One‐year change in sarcopenia was associated with cognitive impairment among haemodialysis patients

Abstract

BackgroundOur study aimed to evaluate change in sarcopenia, its defining components over 1 year follow‐up and investigate associations with subsequent cognitive decline, incident mild cognitive impairment (MCI) and dementia among patients undergoing haemodialysis (HD).MethodsIn the multicentre, longitudinal study, 1117 HD patients aged 56.8 ± 14.3 years (654 men; and 463 women) from 17 dialysis centres in Guizhou Province, China, were recruited in 2019 and followed up for 1 year in 2020. Sarcopenia was diagnosed with Asian Working Group for Sarcopenia criteria using appendicular skeletal muscle mass index (ASMI) and handgrip strength (HGS). Body composition was measured using body composition monitor; body water, weight, and height were corrected to calculate ASMI. HGS was measured by mechanical handgrip dynamometer. Cognitive function was measured with Mini Mental State Examination. Multivariate linear, logistic regression models and subgroup analyses were employed to examine the associations of changes in sarcopenia, ASMI, and HGS with Mini Mental State Examination score change, and incident MCI, dementia.ResultsFour hundred fourteen (37.1%) patients had sarcopenia at baseline; during 1 year follow‐up, 257 (23.0%) developed MCI and 143 (12.8%) developed dementia. According to changes in sarcopenia, patients were stratified into four groups: non‐sarcopenia; non‐sarcopenia to sarcopenia; sarcopenia; and sarcopenia to non‐sarcopenia. HD patients in sarcopenia and non‐sarcopenia to sarcopenia groups had higher risk of MCI (34.8%, 32.0%, vs. 17.4%) and dementia (20.6%, 19.8%, vs. 8.7%), compared non‐sarcopenia group (P < 0.001). Multivariate linear regression analyses showed that sarcopenia [regression coefficients (β) −1.098, 95% confidence interval (CI) −1.872, −0.324, P = 0.005] and non‐sarcopenia to sarcopenia (β −1.826, −2.441, −1.212, P < 0.001) were associated with faster cognitive decline compared to non‐sarcopenia. HGS decline (β 0.046, 0.027–0.064, P < 0.001) and ASMI decline (β 0.236, 0.109–0.362, P < 0.001) were both positively associated with cognitive decline. Multivariate logistic regression analyses demonstrated that patients with sarcopenia and non‐sarcopenia to sarcopenia were both at increased risk of developing MCI [odds ratio (OR) 1.788, 95% CI 1.115–2.870, P = 0.016 and OR 1.589, 95% CI 1.087–2.324, P = 0.017, respectively], but only non‐sarcopenia to sarcopenia was at increased risk of dementia (OR 1.792, 95% CI 1.108–2.879, P = 0.017). Both greater change of ASMI and HGS had lower risk of MCI with adjusted ORs of 0.857 (0.778–0.945, P = 0.002) and 0.976 (0.963–0.989, P < 0.001). Robust associations were found among female individuals, aged >60 years, and with low educational level.ConclusionsLongitudinal associations were observed between new‐onset, persistent sarcopenia, and cognitive impairment. Early detection and intervention should be implemented to delay the onset of sarcopenia and improve cognitive health among HD patients.

Thresholds of handgrip strength for all-cause mortality in patients with chronic kidney disease: a secondary systematic review with dose-response meta-analysis

“…Age, baseline nutritional status, and physical activity level are key variables that may influence handgrip strength [ 42–44 ]. In addition, previous studies have shown that dialysis treatment leads to muscle atrophy, which reduces handgrip strength [ 45 ], whereas transplantation may have beneficial effects on muscle strength in patients with end-stage renal disease [ 46 ]. These characteristics may have various implications for heterogeneous samples, thus making the external validity of this meta-analysis challenging for generalizability.…”

Longitudinal changes in sarcopenia was associated with survival among cirrhotic patients

“…Sarcopenia is a syndrome characterized by the progressive loss of skeletal muscle mass, strength, and function ( 29 , 30 ). Sarcopenia status may constantly change; therefore, the longitudinal assessment of sarcopenia is important.…”

“…The prevalence of sarcopenia in cirrhotic patients is considerably reported with a wide variety due to the differences in sample size, ethnicity, diagnostic criteria, assessment procedures, and diagnostic thresholds for sarcopenia ( 26 , 30 , 33 , 34 ). A previous meta-analysis found the prevalence in patients with cirrhosis was 37.5% ( 35 ).…”

“…Similarly, patients with sarcopenia also had a higher prevalence of mortality than those without sarcopenia in this study. Sarcopenia status may constantly change; therefore, these prognostic values for mortality might also change over time ( 30 ). From the Kaplan–Meier curves, the overall survival rate was significantly lower in the persistent sarcopenia and new-onset sarcopenia than in the non-sarcopenia group and sarcopenia to non-sarcopenia group in our study.…”

“…We speculate that the large difference in the number of patients between the two groups may have led to some bias in the long-term follow-up. A previous study focused on patients undergoing hemodialysis found that longitudinal associations were observed between new-onset, persistent sarcopenia, and cognitive impairment ( 30 ). Another study showed that sarcopenia is progressive and that sarcopenia from longitudinal measures are predictor of clinical outcomes ( 23 ).…”