Association of Sarcopenia Risk with Depressive and Anxiety Symptoms in Patients on Maintenance Hemodialysis: A Cross-Sectional Study

Background and Objectives: Increased risk of sarcopenia and depressive and anxiety symptoms are common in patients on maintenance hemodialysis (HD) and may share inflammatory and nutritional pathways. We examined how sarcopenia risk, affective symptoms, adherence to the Mediterranean diet and routine laboratory markers are related in patients on HD. Materials and Methods: In this single-center, cross-sectional study, 95 patients on maintenance HD completed the SARC-F questionnaire, the Hospital Anxiety and Depression Scale (HADS) and a 14-item Mediterranean diet score (MEDI). Associations were assessed with Kendall’s τb, 45 laboratory variables were summarized with principal component analysis, and predictors of HADS depression (HADS-D) and anxiety (HADS-A) scores were examined with multiple linear regression and Akaike-weighted multimodel inference. Results: An increased risk of sarcopenia (SARC-F ≥ 4) was present in 40.0% of patients, elevated depressive symptoms (HADS-D ≥ 8) in 29.5% and elevated anxiety symptoms (HADS-A ≥ 8) in 9.5%; adherence to the Mediterranean diet was low (median MEDI score 6 of 14). SARC-F scores correlated with HADS-D (τb = 0.25, p < 0.001) and HADS-A scores (τb = 0.15, p = 0.047), whereas none of the questionnaire scores was associated with leukocyte count, CRP, albumin, or either of the first two principal components of the 45 laboratory variables, which together explained 22.6% of the total variance. In multivariable analysis, age and SARC-F were independently associated with depressive symptoms (SARC-F: B = 0.39 per point, p = 0.009). For anxiety symptoms, the overall model was not statistically significant (R2 = 0.09; F(7, 87) = 1.23, p = 0.30), and no individual predictor showed a statistically significant association. The summed Akaike weight for SARC-F did not exceed the permutation-based null expectation (p = 0.055). Conclusions: Sarcopenia risk was modestly associated with depressive symptoms and showed the highest relative importance among the predictors of anxiety symptoms, although the association with anxiety did not reach conventional statistical significance in the full model. These associations were not reflected in routine laboratory markers. Combined screening with SARC-F and HADS may help identify patients who could benefit from further functional and psychological assessment.