Assessing lean tissue by bioelectrical impedance analysis pre hemodialysis underestimates the prevalence of sarcopenia in maintenance hemodialysis patients

Abstract

Patients undergoing maintenance hemodialysis dialysis (MHD) are at high risk of sarcopenia. Diagnosing sarcopenia requires measurement of both muscle mass and muscle function. However, few studies have rigorously evaluated the best timing for assessment. This study aimed to evaluate the changes in body composition following hemodialysis in an Asian population. Overall, 87 MHD patients were included. Body composition was estimated using bioelectrical impedance analysis. Handgrip strength was measured using a quantitative handgrip dynamometer, and physical performance was assessed using the 6-m usual gait speed. All measurements were performed pre and post dialysis. Blood samples were collected before and after the same dialysis session. The prevalence of sarcopenia ranged from 6.9% to 18.8% pre dialysis (40–59-year group, 6.9%; 60–80-year group, 16.7%; >80-year group, 18.8%) and from 13.8% to 62.5% post dialysis. The body weight decreased from 59.32\u2009±\u200911.20\u2009kg pre dialysis to 57.71\u2009±\u200911.05\u2009kg post dialysis. Both the extracellular and intracellular water levels decreased post dialysis (from 14.70\u2009±\u20093.81 to 13.6\u2009±\u20092.82\u2009L, P\u2009<\u20090.001, and from 21.30\u2009±\u20094.20 to 20.8\u2009±\u20094.13\u2009L, P\u2009<\u20090.001, respectively). Albumin and creatinine levels were significantly lower in patients with sarcopenia. Elevated high-sensitivity C-reactive protein and interleukin-6 levels were observed in sarcopenia patients. The prevalence of sarcopenia in MHD patients varies greatly according to the timing of measurements. Although predialysis measurement is preferred, it underestimates the prevalence of sarcopenia in MHD patients.