Ritin Fernandez
Credit: JPI
New research is shedding light on a high prevalence of sarcopenia among patients with chronic kidney disease (CKD) receiving dialysis, especially those on hemodialysis.1
The systematic review included 62 studies with > 15,000 participants and determined the global prevalence of sarcopenia to be 30.1% for hemodialysis and 20.5% for peritoneal dialysis. Investigators additionally noted differences in prevalence based on which criteria was used and the timing of lean muscle mass (LMM) measurement.1
Defined as the gradual loss of muscle mass, strength, and function, sarcopenia commonly affects the elderly population and is widely attributed to aging. However, chronic diseases like chronic obstructive pulmonary disease, kidney disease, diabetes, cancer, and HIV have also been identified as potential causes and exacerbating factors of sarcopenia.2
“Although several studies have reported the prevalence of sarcopenia in the CKD and dialysis population, there remains a significant lack of quantitative syntheses focusing on dialysis modality assessment criteria, timing of assessment, and the tools used for measuring muscle mass,” Ritin Fernandez, a professor at the University of Newcastle and assistant dean (International) at the College of Health, Medicine, and Wellbeing, and colleagues wrote.1 “This gap limits the ability to draw meaningful comparisons and inform clinical practice.”
To address this gap in research, investigators systematically searched Ovid MEDLINE, Embase, Allied and Complementary Medicine Database, CINAHL, and Scopus electronic databases for studies assessing sarcopenia in adults ≥ 18 years of age with CKD undergoing dialysis.1
Investigators retrieved an initial 174 articles, 62 of which met the inclusion criteria. These studies involved 15,382 participants (ranging from 20 to 3196 in each study), the majority of whom were receiving hemodialysis treatment (92%). All studies were published in the last 10 years, predominately in China (22%), Japan (19%), Korea (8%), and Taiwan (6%).1
Results showed the global prevalence of sarcopenia was 30.1% (95% CIm 25.6%–39.9%; I2: 97.1%) among people receiving hemodialysis and 20.5% (95% CI, 15.1–26.4%; I2: 80.0%) among people receiving peritoneal dialysis. Investigators noted sarcopenia prevalence ranged from 23.1%-30.3% in hemodialysis and from 6.1%-26.9% in peritoneal dialysis based on the assessment criteria used.1
To assess the effect of the timing of LMM assessment, investigators categorized studies using bioimpedance analysis (BIA) or bioimpedance spectroscopy (BIS) into pre- and post-dialysis. A total of 10 studies (n = 5177) investigated the LMM pre-dialysis with a sarcopenia prevalence of 24.2% (CI, 14.8%–35%; I2: 97.8%). When the same instrument was used post-dialysis (14 studies, n = 3502), the prevalence of sarcopenia was 33% (CI, 24.7%–41.7%; I2: 96.3%).1
Further analysis revealed measuring muscle mass after dialysis using dual-energy X-ray assessment yielded a lower prevalence of sarcopenia (22.5%; CI, 12.9–33.8; I2: 93.3%) than BIA/BIS (33%; CI, 24.7–41.7; I2: 93.3%).1
Investigators identified age, sex, diabetes, inflammation markers, nutritional indices, and dialysis vintage as risk factors for sarcopenia in the hemodialysis population but called attention to high heterogeneity between studies.1
“There is a need for additional research to assess the practicality of various assessment tools and the role of other measurements or predictors of low muscle mass, strength, and sarcopenia,” investigators concluded.1 “Global research would benefit from the development of a single criterion to be applied to dialysis patients and standardize screening tools for this population.”
References
-
Stockings J, Heaney S, Chu G, et al. Prevalence and Risk Factors of Sarcopenia in People Receiving Dialysis: A Systematic Review and Meta-Analysis. Seminars in Dialysis. https://doi.org/10.1111/sdi.70000
-
Cleveland Clinic. Sarcopenia. June 3, 2022. Accessed July 15, 2025. https://my.clevelandclinic.org/health/diseases/23167-sarcopenia