Impact of sarcopenia on mortality in patients undergoing maintenance hemodialysis / 中华肾脏病杂志

ABSTRACT

Objective:To investigate the impact of sarcopenia on mortality in maintenance hemodialysis (MHD) patients.Methods:It was a retrospective cohort study. MHD patients admitted to the blood purification center of Guangzhou Red Cross Hospital in March 2021 were recruited. Demographic data and laboratory indicators, grip strength, and bioelectrical impedance analysis indexes were collected. The patients were divided into sarcopenia group and non-sarcopenia group based on whether they had sarcopenia or not. By following up for 18 months, the survival status of the patients was documented. Kaplan-Meier method, multivariate Cox regression model, and Fine-Gray competing risk model were used to assess the relationship between sarcopenia and all-cause mortality, cardio-cerebrovascular disease mortality, and infection-related disease mortality.Results:A total of 143 MHD patients were enrolled in this study, with age of 65 (58,74) years old and 89 males (62.24%). The prevalence of sarcopenia was 25.17% (36/143). The sarcopenia group had older age ( Z=3.486, P<0.001), higher single-pool Kt/V ( Z=3.634, P<0.001), interleukin-6 ( Z=3.434, P<0.001) and extracellular water/intracellular water ratio ( Z=2.477, P=0.013), and lower body mass index ( Z=-3.210, P=0.001), serum phosphorus ( t=2.475, P=0.015), serum creatinine ( t=3.319, P=0.001), serum albumin ( t=2.851, P=0.005), serum prealbumin ( t=3.384, P<0.001), extracellular water ( Z=-5.124, P<0.001), intracellular water ( Z=-5.417, P<0.001), grip strength ( Z=-3.796, P<0.001) and appendicular skeletal muscle mass index ( t=3.862, P<0.001) than those in the non-sarcopenia group. Kaplan-Meier survival curves showed that the overall survival rate in the sarcopenia group was lower than that in the non-sarcopenia group (Log-rank test χ2=15.99, P<0.001). Multivariable Cox regression analysis demonstrated that sarcopenia was independently correlated with all-cause mortality in MHD patients after adjusting for confounding factors ( HR=2.75, 95% CI 1.07-7.10, P=0.036). Fine-Gray competing risk model result showed that there was no statistically significant difference in cardio-cerebrovascular disease mortality between sarcopenia group and non-sarcopenia group ( SHR=4.99, 95% CI 0.94-26.85, P=0.069); the risk of infection-related disease mortality in sarcopenia group was 5.76 folds than that in non-sarcopenia group ( SHR=5.76, 95% CI 1.15-28.96, P=0.034). Conclusions:There is prevalent sarcopenia in MHD patients. Moreover, sarcopenia is an independent risk factor of all-cause mortality and infection-related disease mortality in MHD patients.