Abstract
BACKGROUND: Chronic kidney disease (CKD) and sarcopenia are independently associated with adverse cardiovascular and mortality outcomes. However, the combined impact of CKD and sarcopenia remains poorly understood. To evaluate the combined effects of CKD and sarcopenia on cardiovascular disease (CVD) and mortality risks in a large population-based cohort. METHODS: We analyzed data from 477,380 participants in the UK Biobank, categorized into four groups based on the presence or absence of CKD and sarcopenia: Non-CKD Non-Sarcopenia, Non-CKD Sarcopenia, CKD Non-Sarcopenia, and CKD Sarcopenia. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for CVD and mortality outcomes. Kaplan-Meier survival analyses compared event-free survival across the groups. RESULTS: Participants with both CKD and sarcopenia exhibited the highest risks across all outcomes compared to those without either condition. For stroke, the adjusted HR was 2.17 (95% CI: 1.65-2.86), significantly higher than CKD alone (HR: 1.69, 95% CI: 1.47-1.94) or sarcopenia alone (HR: 1.28, 95% CI: 1.03-1.59). Similar trends were observed for coronary artery disease (CAD) and heart failure (HF), with HRs of 1.53 (95% CI: 1.38-1.69) and 2.22 (95% CI: 1.99-2.47), respectively, in the CKD-sarcopenia group. The coexistence of CKD and sarcopenia was also associated with significantly elevated all-cause mortality (HR: 2.59, 95% CI: 2.17-3.09) and cardiovascular-specific mortality (HR: 4.08, 95% CI: 2.95-5.66). CONCLUSION: The coexistence of CKD and sarcopenia significantly amplifies the risks of CVD and mortality, highlighting the need for integrated management strategies to address this high-risk population. Early detection and tailored interventions targeting these dual risk factors may mitigate their compounded burden and improve clinical outcomes.