Prevalence and Factors Associated with Sarcopenia in Chronic Kidney Disease Patients Undergoing Dialysis: A Single Center, Cross-sectional Study
Abstract
Background: Sarcopenia is associated with worse outcomes in stage 5 Chronic Kidney Disease on dialysis (CKD 5D) patients, influenced by various diagnostic criteria and patient characteristics. Nonetheless, the factors contributing to sarcopenia in CKD 5D remain underexplored.
Objective: To investigate the prevalence and factors associated with sarcopenia in the CKD 5D population.
Methods: An observational cross-sectional study was conducted on 132 CKD 5D patients (≥18 years old, dialysis ≥ 3 months) at Hasan Sadikin Hospital from July to August 2024. Descriptive statistics, bivariate analysis, and logistic regression were utilized to determine the prevalence of sarcopenia and its association with the Simplify Creatinine Index (SCI), physical activity, nutritional status, phosphate, and calcium serum levels. Hand Grip Strength (HGS) assessed muscle strength, Bioelectrical Impedance Spectroscopy (BIS) measured muscle mass, the 6-meter walk test evaluated physical performance, and the Asian Working Group for Sarcopenia (AWGS) 2019 criteria were employed for diagnosing sarcopenia.
Results: Sarcopenia prevalence was 15.9%. Bivariate analysis revealed significant correlations with underweight (p=0.014), malnutrition (p=0.041), phosphate serum level (p=0.047), and calcium serum level (p=0.043). Logistic regression indicated that higher serum levels of calcium and phosphate and healthy nutritional status, served as protective factors against sarcopenia, with odds ratios of 0.677 (OR 0.677; CI 95% 0.493-0.93 and OR 0.313; CI 95% 0.130-0.755).
Conclusion: Sarcopenia prevalence was 15.9%. Phosphate and calcium serum levels, underweight, and malnutrition were significantly correlated with sarcopenia. Higher serum phosphate and calcium levels, higher body weight, and good nutrition status were protective factors against sarcopenia in CKD 5D patients.
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References
Kim JK, Choi SR, Choi MJ, Kim SG, Lee YK, Noh JW, et al. Prevalence of and factors associated with sarcopenia in elderly patients with end-stage renal disease. Clin Nutr. 2014;33(1):64–8. doi:10.1016/j.clnu.2013.04.002
Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020;21(3):300-307.e2. doi:10.1016/j.jamda.2019.12.012
Carrero JJ, Chmielewski M, Axelsson J, Snaedal S, Heimbürger O, Bárány P, et al. Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients. Clin Nutr. 2008;27(4):557–64. doi:10.1016/j.clnu.2008.04.007
Martinson M, Ikizler TA, Morrell G, Wei G, Almeida N, Marcus RL, et al. Associations of body size and body composition with functional ability and quality of life in hemodialysis patients. Clin J Am Soc Nephrol. 2014;9(6):1082–90. doi:10.2215/cjn.09200913
Beddhu S, Pappas LM, Ramkumar N, Samore M. Effects of body size and body composition on survival in hemodialysis patients. J Am Soc Nephrol. 2003;14(9):2366–72. doi:10.1097/01.asn.0000083905.72794.e6
Sato E, Mori T, Mishima E, Suzuki A, Sugawara S, Kurasawa N, et al. Metabolic alterations by indoxyl sulfate in skeletal muscle induce uremic sarcopenia in chronic kidney disease. Sci Rep. 2016;6(1). doi:10.1038/srep36618
Avin KG, Moorthi RN. Bone is not alone: The effects of skeletal muscle dysfunction in chronic kidney disease. Curr Osteoporos Rep. 2015;13(3):173–9. doi:10.1007/s11914-015-0261-4
Sabatino A, Cuppari L, Stenvinkel P, Lindholm B, Avesani CM. Sarcopenia in chronic kidney disease: what have we learned so far? J Nephrol. 2021;34(4):1347–72. doi:10.1007/s40620-020-00840-y
da Silva MZC, Vogt BP, Reis NS do C, Caramori JCT. Update of the European consensus on sarcopenia: what has changed in diagnosis and prevalence in peritoneal dialysis? Eur J Clin Nutr. 2019;73(8):1209–11. doi:10.1038/s41430-019-0468-z
Matsuzawa R, Yamamoto S, Suzuki Y, Imamura K, Harada M, Matsunaga A, et al. The clinical applicability of ultrasound technique for diagnosis of sarcopenia in hemodialysis patients. Clin Nutr. 2021;40(3):1161–7. doi:10.1016/j.clnu.2020.07.025
Chen YY, Kao TW, Chou CW, Wu CJ, Yang HF, Lai CH, et al. Exploring the link between serum phosphate levels and low muscle strength, dynapenia, and sarcopenia. Sci Rep. 2018;8(1). doi:10.1038/s41598-018-21784-1
Vervloet MG, Sezer S, Massy ZA, Johansson L, Cozzolino M, Fouque D, et
al. The role of phosphate in kidney disease. Nat Rev Nephrol. 2017;13(1):27–38. doi:10.1038/nrneph.2016.164
Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208–18. doi:10.1097/01.asn.0000133041.27682.a2
Jauwerissa R, Marbun MBH, Nugroho P, Rinaldi I, Suhardjono S, Shatri H, et al. Factors associated with sarcopenia in maintenance hemodialysis patients: a cross-sectional study. Acta Med Indones. 2023;55(1):26–32.
Umakanthan M, Li JW, Sud K, Duque G, Guilfoyle D, Cho K, et al. Prevalence and factors associated with sarcopenia in patients on maintenance dialysis in Australia-A single centre, cross-sectional study. Nutrients. 2021;13(9):3284. doi:10.3390/nu13093284
Ren H, Gong D, Jia F, Xu B, Liu Z. Sarcopenia in patients undergoing maintenance hemodialysis: incidence rate, risk factors and its effect on survival risk. Ren Fail. 2016;38(3):364–71. doi:10.3109/0886022x.2015.1132173
Cai G, Ying J, Pan M, Lang X, Yu W, Zhang Q. Development of a risk prediction nomogram for sarcopenia in hemodialysis patients. BMC Nephrol. 2022;23(1):319. doi:10.1186/s12882-022-02942-0
Berndt T, Kumar R. Phosphatonins and the regulation of phosphate homeostasis. Annu Rev Physiol. 2007;69(1):341–59. doi:10.1146/annurev.physiol.69.040705.141729
Vettoretti S, Caldiroli L, Armelloni S, Ferrari C, Cesari M, Messa P. Sarcopenia is associated with malnutrition but not with systemic inflammation in older persons with advanced CKD. Nutrients. 2019;11(6):1378. doi:10.3390/nu11061378
Macedo C, Amaral TF, Rodrigues J, Santin F, Avesani CM. Malnutrition and sarcopenia combined increases the risk for mortality in older adults on hemodialysis. Front Nutr. 2021;8:721941. doi:10.3389/fnut.2021.721941
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