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Chronic kidney disease, especially in end stages, affects the nutritional status of patients, by creating an imbalance between intake and expenditure of energy and nutrients. This imbalance can lead to two nutritional disorders, with similar clinical presentations: malnutrition and sarcopenia. Malnutrition implies weight loss, whereas sarcopenia can occur in patients with obesity, called sarcopenic obesity. There are various criteria and cut-off points for each of these disorder diagnoses, leading to different results. The objective of this study was to determine the prevalence of sarcopenia, sarcopenic obesity, and malnutrition in a population of chronic hemodialysis patients, the use of different diagnostic tools, and to compare the results between the different methods.
Data were collected from 93 patients (50.5% women), over 18 years, under chronic hemodialysis treatment. Measurements of weight and height, body composition by bioelectrical impedance (fat mass and lean mass), and grip strength by dynamometry were performed. To calculate appendicular muscle mass, a validated equation for this population was used. The diagnosis of sarcopenia was based on the Asian Working Group for Sarcopenia (AWGS) criteria. The Subjective Global Assessment (SGA) tool was used to diagnose malnutrition. For the diagnosis of obesity, the Body Mass Index (BMI) was used, as well as data of the percentage of fat mass (%FM)
The use of bioelectrical impedance is recommended for the evaluation of muscle mass and the diagnosis of sarcopenia, as well as for the evaluation of fat mass and the diagnosis of obesity. The use of BMI for the diagnosis of obesity is discouraged. The use of dynamometry is suggested, both for the diagnosis of sarcopenia and for the early detection of pre-sarcopenia. Due to the large percentage of sarcopenic patients who suffer concomitantly from malnutrition, it is recommended the use of SGA for its diagnosis, because it assesses several domains of nutritional status that are not included among the sarcopenia diagnostic criteria. Furthermore, due to its easy application, it can be implemented frequently, allowing early intervention.