Screening of hemodialysis patients for sarcopenia based on the Ishii score

Abstract

The number of elderly dialysis patients is increasing rapidly, which presents significant challenges relating to the diagnosis and treatment of sarcopenia. However, no easily applicable measure of sarcopenia for use in the clinical setting currently exists, and the specialized equipment used to diagnose sarcopenia in clinical practice； i.e., dual energy x‒ray absorptiometry or bioelectrical impedance analysis (BIA), has some significant limitations. The Ishii score (IS), which is based on three easily obtainable variables, age, grip strength, and calf circumference, has been developed, and it has been demonstrated that sarcopenia can be detected in older adults with high accuracy based on the IS. The purpose of this study was to investigate whether the IS has validity as a diagnostic screening tool for sarcopenia in hemodialysis (HD) patients. Two cohorts of maintenance HD patients, 82 at N clinic and 28 at O hospital, were studied. The calculation of the IS, anthropometric measurements, and BIA were performed after HD treatment. The patients with suspected sarcopenia； i.e., those with IS of ＞160, were significantly older and had significantly lower mean arm circumference, calf circumference, and serum albumin values than the patients that were not suspected to have sarcopenia (P＜0.05). The subjects at N clinic consisted of patients who did not require assistance with hospital visits (group A, 22％), patients who needed assistance with walking (group B, 58.5％), and wheelchair users (group C, 22％). Group C had significantly higher IS than groups A and B (P＜0.001). The IS was significantly inversely correlated with the serum level of creatinine, a muscle metabolite (r＝－0.795, P＜0.001), and was also significantly inversely correlated with the skeletal muscle index according to BIA (r＝－0.805, P＜0.001). In conclusion, IS is a useful diagnostic screening tool for detecting sarcopenia in HD patients in clinical practice.