Archives of Gerontology and Geriatrics · Nov 2026
Possible Sarcopenia, Abdominal Obesity, and All-Cause Mortality in Middle-Aged and Older Adults with Chronic Kidney Disease: A Dual-Cohort Study
By Fu M, Wang Y, Chen S et al.
Background Possible sarcopenia (low muscle strength) is a strong predictor of mortality in chronic kidney disease (CKD). While abdominal obesity is prevalent, whether it predicts mortality or modifies the association between muscle weakness and mortality remains controversial. We investigated their independent and joint associations with all-cause mortality in CKD. Methods This study analyzed adults with CKD aged ≥45 years from CHARLS (n=1,005) and NHANES (n=1,070). Participants were categorized into four phenotypes: NPS/NAO (neither condition), NPS/AO (abdominal obesity alone), PS/NAO (possible sarcopenia alone), and PS/AO (both conditions). Mortality risk was evaluated using multivariable Cox models and restricted cubic splines. Results PS/NAO was associated with elevated all-cause mortality (adjusted HR in CHARLS: 1.980, 95% CI 1.333–2.941; NHANES: 2.191, 1.194–4.020). The estimate for PS/AO was less precise and did not reach statistical significance (CHARLS: 1.288, 0.711–2.333; NHANES: 1.171, 0.661–2.075). Direct comparisons and interaction analyses revealed no evidence that abdominal obesity modified the mortality risk associated with possible sarcopenia. No significant association was observed between NPS/AO and mortality. Handgrip strength showed an inverse linear association with mortality, whereas waist circumference provided neither independent nor incremental prognostic value. Conclusions Possible sarcopenia independently predicts all-cause mortality in CKD, though this association did not retain statistical significance in CHARLS when restricted to participants with eGFR <60 mL/min/1.73 m². Waist circumference provides no incremental prognostic value beyond handgrip strength, and the study was underpowered to characterize the concurrent phenotype. Prognostic evaluation in CKD should focus on routine muscle strength assessment rather than abdominal adiposity. Clinical trial number not applicable.