Association between the psoas muscle index and hospitalization for pneumonia in patients undergoing hemodialysis

Abstract

Background Although muscle mass loss and pneumonia are common and crucial issues in hemodialysis (HD) patients, few reports have focused on their association, which remains unclear. This study assessed the association between skeletal muscle mass and the incidence of pneumonia in HD patients using the psoas muscle index (PMI). Methods This retrospective study included 330 patients on HD who were treated at a single center between July 2011 and June 2012. The observation period was between July 2011 and June 2021. Demographic, clinical, and HD data were collected, and the associations between PMI and hospitalization due to bacterial pneumonia were evaluated using Cox proportional hazards models adjusted for patients’ background data. Additionally, the correlation between patient characteristics and PMI was evaluated using multivariable linear regression. Results Among 330 patients (mean age, 67.3 ± 13.3; 56.7% male; median dialysis vintage 58 months, (interquartile range [IQR] 23–124), 79 were hospitalized for pneumonia during the observation period (median observation period was 4.5 years [IQR 2.0–9.1]). The multivariable Cox proportional analysis, which was adjusted for age, sex, dialysis vintage, diabetes mellitus, and stroke history and considered death as a competing risk, indicated that decreased PMI/(standard deviation) was closely associated with the development of pneumonia (hazard ratio: 0.67, 95% confidence interval: 0.47–0.95, p = 0.03). Conclusions Skeletal muscle mass was associated with the development of pneumonia in patients on HD and could be a useful marker for the risk of pneumonia.

Survival and cognitive deterioration in elderly patients undergoing hemodialysis

“…Given that the serum creatinine level was significantly lower in both the MCI and suspected dementia groups than in the normal group, cognitive dysfunction may be associated with loss of muscle mass. Moreover, muscle mass loss is associated with mortality in patients undergoing hemodialysis 13,26,27 …”

“…Moreover, muscle mass loss is associated with mortality in patients undergoing hemodialysis. 13,26,27 Malnutrition, which is an important aspect of frailty, is associated with cognitive impairment in patients undergoing hemodialysis. 23 Based on logistic regression analysis in this study, GNRI has a negative impact on cognitive function.…”

Importance of feeding status evaluation in older patients undergoing hemodialysis

“…One aspect is low BMI as a cause of poor feeding status; BMI is related with swallowing function that is associated with muscle mass. Previous studies have suggested that patients undergoing hemodialysis tend to lose their muscle mass, which leads to weakened swallowing function [20][21][22]. A decrease in muscle mass results in weakness [23] and loss of mobility [24]; these changes can negatively correlate with the effective flow of swallowed materials [2].…”