Impact of diabetes on sarcopenia and mortality in patients undergoing hemodialysis

Abstract

Background Sarcopenia has become a serious disorder in modern society. Chronic kidney disease requiring dialysis and diabetes are some of the disorders that accelerate the onset and progression of sarcopenia. We, therefore, investigated the prevalence of sarcopenia in patients undergoing hemodialysis (HD) and confirmed the impact of diabetes mellitus (DM) on this population. Methods This study included 308 patients whose muscle strength and mass had been evaluated using handgrip strength and dual-energy X-ray absorptiometry, respectively. Sarcopenia was defined according to the criteria established by the Asian Working Group on Sarcopenia. In addition, this cohort had been followed up for 9 years. Results The prevalence of sarcopenia was 40% (37% in males and 45% in females) with gender differences being insignificant ( p = 0.237). The DM morbidity rate was significantly higher in those with sarcopenia than in those without sarcopenia (41% vs. 27%, p = 0.015). Multivariate regression analyses showed that the presence of DM was an independent contributor to sarcopenia in patients undergoing HD (odds ratio 3.11; 95% confidence interval 1.63–5.93; p < 0.001). During the follow-up of 76 ± 35 months, 100 patients died. Patients with sarcopenia demonstrated significantly higher rates of all-cause mortality than those without sarcopenia (p < 0.001 using the log-rank test). Multivariate Cox proportional hazards analyses revealed that the presence of DM was significantly associated with higher all-cause mortality (adjusted hazard ratio: 2.39; 95% confidence interval 1.51–3.81; p < 0.001). Conclusions The prevalence of sarcopenia among this cohort of patients undergoing HD was determined to be 40%. Moreover, the presence of DM was an independent contributor to sarcopenia and an independent predictor of all-cause mortality in this population. Electronic supplementary material The online version of this article (10.1186/s12882-019-1271-8) contains supplementary material, which is available to authorized users.

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

“…These findings suggest that uremia may have a role in the pathogenesis AF, but the mechanism remains to be investigated. While a previous 9-year cohort study in Japan showed that DM was highly associated with all-cause mortality in patients undergoing hemodialysis (adjusted HR: 2.39; p < 0.001) [26], the present study showed that DM was not significantly associated with the risk of mortality. This discrepancy may result from the difference in race, glucose control status or relative short study period of the present study.…”

Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

“…The inverse relationship between Kt/V and physical performance was consistently shown in other studies, suggesting that this relationship is likely to be a universal phenomenon [24,34,36,46]. We speculate that the low muscle mass and subsequent decreased volume of distribution of urea in the body (V) in patients with low GS and HS resulted in a relative increase in the value of Kt/V without affecting the true dialysis efficacy [47].…”

“…Compared to the elderly population, in which the prevalence of sarcopenia is 11% [33], CKD patients are likely to be much more prone to its occurrence, with an estimated prevalence of 30 -60% [20,21,24,[34][35][36]. The two main components of sarcopenia, muscle strength and mass, are dissociated in the setting of ESRD, and the muscle strength is more important than muscle mass in terms of patient outcomes [20,35].…”

“…As shown in Table 2, GS and HS were significantly associated with comorbidity scores and poor physical status (Charlson comorbidity scores of 4 [2,4] vs. 4 [3,5] vs. 5 [3,5] vs. 5 [4,5] and Liu comorbidity scores of 4 [3,5] vs. 4 [3,6] vs. 6 [4,7] vs. 6 [4,7] for the normal GS and HS, normal GS and low HS, low GS and normal HS, and low GS and HS groups, respectively; p < 0.001 for both comparisons). In addition, patients with low GS and HS showed profoundly impaired cognitive functioning as assessed by the MMSE and the KDQOL-SF (28 [26,29] vs. 27 [24,28] vs. 27 [25,30] vs. 27 [23,29] low GS and HS groups; p = 0.030 and 0.007, respectively). The social activity index was relatively maintained in the low GS and HS groups.…”

Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

“…Compared to the elderly population, in which the prevalence of sarcopenia is 11% [32], CKD patients are likely to be much more prone to its occurrence, with an estimated prevalence of 30 -60% [20,21,24,[33][34][35]. The two main components of sarcopenia, muscle strength and mass, are dissociated in the setting of ESRD, and the muscle strength is more important than muscle mass in terms of patient outcomes [20,34].…”