Diagnosis, prevalence, and mortality of sarcopenia in dialysis patients: a systematic review and meta‐analysis

Abstract

There is no consensus on the prevalence of sarcopenia or its impact on mortality in end-stage renal disease patients undergoing dialysis. This review aimed to summarize the diagnostic criteria of sarcopenia and its prevalence and impact on the mortality of end-stage renal disease patients undergoing dialysis. Embase, MEDLINE, PubMed, and Cochrane Library were searched from inception to 8 May 2021 to retrieve eligible studies that assessed muscle mass by commonly used instruments, such as dual-energy X-ray absorptiometry, bioelectrical impedance analysis, magnetic resonance imaging, and body composition monitor. Two assessment tools matched to study designs were employed to evaluate study quality. Pooled sarcopenia prevalence was calculated with 95% confidence interval (CI), and heterogeneity was estimated using the I 2 test. Associations of sarcopenia with mortality were expressed as hazard ratio (HR) and 95% CI. The search identified 3272 studies, and 30 studies (6162 participants, mean age from 47.5 to 77.5 years) were analysed in this review. The risk of bias in the included studies was low to moderate. Twenty-two studies defined sarcopenia based on low muscle mass (LMM) plus low muscle strength and/or low physical performance, while eight studies used LMM alone. Muscle mass was assessed by different instruments, and a wide range of cut-off points were used to define LMM. Overall, sarcopenia prevalence was 28.5% (95% CI 22.9-34.1%) and varied from 25.9% (I 2 = 94.9%, 95% CI 20.4-31.3%; combined criteria) to 34.6% (I 2 = 98.1%, 95% CI 20.9-48.2%; LMM alone) (P = 0.247 between subgroups). The statistically significant differences were not found in the subgroups of diagnostic criteria (P > 0.05) and dialysis modality (P > 0.05). Additionally, the sarcopenia prevalence could not be affected by average age [regression coefficient 0.004 (95% CI: À0.005 to 0.012), P = 0.406] and dialysis duration [regression coefficient 0.002 (95% CI À0.002 to 0.005), P = 0.327] in the meta-regression. The pooled analyses showed that combined criteria of sarcopenia were related to a higher mortality risk [HR 1.82 (I 2 = 26.3%, 95% CI 1.38-2.39)], as was LMM [HR 1.61 (I 2 = 26.0%, 95% CI 1.31-1.99)] and low muscle strength [HR 2.04 (I 2 = 80.4%, 95% CI 1.19-3.5)]. Although there are substantial differences in diagnostic criteria, sarcopenia is highly prevalent in dialysis patients and is linked to increased mortality. The standardization of sarcopenia diagnostic criteria would be beneficial, and future longitudinal studies are needed to investigate the prevalence and prognostic value of sarcopenia in dialysis patients.

The Impact of Falls: A Qualitative Study of the Experiences of People Receiving Haemodialysis

“…Such strategies have, however, been linked to further weakness, mobility limitations increasing the risk of future falls and, as was the case within our study, social isolation, and loneliness [ 44 ]. These issues may be particularly problematic in the HD population who already have a high burden of sarcopenia, frailty and treatment, and low levels of social participation [ 47 , 48 , 49 ]. Our findings indicate that more effective strategies for falls prevention in the HD population are urgently required.…”

Comparison of various indices for predicting sarcopenia and its components in patients receiving peritoneal dialysis

“…In our study, the prevalence of sarcopenia was 37.7%. A recent meta-analysis showed that the prevalence of sarcopenia in patients receiving PD was 4-48% 5 . Although the prevalence range is very wide due to the different criteria applied for sarcopenia and ethnicities, the prevalence of sarcopenia in our study is within the range reported in previous studies.…”

Frailty, multimorbidity and sarcopaenia in haemodialysis patients

“…Using a nutritional risk index, higher scores indicating worse nutritional state were found to be associated with lower muscle mass, lower strength, and lower physical performance in haemodialysis patients [37]. Similar to the general population, sarcopaenia has been found to be associated with increased frailty and higher rates of mortality [38 ▪ ,39]. The prevalence of sarcopaenia in older haemodialysis patients was found to be between 37 and 40% [40].…”