Association of sarcopenia and its components with clinical outcomes in patients undergoing peritoneal dialysis

Abstract

Background: Further studies are needed to identify whether muscle mass, muscle strength, or sarcopenia is the best indicator of survival in patients undergoing peritoneal dialysis (PD). We aimed to compare the association of sarcopenia and its components with survival in patients undergoing PD.

Methods: We identified all patients with PD (n = 199). We routinely recommended handgrip strength (HGS) and lean mass measurements using dual energy X-ray absorptiometry in all patients with PD. Sarcopenia was defined using cutoff values from the Asian Working Group for Sarcopenia. We evaluated the patient and technique survival rates.

Results: The number of patients with low HGS was 95 (47.7%). The median follow-up interval was 17 months (interquartile range, 13-21 months). Kaplan-Meier curve analysis showed that patients with low HGS or sarcopenia had poorer patient and technique survival compared with patients with normal HGS or without sarcopenia. Cox regression analysis showed that patients with low HGS had greater hazard ratios for patient death and technique failure compared with those with normal HGS. However, patients with low muscle mass were not significantly higher hazard ratios for patient death or technique failure compared with those with normal muscle mass. Patients with sarcopenia had significantly greater hazard ratios for patient death or technique failure than those without sarcopenia only in univariate analysis.

Conclusion: The present study demonstrated that HGS may be superior to muscle mass or sarcopenia for predicting patient or technique survival in patients undergoing PD.

Keywords: Hand strength; Muscle; Peritoneal dialysis; Sarcopenia; Survival.

Figure 1.. Kaplan-Meier curves of patient survival according to SP components.

(A) The patient survival rates in patients with normal and low HGS were 98.0% and 93.4% at 200 days and 96.9% and 75.4% at 600 days, respectively. (B) The patient survival rates in patients with normal and low MM were 98.7% and 94.0% at 200 days and 92.6% and 82.5% at 600 days, respectively. (C) The patient survival rates in patients without and with SP were 97.7% and 91.8% at 200 days and 93.4% and 73.0% at 600 days, respectively. HGS, handgrip strength; MM, muscle mass; SP, sarcopenia.

Figure 2.. Kaplan-Meier curves of technique survival according to SP components.

(A) The technique survival rates in patients with normal and low HGS were 94.1% and 89.2% at 200 days and 89.3 and 71.0% at 600 days, respectively. (B) The technique survival rates in patients with normal and low MM were 96.0% and 89.1% at 200 days and 86.1% and 76.7% at 600 days, respectively. (C) The technique survival rates in patients without and with SP were 94.0% and 87.2% at 200 days and 86.2% and 69.3% at 600 days, respectively. HGS, handgrip strength; MM, muscle mass; SP, sarcopenia.

Figure 3.. Receiver operating characteristic curves of indicators used to predict patient death or technique failure at the end point of follow-up.

Curves of indicators for predicting patient death in male (A) and female patients (B). Curves of indicators for predicting technique failure in male (C) and female patients (D). ALM, appendicular lean mass; GNRI, geriatric nutritional risk index; HGS, handgrip strength.