Lean Mass Index Adjustment of eGFR Strengthens Associations with Cardiometabolic Risk Factors
Year: 2026
Type: article
Abstract: Background/Objectives The accurate estimation of glomerular filtration rate (GFR) is essential for assessing trends in the prevalence (CKD), yet standard serum creatinine (SCr)-based estimates (eGFRSCr) are limited by individual variations in muscle mass. While demographic surrogates like age and sex are typically used to account for these variations, they often lead to eGFR misclassification in individuals. This study investi-gated whether normalizing SCr to Dual-energy X-ray absorptiometry (DEXA)-derived Lean Mass Index (LMI) improves the association with cardiometabolic risk. Methods We analyzed data from 11,143 adults (mean age 46.0 ± 17.2 years) in the Austrian LEAD (Lung, hEart, sociAl, boDy) cohort. Individual SCr concentrations were normalized to sex- and age-specific LMI reference values to calculate LMI-adjusted eGFR (eGFRLMISCr). The strength of associations between eGFRSCr and eGFRLMISCr with cardiometabolic risk factors (dyslipidemia, hypertension, pre-diabetes/diabetes, and metabolic syndrome) was compared using age- and sex-adjusted logistic regression with bootstrap resampling. Results While eGFRSCr and eGFRLMISCr were highly correlated (R2 = 0.897), LMI adjust-ment led to significant reclassification between CKD stages G1, G2, and G3a. eGFRLMISCr demonstrated significantly stronger associations with dyslipidemia, arterial hyperten-sion, pre-diabetes/diabetes, and metabolic syndrome compared to standard eGFRSCr. Longitudinal analysis showed that LMI adjustment stabilizes eGFR change estimates, particularly in younger men. Conclusion Adjusting serum creatinine for LMI signifi-cantly enhances the epidemiological utility of GFR estimation. GFRLMISCr improves car-diometabolic risk stratification, potentially offering a valuable method to "salvage" the utility and comparability of eGFRSCr in historic cohorts in early-stage filtration impair-ment in settings where DEXA but not Cystatin C is available.
Source: Diagnostics
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,137
OpenAlex ID: W7169919611