Sarcopenic obesity and its relation with muscle quality and mortality in patients on chronic hemodialysis.

BACKGROUND & AIMS: Sarcopenia is prevalent in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), and is associated with poor outcomes, while obesity may be protective. Sarcopenic obesity is associated with increased frailty, morbidity and mortality in the general population. Myosteatosis, i.e., muscle fat infiltration, has major effects on muscle strength and physical performance, but is poorly investigated in the nephrology setting. In the present study we aimed to assess the association between sarcopenic obesity, as diagnosed by abdominal CT, and mortality. Moreover, the relationship between myosteatosis, sarcopenic obesity and mortality was also investigated. METHODS: This is a retrospective study in which ESKD patients on HD submitted to unenhanced abdominal CT for clinical reasons at least 6 months after dialysis initiation were evaluated for sarcopenic obesity and myosteatosis, defined as intermuscular fat area and low attenuation muscle area. Sarcopenic obesity was diagnosed in cases of low abdominal skeletal muscle area and high total fat area. Receiver-operating characteristics (ROC) analysis with Youden index was used to determine the cut-off for high total fat area. Intermuscular fat area and low attenuation muscle area were evaluated by applying the Hounsfield unit of interest (-190; -30, and -29; +29 respectively). Cox regression analysis was used to evaluate the association between predictors and mortality risk. RESULTS: We enrolled 212 patients, aged 68.8 (±14.7) years, 65.5% (139/212) male. Median follow-up was 19.7 (interquartile range [IQR] 2.7-35) months. Sarcopenic obesity was diagnosed in 19.8% of patients and was associated with increased mortality (HR: 3.29 (1.72; 6.27), P < 0.001), and with the presence of myosteatosis. Both intermuscular fat area and low attenuation muscle area were associated with increased mortality in adjusted analyses. CONCLUSIONS: Patients with sarcopenic obesity have increased myosteatosis. Sarcopenic obesity and myosteatosis are associated with increased mortality in patients on HD.

Very High Resolution Projections over Italy under different CMIP5 IPCC scenarios.

This paper introduces VHR-PRO_IT (Very High-Resolution PROjections for ITaly), an open access hourly climate projection with a resolution of ≃2.2 km (i.e., Convection Permitting Scale) up to 2050, covering the Italian peninsula and some neighbouring areas. VHR-PRO_IT is produced within the Highlander project ( https://highlanderproject.eu/ ) by dynamically downscaling the Italy8km-CM climate projection (spatial resolution ≃8 km; output frequency = 6 h; driven CMIP5 GCM = CMCC-CM) with the Regional Climate Model COSMO-CLM under the IPCC RCP4.5 and RCP8.5 scenarios. It covers the 60-year period 1989-2050. VHR-PRO_IT is intended for research purposes in the field of climate studies. For example, it may be included in the ongoing activities to clarify the added value of running climate simulation at the convection-permitting scale.