Calf Knows Best: Gastrocnemius Sonoelastography as a Sensitive Marker of Muscle Mass in End-Stage Kidney Disease

Calf Knows Best: Gastrocnemius Sonoelastography as a Sensitive Marker of Muscle Mass in End-Stage Kidney Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Calf Knows Best: Gastrocnemius Sonoelastography as a Sensitive Marker of Muscle Mass in End-Stage Kidney Disease Ying-Chou Chen, Jia-Feng Chen, Shan-Fu Yu, Chung-Yuan Hsu, Wen-Chan Chiu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7942178/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Muscle loss and weakness are hallmarks of end-stage kidney disease (ESKD), driving disability and poor outcomes. Traditional assessments of muscle health are often invasive, time-consuming, or insensitive. Sonoelastography, which quantifies muscle stiffness, offers a noninvasive alternative. Yet, the optimal muscle group for detecting sarcopenia in ESKD remains unclear. Methods : In this prospective cohort study, 150 ESKD patients (mean age 64.7 ± 13.5 years; BMI 23.9 ± 4.3 kg/m²) underwent sonoelastography of five muscle groups: biceps, supinator, erector spinae, quadriceps, and gastrocnemius. Each site was measured three times over 3-month intervals. Muscle mass was evaluated using dual-energy X-ray absorptiometry (DXA) as appendicular lean mass/height² (ALM/H²). Correlations between Hard (%) values and ALM/H² were examined with Pearson's correlation and multivariable regression models. Results : Among all examined muscles, gastrocnemius Hard (%) emerged as the most robust correlate of ALM/H² (r = 0.471, p < 0.001), outperforming upper- and trunk-limb muscles. Regression analysis confirmed gastrocnemius stiffness as an independent predictor of muscle mass (ß = 0.497, p = 0.001), even after adjusting for demographic and clinical confounders. Conclusion : The calf muscle, often overlooked in routine assessments, outperformed other muscle groups as the most sensitive sonoelastographic marker of muscle mass in ESKD. This finding highlights the gastrocnemius as a practical"sentinel muscle" for noninvasive monitoring of sarcopenia in dialysis populations. End-stage kidney disease (ESKD) Sarcopenia Muscle sonoelastography Gastrocnemius stiffness Muscle mass assessment Appendicular lean mass (ALM) Figures Figure 1 Figure 2 Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7942178","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":543110371,"identity":"0c9c5cd9-f292-42ea-80a3-cfaefc8bd694","order_by":0,"name":"Ying-Chou 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03:05:28","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":119549,"visible":true,"origin":"","legend":"","description":"","filename":"8ea5acd9253d4404a4893e268ab7502c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7942178/v1/952287e3fdbf17be905ba5fe.xml"},{"id":96228169,"identity":"42f67e1c-efdd-4ad5-8a15-2a211c20535c","added_by":"auto","created_at":"2025-11-19 03:05:28","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":132999,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7942178/v1/95d811e2ae1bf587404c0c29.html"},{"id":96228161,"identity":"eca282bf-fa2a-40d2-a590-518a88007ddc","added_by":"auto","created_at":"2025-11-19 03:05:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":958889,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative sonoelastography image of the gastrocnemius muscle in a 72-year-old woman with end-stage kidney disease (ESKD). The left panel shows the B-mode ultrasound image, while the right panel displays the corresponding elastography color map. The region of interest (ROI, circle) was analyzed to quantify muscle stiffness, yielding a hardness value of 43.45%. The patient's appendicular lean mass index (ALM/H²) was 4.23 kg/m², consistent with reduced muscle mass.\u003c/p\u003e","description":"","filename":"figure1sonoelastographyESKD.png","url":"https://assets-eu.researchsquare.com/files/rs-7942178/v1/c8873001bd3eadb2eb622bb8.png"},{"id":96228160,"identity":"24505632-f415-4386-91b6-947dfa2b834e","added_by":"auto","created_at":"2025-11-19 03:05:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":202435,"visible":true,"origin":"","legend":"\u003cp\u003eComparative correlation of muscle stiffness with muscle mass across five muscle groups in ESKD. The bar chart illustrates Pearson's correlation coefficients (r) between sonoelastographic muscle stiffness (Hard %) and appendicular lean mass/height² (ALM/H²). Among the examined muscle groups (biceps, rotator cuff, erector spinae, quadriceps, and gastrocnemius), the gastrocnemius demonstrated the strongest association with muscle mass (r = 0.47, p\u0026lt; 0.001), highlighting its potential as a sensitive marker for sarcopenia monitoring in ESKD patients.\u003c/p\u003e","description":"","filename":"Fig2.comparisonmuscles2line.png","url":"https://assets-eu.researchsquare.com/files/rs-7942178/v1/e6112ea2e0c17f2c45889643.png"},{"id":105564667,"identity":"b82d4e63-0a10-40c9-be1c-f2332991d849","added_by":"auto","created_at":"2026-03-27 12:50:26","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":691425,"visible":true,"origin":"","legend":"","description":"","filename":"CalfKnowsBestRevisedAffiliations.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7942178/v1_covered_9f289036-9112-48d6-9a9e-fc8d82a91f8b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Calf Knows Best: Gastrocnemius Sonoelastography as a Sensitive Marker of Muscle Mass in End-Stage Kidney Disease","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"End-stage kidney disease (ESKD), Sarcopenia, Muscle sonoelastography, Gastrocnemius stiffness, Muscle mass assessment, Appendicular lean mass (ALM)","lastPublishedDoi":"10.21203/rs.3.rs-7942178/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7942178/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eMuscle loss and weakness are hallmarks of end-stage kidney disease (ESKD), driving disability and poor outcomes. Traditional assessments of muscle health are often invasive, time-consuming, or insensitive. Sonoelastography, which quantifies muscle stiffness, offers a noninvasive alternative. Yet, the optimal muscle group for detecting sarcopenia in ESKD remains unclear.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eIn this prospective cohort study, 150 ESKD patients (mean age 64.7 ± 13.5 years; BMI 23.9 ± 4.3 kg/m²) underwent sonoelastography of five muscle groups: biceps, supinator, erector spinae, quadriceps, and gastrocnemius. Each site was measured three times over 3-month intervals. Muscle mass was evaluated using dual-energy X-ray absorptiometry (DXA) as appendicular lean mass/height² (ALM/H²). Correlations between Hard (%) values and ALM/H² were examined with Pearson's correlation and multivariable regression models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eAmong all examined muscles, gastrocnemius Hard (%) emerged as the most robust correlate of ALM/H² (r = 0.471, p \u0026lt; 0.001), outperforming upper- and trunk-limb muscles. Regression analysis confirmed gastrocnemius stiffness as an independent predictor of muscle mass (ß = 0.497, p = 0.001), even after adjusting for demographic and clinical confounders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe calf muscle, often overlooked in routine assessments, outperformed other muscle groups as the most sensitive sonoelastographic marker of muscle mass in ESKD. This finding highlights the gastrocnemius as a practical\"sentinel muscle\" for noninvasive monitoring of sarcopenia in dialysis populations.\u003c/p\u003e","manuscriptTitle":"Calf Knows Best: Gastrocnemius Sonoelastography as a Sensitive Marker of Muscle Mass in End-Stage Kidney Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 03:05:23","doi":"10.21203/rs.3.rs-7942178/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e1d113ba-bf28-4d0e-8046-71e738ada393","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-24T08:28:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 03:05:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7942178","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7942178","identity":"rs-7942178","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}