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Abstract Background and Aims Sarcopenia is associated with all-cause mortality in older dialysis patients. Although obesity is a risk factor for a variety of diseases in the general population, obese hemodialysis patients have a survival advantage over lean patients. Some hemodialysis patients are obese but have reduced muscle mass, a condition known as sarcopenic obesity. The characteristics and diagnostic criteria for sarcopenic obesity in dialysis patients remain unclear. This study aims to determine the prevalence and clinical characteristics of patients at risk for sarcopenia or sarcopenic obesity. Method The dialysis centers involved in this study were four dialysis centers belonging to Seiei-kai Medical Corporation. Hemodialysis patients attending these facilities were included. Obesity was defined as a BMI of 25 kg/m2 or higher, and sarcopenia risk was described as a SARC-F questionnaire score of 4 or higher and a sit-to-stand test (SS-5) of 12 seconds or longer. Patients were classified as sarcopenic obese if they met both criteria. Patients classified as obese (OB) or sarcopenic obesity (SO) were compared for the following factors: age, history of dialysis, sex ratio, presence of diabetes, blood biochemical tests, Kt/V, nPCR, %CGR, number of falls in the past year, and symptoms using the Patients Reported Outcomes Measure (PROM). Results We analyzed the cross-sectional data of 622 patients attending our four dialysis centers. The prevalence of SO among all patients was 6% (34 patients), and OB was 26% (164 patients); Hb (10.9 ± 1.5 vs. 11.4 ± 1.2 g/dl; p=0.03), albumin (3.40 ± 0.3 vs. 3.63 ± 0.3 mg/dl; p0.01) and nPCR (0.82 ± 0.16 vs. 0.91 ± 0.13 g/kg/day; p=0.01) were significantly lower in the SO group than in the OB group. Age (72.4 ± 9.2 vs. 32.9 ± 12.7 years; p0.01) was higher in the SO group, and patients with a history of falls were significantly more likely to be in the SO group (59% vs. 29%; p0.01). Symptom severity as measured by the PROM was also higher in the SO group. Conclusion This study showed that patients in the SO group were more likely to fall and had inadequate protein intake. In addition, patients in the SO group are older and have more severe PROM symptoms. Interventions to increase muscle strength and improve physical function should be considered for patients with SO. Nutritional support, treatment of individual symptoms, and exercise therapy will be necessary, and these interventions may be complex and challenging. We will design an observational study on the prognostic impact of sarcopenic obesity. A limitation of this study is that we used the SARC-F questionnaire and SS-5 rather than the AWGS criteria to assess sarcopenia, which may not have captured true sarcopenia.
Minoru Ito (Wed,) studied this question.