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Sarcopenia is a progressive and generalized musculoskeletal disease with a high prevalence in patients undergoing hemodialysis, being strongly associated with adverse clinical outcomes. There are well-known dialysis-related factors that can lead to sarcopenia, such as the loss of nutrients during hemodialysis, unpleasant symptoms, low protein balance, and reduced physical activity levels. However, the impact of dialysis vintage over time on musculoskeletal health and its association with sarcopenia remains unclear. To address this knowledge gap, we explored the association between sarcopenia and dialysis vintage.
This is a cross-sectional analysis from the SARC-HD, a multicenter prospective cohort study being conducted in 3 regions of Brazil. Adults (≥18 years) undergoing hemodialysis for ≥3 months were included. Sarcopenia algorithm was defined according to the revised European Working Group on Sarcopenia in Older People as probable sarcopenia (low muscle strength), confirmed sarcopenia (low muscle strength + low muscle quantity), and severe sarcopenia (low muscle strength + low muscle mass + low physical performance). Muscle strength was assessed by handgrip strength, muscle mass by calf circumference, and physical performance by gait speed. Patients were divided into 3 groups according to dialysis vintage tertile, defined as the time between the beginning of treatment and study entry: group 1 (3 to 18 months), group 2 (19 to 50 months), and group 3 (>50 months). The chi-square and Pearson correlation tests were conducted.
Among the 728 included patients from 19 different dialysis centers, 38.6% were female, median age of 58 (IQR: 47 – 68) years and a median dialysis vintage of 31 (IQR: 12 – 63) months. Among the participants, 9.5% had probable sarcopenia, 10.4% confirmed sarcopenia, and 5.1% severe sarcopenia. There were no significant correlations between the sarcopenia-related tests (i.e., handgrip strength, calf circumference, and gait speed) and dialysis vintage. When comparing the prevalence of sarcopenia stages among dialysis vintage groups, group 1 showed a higher prevalence of probable sarcopenia (p=0.003), while no significant difference was found for confirmed and severe sarcopenia.
This multicenter study found no significant association between sarcopenia and dialysis vintage in patients undergoing hemodialysis. Yet, those with shorter dialysis vintage had a higher prevalence of probable sarcopenia, the landmark of the disease. Thus, interventions aiming to prevent muscle strength loss may be considered independently of dialysis vintage, but mainly to those recently admitted.