, Melanie M van der Klauw, Stefan P Berger, Stephan J L Bakker, TransplantLines Investigators, Martin H De Borst, Michele F Eisenga, C Annema, S J L Bakker, S P Berger, H Blokzijl, F A J A Bodewes, M T de Boer, K Damman, M H De Borst, A Diepstra, G Dijkstra, R M Douwes, M F Eisenga, M E Erasmus, C T Gan, A W Gomes-Neto, E Hak, B G Hepkema, F Klont, T J Knobbe, D Kremer, H G D Leuvenink, W S Lexmond, V E de Meijer, H G M Niesters, L J van Pelt, R A Pol, R J Porte, A V Ranchor, J S F Sanders, J C Schutten, M J Siebelink, R H J A Slart, J C Swarte, D J Touw, M C van den Heuvel, C van Leer-Buter, M van Londen, E A M Verschuuren, M J Vos, R K Weersma, Joanna Sophia J Vinke, Hanneke J C M Wouters, Suzanne P Stam, Rianne M Douwes, Adrian Post, Antonio W Gomes-Neto, Melanie M van der Klauw, Stefan P Berger, Stephan J L Bakker, TransplantLines Investigators, Martin H De Borst, Michele F Eisenga, C Annema, S J L Bakker, S P Berger, H Blokzijl, F A J A Bodewes, M T de Boer, K Damman, M H De Borst, A Diepstra, G Dijkstra, R M Douwes, M F Eisenga, M E Erasmus, C T Gan, A W Gomes-Neto, E Hak, B G Hepkema, F Klont, T J Knobbe, D Kremer, H G D Leuvenink, W S Lexmond, V E de Meijer, H G M Niesters, L J van Pelt, R A Pol, R J Porte, A V Ranchor, J S F Sanders, J C Schutten, M J Siebelink, R H J A Slart, J C Swarte, D J Touw, M C van den Heuvel, C van Leer-Buter, M van Londen, E A M Verschuuren, M J Vos, R K Weersma

Abstract

Background: Post-transplant anaemia and reduced muscle mass and strength are highly prevalent in kidney transplant recipients (KTRs). Decreased haemoglobin levels, a marker of anaemia, could adversely affect muscle mass and strength through multiple mechanisms, among others, through diminished tissue oxygenation. We aimed to investigate the association between haemoglobin levels with muscle mass and strength in KTRs.

Methods: We included stable KTRs from the TransplantLines Biobank and Cohort study with a functional graft ≥1 year post-transplantation. Muscle mass was assessed using 24 h urinary creatinine excretion rate (CER) and bioelectrical impedance analysis (BIA). Muscle strength was assessed with a handgrip strength test using a dynamometer and, in a subgroup (n = 290), with the five-times sit-to-stand (FTSTS) test. We used multivariable linear and logistic regression analyses to investigate the associations of haemoglobin levels with muscle mass and strength.

Results: In 871 included KTRs [median age 58 (interquartile range (IQR), 48-66)] years; 60% men; eGFR 51 ± 18 mL/min/1.73 m2 ) who were 3.5 (1.0-10.2) years post-transplantation, the mean serum haemoglobin level was 13.9 ± 1.8 g/dL in men and 12.8 ± 1.5 g/dL in women. Lower haemoglobin levels were independently associated with a lower CER (std. β = 0.07, P = 0.01), BIA-derived skeletal muscle mass (std. β = 0.22, P < 0.001), handgrip strength (std. β = 0.15, P < 0.001), and worse FTSTS test scores (std. β = -0.17, P = 0.02). KTRs in the lowest age-specific and sex-specific quartile of haemoglobin levels had an increased risk of being in the worst age-specific and sex-specific quartile of CER (fully adjusted OR, 2.09; 95% CI 1.15-3.77; P = 0.02), handgrip strength (fully adjusted OR, 3.30; 95% CI 1.95-5.59; P < 0.001), and FTSTS test score (fully adjusted OR, 7.21; 95% CI 2.59-20.05; P < 0.001).

Conclusions: Low haemoglobin levels are strongly associated with decreased muscle mass and strength in KTRs. Future investigation will need to investigate whether maintaining higher haemoglobin levels may improve muscle mass and strength in KTRs.

Trial registration: ClinicalTrials.gov NCT03272841.

Keywords: 24 h urinary creatinine excretion; Haemoglobin levels; Handgrip strength; Kidney transplant recipients.

Conflict of interest statement

The authors declare no conflict of interest.

© 2022 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

Figures

Figure 1
Figure 1
Haemoglobin levels and measurements of muscle mass and strength. The correlation and Spearman's rank correlation coefficient between haemoglobin levels and creatinine excretion rate (CER) (A), appendicular skeletal muscle mass (ASMM) (B), handgrip strength (C), and five times sit to stand test score (FTSTS) (D). The grey area represents the 95% confidence interval of the regression line. Data on CER available in 871 KTRs, data on ASMM available in 814 KTRs, data on handgrip strength available in 854 KTRs, and data on FTSTS available in 290 KTRs.

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