What question did this study set out to answer?

This research aims to explore the roles of serum albumin and neopterin as biomarkers of malnutrition and inflammation in sarcopenia among kidney failure patients on maintenance hemodialysis.

July 29, 2026Open Access

Malnutrition and Inflammation in Sarcopenia among Kidney Failure Patients on Maintenance Hemodialysis: Analysis of Serum Albumin and Neopterin

CPCornelia ParinussaHasanuddin University HRHaerani RasyidHasanuddin University SBSyakib BakriHasanuddin University

Key Points

This research aims to explore the roles of serum albumin and neopterin as biomarkers of malnutrition and inflammation in sarcopenia among kidney failure patients on maintenance hemodialysis.
Conducted a cross-sectional study among 88 kidney failure patients undergoing maintenance hemodialysis.
Examined serum albumin and neopterin alongside demographic and clinical data.
Diagnosed sarcopenia using AWGS-2 criteria with bioelectrical impedance analysis, handgrip strength, and the 6-meter walk test.
Incidence of sarcopenia was found in 59% (52 subjects) of patients, with 33% (29 subjects) classified as severe.
Serum albumin and neopterin were significant in predicting the incidence and severity of sarcopenia, with an accuracy of 87.5% and 88.46% respectively.
The area under the curve (AUC) for both incidence and severity was 91.83% in CART analysis.

Abstract

Introduction Chronic kidney disease (CKD) affects more than 10% of the global population. Sarcopenia is a prevalent complication in CKD, especially in kidney failure patients undergoing maintenance hemodialysis (MHD), contributing to disability, hospitalization, and mortality. Multiple factors can cause sarcopenia in this population, including malnutrition and inflammation. Albumin is a well-established nutritional marker of malnutrition, while neopterin, an immune activation marker of malnutrition, has never been studied in sarcopenia in this population. Methods We conducted a cross-sectional study among adult kidney failure patients undergoing MHD. Serum albumin and neopterin were examined as biomarkers of malnutrition and inflammation alongside demographic and clinical data that also serve as risk factors. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia-2 (AWGS-2) criteria, using a bioelectrical impedance analyser (BIA), handgrip strength (HGS), and the 6-meter walk test. Statistical analyses included bivariate correlations and multivariate classification and regression trees (CART) analysis . Results The incidence of sarcopenia among 88 kidney failure patients undergoing MHD was quite high, affecting 52 subjects (59%), and 29 subjects (33%) were classified as severe sarcopenia. Albumin and neopterin, as biomarkers of malnutrition and inflammation, remain important variables in the incidence (accuracy 87.5%, area under the curve (AUC) 91.83%) and severity (accuracy 88.46%, AUC 91.83%) of sarcopenia among kidney failure patients undergoing MHD in multivariate analysis using classification and regression trees (CART). Conclusions Low serum albumin indicated malnutrition, and high serum neopterin indicated inflammation, becoming a potential biomarker in the incidence and severity of sarcopenia among kidney failure patients undergoing MHD.

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