Sarcopenic obesity and its association with frailty and protein-energy wasting in hemodialysis patients: preliminary data from a single center in Japan

Background This study investigated the prevalence of sarcopenia or sarcopenic obesity and their association with frailty and protein-energy wasting (PEW) in hemodialysis patients. Methods The present study enrolled 117 adult hemodialysis patients (35% female, 64 [+ or -] 12 years old) from single units of a hemodialysis center. The patients were divided into four groups: normal, obese, sarcopenia, and sarcopenic obesity. Sarcopenia was diagnosed by Asian Working Group for Sarcopenia (AWGS) criteria, and obesity was defined as an extensive percent body fat mass greater than 40% in females and 30% in males. Skeletal muscle mass and percent fat mass were evaluated by multifrequency whole-body bioimpedance electrical analysis after a midweek dialysis session. Handgrip strength and a short physical performance battery (SPPB) were assessed before a dialysis session as indicators of muscle strength and physical performance. Moreover, participants completed the Kihon Checklist and the criteria proposed by the International Society of Renal Nutrition and Metabolism expert panel to classify frailty and PEW. We performed multivariate logistic regression analysis to identify the clinical risk of frailty and PEW in patients with sarcopenia or sarcopenic obesity. Results Forty-six (39.3%) patients were classified as normal; 18 (15.4%), as obese; 35 (29.9%), as having sarcopenia; and 18 (15.4%), as having sarcopenic obesity. The sarcopenia or sarcopenic obesity group had significantly lower handgrip strength than the normal or obesity group (all p < 0.05). In addition, the sarcopenia and sarcopenic obesity groups had significantly lower SPPB scores than the normal group (p < 0.05, respectively). In the multivariate analysis, the sarcopenic obesity group had a significantly higher risk of frailty than the normal group in the multivariate analysis after adjusting for age and gender (OR 4.518, 95%CI 1.218-16.752, p = 0.024). However, sarcopenic obesity was not associated with a higher likelihood of PEW, and sarcopenia imposed a significantly higher risk of PEW (OR 4.272, 95%CI 1.157-15.778, p = 0.029) than that in the normal group after adjusting for confounding factors. Conclusion Sarcopenic obesity was closely associated with frailty compared with the normal condition in HD patients. However, sarcopenic obesity was not associated with a higher likelihood of PEW. Keywords: Hemodialysis, Sarcopenia, Sarcopenic obesity, Protein-energy wasting, Frailty