Relationship between sarcopenia and prognosis during the initial period of hemodialysis

Abstract

[Background] Sarcopenia has been shown to be an independent predictor of overall survival in various kinds of diseases. We investigated the relationship between sarcopenia and prognosis during the initial period of hemodialysis. We performed a retrospective analysis of 82 patients who were started on hemodialysis at our hospital between April 2008 and March 2018. [Methods] Skeletal muscle mass was evaluated using the psoas muscle mass index (PMI: psoas major muscle area at the level of the third lumbar vertebra (cm²) /height×height (m²)) on CT images. [Results] The patients with low PMI exhibited a higher frequency of heart disease and lower serum albumin levels than those with normal PMI. The overall survival rate was significantly lower in the patients with low PMI than in the patients with normal PMI (p<0.0001). A low PMI and older age were identified as prognostic factors for overall survival in the multivariate analysis (hazard ratios (HR) =3.23 and 3.96, respectively; p=0.013 and 0.0089, respectively). [Conclusion] Skeletal muscle mass is closely correlated with mortality among patients that are starting hemodialysis. Clinicians should consider employing nutritional and exercise-based interventions against sarcopenia before initiating hemodialysis in patients with end-stage chronic kidney disease.