#3007 Association between sarcopenia and clinical outcomes in patients on maintenance hemodialysis

Abstract Background and Aims Sarcopenia is a generalized skeletal muscle disorder characterized by the progressive loss of skeletal muscle mass, strength, and function, resulting in worse quality of life and increased mortality. Chronic kidney disease and hemodialysis (HD) favor the development of sarcopenia; however, factors associated with sarcopenia in HD patients have not been well-studied. This study aimed to determine the prevalence and risk factors for sarcopenia in HD patients and to analyze the relationship between sarcopenia and overall morbidity and mortality. Method We conducted short-term follow-up prospective cohort study among maintenance HD patients. Hand Grip Strength was measured by a resisted hand-held dynamometer to identify muscle strength and Bioimpedance Spectroscopy to calculate appendicular skeletal muscle mass (ASM). Finally, appendicular skeletal muscle index (ASMI) was calculated as ASM (kg) divided by weight squared (m2). Patients were categorized as sarcopenic or non-sarcopenic using Revised European Working Group criteria (EWGSOP2). Low muscle mass was defined as an ASMI value of7.00 kg/m2 for men and5.40 kg/m2 for women; low muscle strength was defined as a hand grip strength of28 kg for men and18 kg for women. Results Our study enrolled 176 adult HD patients (60% male, 56.1 ± 14.8 years of age). Median follow-up was 15.9 (interquartile range IQR 8.6–21) months. Sarcopenia was present in 32.5 % of males and 28% of female patients and associated with older age (55.2 ± 13.4 vs. 64.0 ± 7.3, p0.001), lower body mass index (25.3 ± 1.3 vs. 22.8 ± 3.1 kg/m2, p0.05), longer dialysis vintage (9.2 ± 1.1 vs. 6.2 ± 1.9 years, p0.001) lower Kt/V and lower serum phosphorus and albumin levels (p = 0.037, p = 0.042 and p = 0.048, respectively). In the multivariate analysis, the sarcopenic group had a significantly higher risk for all causes hospitalization than the non-sarcopenic group after adjusting for age and gender (OR 3.92, (95%CI 1.21–12.53, p = 0.031)). Sarcopenia was significantly associated with higher mortality risk (adjusted OR 1.76 (95% CI 1.32 to 2.67)), cardiovascular (adjusted OR 3.31 (95% CI 1.55 to 9.22)) and cerebrovascular events (adjusted OR 2.67 (95% CI 1.52 to 6.03)). Kaplan–Meier survival analysis showed a twelve-month survival rate of 82.1% in sarcopenic patients, which was significantly lower than the non-sarcopenic group (p = 0.034). Finally, both ASM and low muscle strength were independently related to increased mortality risk in dialysis patients (OR 1.86; 95% CI 1.31 to 2.62 and OR 2.31 95% CI 1.49 to 3.93, respectively). Conclusion Our study demonstrated that sarcopenia was highly prevalent among HD patients and was shown to be a significant predictor of poor patients outcomes. Future research should address whether the early diagnosis and treatment of sarcopenia improve outcomes.