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Nutrition in acute and chronic diseases

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

Abstract

Background/objectives

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.

Subjects/methods

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.

Results

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 ± 11.20 kg pre dialysis to 57.71 ± 11.05 kg post dialysis. Both the extracellular and intracellular water levels decreased post dialysis (from 14.70 ± 3.81 to 13.6 ± 2.82 L, P < 0.001, and from 21.30 ± 4.20 to 20.8 ± 4.13 L, P < 0.001, 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.

Conclusion

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.

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Fig. 1: Patient flowchart.
Fig. 2: Prevalence of sarcopenia in different age groups pre and post dialysis.
Fig. 3: Bland–Altman analysis comparing pre and post dialysis.
Fig. 4: Pearson correlation of change in body water and lean tissue mass.

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Acknowledgements

This study was supported by grants from the Project of Scientific Research Foundation of Chinese Medicine (2017ZA012) and General Project Funds from the Health Department of Zhejiang Province (2017KY213).

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Correspondence to Qiang He.

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Wang, M., Liu, L., Shen, X. et al. Assessing lean tissue by bioelectrical impedance analysis pre hemodialysis underestimates the prevalence of sarcopenia in maintenance hemodialysis patients. Eur J Clin Nutr (2021). https://doi.org/10.1038/s41430-020-00835-9

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