Prevalence And Risk Factors Of Maintenance Hemodialysis-Associated Sarcopenia

Sarcopenia refers to the decline of muscle mass,strength,and function with aging and maintenance hemodialysis(MHD)associated sarcopenia refers to decreased muscle strength,structural changes and muscle atrophy caused by renal dysfunction,toxin accumulation,protein-energy wasting,chronic inflammation,and metabolic acidosis.Up-to-now,there are few studies on the prevalence and related factors of hemodialysis-associated sarcopenia.The purpose of this study is to observe the incidence and to explore risk factors,so as to provide evidences for the prevention and treatment of sarcopenia.A cross-sectional study was conducted among 359 MHD patients in 4blood purification centers in Beijing,including 218 males and 141 females.Patients’ data were collected and creatinine,triglyceride,high-density lipoprotein,uric acid were tested.Human body composition analyzer was used for measuring composition.Muscle mass,upper arm circumference,skinfold thickness,walking speed and grip strength were measured.The scores of nutrition,sleep,depression,anxiety and quality of life were collected by questionnaire.A total of 359 MHD patients were enrolled in this study.There were 83 cases in sarcopenia group.The prevalence of MHD-associated sarcopenia was 23.1%.The prevalence of sarcopenia in patients under 45 years old,among 45 ～ 59 years old,60 ～ 74 years old and over 75 years old were11.54%,13.08%.27.07%,54.55% respectively.The MHD patients aged over 60 were compared with the sarcopenia database of the elderly.The results indicated that the prevalence of MHD-related sarcopenia aged over60 was higher than that of normal people(33.9%VS1.9%,P<0.05).The 359 subjects were divided into the sarcopenia group(83)and the non-sarcopenia group(276).The clinical characteristics of the two groups and risk factors of MHD-related sarcopenia were analyzed.The age of sarcopenia group was higher than that of non-sarcopenia group,and the prevalence of sarcopenia increased with the increase of age.The BMI of the sarcopenia group was lower than that of the non-sarcopenia group,and the prevalence of sarcopenia decreased with the increase of BMI.The sarcopenia group was significantly lower than the non-sarcopenia group in terms of gait speed,ASMI,handgrip strength,triceps skin-fold thickness,mid-arm circumference,mid-upper arm muscle circumference,BMI,fat mass,bone,protein,water,skeletal muscle,percentage of body fat,fat free weight and other aspects,P<0.05.The gait speed,handgrip strength,ASMI,BMI,fat mass,bone mass,protein,water,skeletal muscle,body fat percentage,fat free body weight of MHD patients were significantly lower than normal people.The uric acid,triglyceride and creatinine in sarcopenia group were lower than those in non-sarcopenia group(P < 0.05).KT/V and high-density lipoprotein in sarcopenia group were higher than those in non-sarcopenia group(P < 0.05).Multivariate Logistic regression analysis showed that age(OR:1.962,95%CI:1.264～3.044),malnutrition(OR=2.697,95%CI=1.283～5.669)and depression(OR=1.707,95%CI=1.116～2.611)were independent risk factors for sarcopenia.BMI(OR=0.040,95%CI=0.015～0.108)were protective factors for sarcopenia.The study showed that the prevalence of MHD sarcopenia ranges from11.54% to 54.55%;the prevalence of sarcopenia increased with the increase of age;the prevalence of MHD-associated sarcopenia was much higher than that of normal people;age,malnutrition and depression were independent risk factors for sarcopenia;BMI was a protective factor for sarcopenia.