Please use this identifier to cite or link to this item:
Title: Quality over quantity? Effects of skeletal muscle myosteatosis and fibrosis on physical functioning in chronic kidney disease
Authors: Wilkinson, Thomas J.
Gould, Douglas W.
Nixon, Daniel G. D.
Watson, Emma L.
Smith, Alice C.
First Published: 22-Jun-2018
Publisher: Oxford University Press (OUP) for European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
Citation: Nephrology Dialysis Transplantation, 2018, gfy139
Abstract: Background Chronic kidney disease (CKD) is characterised by adverse changes in body composition, which are associated with poor clinical outcome and physical functioning. Whilst size is key for muscle functioning, changes in muscle quality specifically increase in intramuscular fat infiltration (myosteatosis) and fibrosis (myofibrosis) may be important. We investigated the role of muscle quality and size on physical performance in non-dialysis CKD patients. Methods Ultrasound (US) images of the rectus femoris (RF) were obtained. Muscle quality was assessed using echo intensity (EI), and qualitatively using Heckmatt’s visual rating scale. Muscle size was obtained from RF cross-sectional area (RF-CSA). Physical function was measured by the sit-to-stand-60 (STS-60) test, incremental (ISWT) and endurance shuttle walk tests (ESWT), lower limb and handgrip strength, exercise capacity (VO2peak), and gait speed. Results patients (58.5±14.9) years, 46% female, eGFR 31.1±20.2 mL/min/1.73m2 40 ) were recruited. Lower EI (i.e. higher muscle quality) was significantly associated with better physical performance [STS-60 (r=.363) and ISWT (r=.320)], and greater VO2peak (r=.439). The qualitative rating were closely associated with EI values, and significant differences in function was seen between the ratings. RF-CSA was a better predictor of performance than muscle quality. Conclusions In CKD, increased US-derived EI was negatively correlated with physical performance, however, muscle size remains the largest predictor of physical function. Therefore, in addition to the loss of muscle size, muscle quality should be considered an important factor that may contribute to deficits in mobility and function in CKD. Interventions such as exercise could improve both of these factors.
DOI Link: 10.1093/ndt/gfy139
ISSN: 0931-0509
eISSN: 1460-2385
Embargo on file until: 22-Jun-2019
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2018, OUP. Deposited with reference to the publisher’s open access archiving policy. (
Description: The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.
Appears in Collections:Published Articles, Dept. of Infection, Immunity and Inflammation

Files in This Item:
File Description SizeFormat 
Wilkinson+et+al_Quality+over+quantity+in+CKD+manuscript_NDT_REVISION+3_CLEAN+VERSION.pdfPost-review (final submitted author manuscript)2.33 MBAdobe PDFView/Open

Items in LRA are protected by copyright, with all rights reserved, unless otherwise indicated.