Sarcopenia and Mortality in Older Hemodialysis Patients

Abstract

(1) Sarcopenia is a progressive loss of skeletal muscle mass and strength. The aim of this study was to determine the association of sarcopenia, defined according to the Working Group on Sarcopenia in Older People (EWGSOP2) diagnostic criteria, with mortality at 24 months in very elderly hemodialysis patients. (2) A prospective study was conducted in 60 patients on chronic hemodialysis who were older than 75 years. Sarcopenia was diagnosed according to EWGSOP2 criteria. Additionally, clinical, anthropometric and analytical variables and body composition by bioimpedance were assessed. The date and cause of death were recorded during 2 years of follow-up. (3) Among study participants, 41 (68%) were men, the mean age 81.85 ± 5.58 years and the dialysis vintage was 49.88 ± 40.29 months. The prevalence of probable sarcopenia was 75% to 97%, depending on the criteria employed: confirmed sarcopenia ranged from 37 to 40%, and severe sarcopenia ranged from 18 to 37%. A total of 30 (50%) patients died over 24 months. Sarcopenia probability variables were not related to mortality. In contrast, sarcopenia confirmation (appendicular skeletal muscle mass, ASM) and severity (gait speed, GS) variables were associated with mortality. In multivariate analysis, the hazard ratio (95% confidence interval) for all-cause death was 3.03 (1.14–8.08, p = 0.028) for patients fulfilling ASM sarcopenia criteria and 3.29 (1.04–10.39, p = 0.042) for patients fulfilling GS sarcopenia criteria. (4) The diagnosis of sarcopenia by EWGSOP2 criteria is associated with an increased risk of all-cause death in elderly dialysis patients. Specifically, ASM and GS criteria could be used as mortality risk markers in elderly hemodialysis patients. Future studies should address whether the early diagnosis and treatment of sarcopenia improve outcomes.

Development of a risk prediction nomogram for sarcopenia in hemodialysis patients

“…In addition, mitochondrial dysfunction and hormonal changes caused by aging are also related to sarcopenia [5]. Our findings on the relationship between age and sarcopenia are consistent with previous studies [6,8,35]. However, there are some controversies, Wang et al [14] systematic review have shown the age of HD patients was no significant influence on sarcopenia prevalence.…”

High prevalence of sarcopenia and myosteatosis in patients undergoing hemodialysis

“…Sarcopenia is characterized by a gradual decline in physical performance, strength, and skeletal muscle mass (1,2). It has a prevalence of between 28.5% and 40.3% in patients receiving hemodialysis (3)(4)(5)(6)(7) and results in poor clinical outcomes (7)(8)(9). The complex pathophysiology of sarcopenia may be exacerbated by metabolic acidosis, oxidative stress, accumulated uremic toxins, inflammation, insulin resistance, malnutrition, protein restriction, decreased appetite, myostatin overexpression, ubiquitination, and physical inactivity (10).…”

Sarcopenia of kidney transplant recipients as a predictive marker for reduced graft function and graft survival after kidney transplantation

“…In addition to age-related processes, sarcopenia in potential KT recipients is also worsened by various factors, including malnutrition, metabolic acidosis, accumulation of uremic toxins, and amino acid loss during dialysis, as well as typical low-threshold inflammation [34]. Malnutrition is very common in patients requiring dialysis and leads to sarcopenia in these patients by reducing muscle mass and strength as well as physical performance [35].…”