Risk Factors for Sarcopenia in Older Adults on MHD Include Physical Activity, Nutrition

New research provides insights into the distinct stage-specific progression patterns and identifiable risks of sarcopenia among older adults undergoing maintenance hemodialysis (MHD).1

“This study revealed differences in body composition, physical activity levels, nutritional status, and self-management abilities across different stages of sarcopenia in MHD patients, highlighting the importance of early identification and intervention,1” wrote study investigator Jinguo Li, a student and intern at the research center of clinical laboratory sciences at Bengbu Medical University, and colleagues.

Older adults receiving maintenance hemodialysis (MHD) commonly experience protein-energy wasting, chronic inflammation, dialysis-related metabolic disturbances, reduced physical activity, and psychosocial stressors. Together, these factors accelerate muscle loss and functional decline, placing this population at heightened risk for sarcopenia.1

Findings from this multicenter cross-sectional study highlight the importance of early screening and preventive strategies in aging MHD populations, suggesting clinicians can integrate improved nutrition, physical activity, and self-efficacy interventions to delay sarcopenia progression and promote healthy aging.1

The Asian Working Group for Sarcopenia’s (AWGS) 2019 consensus introduced the concept of possible sarcopenia, defined as reduced muscle strength and/or physical function in the setting of preserved muscle mass. Because this stage is considered potentially reversible, prior research has emphasized its importance as a target for early intervention. However, data on its prevalence, clinical implications, and progression among patients receiving MHD remain limited.2

Li and colleagues evaluated sarcopenia in a study that enrolled 448 older adults ≥ 60 years of age receiving maintenance hemodialysis 2-3 times per week for ≥3 months, with each session lasting 4 hours and a blood flow rate of no less than 200 mL/min from 3 tertiary hospitals in Bengbu, China.1

To evaluate sarcopenia, they applied AWGS 2019 staging criteria, which incorporate assessments of muscle mass, muscle strength, and physical function and conducted routine surveys before patients’ mid-week dialysis, including a modified quantitative subjective global assessment (MQSGA) for nutritional status, an International Physical Activity Questionnaire (IPAQ-SF) to assess physical activity, and the self-efficacy for managing chronic disease 6-item scale (SES6).1

Investigators categorized sarcopenia into 3 stages:

• Possible Sarcopenia: a decline in muscle strength and/or physical function, but muscle mass is not yet reduced.
• Confirmed Sarcopenia: low skeletal muscle mass is combined with either muscle strength decline or physical function reduction.
• Severe Sarcopenia: low skeletal muscle mass, muscle strength decline, and physical function reduction.

Patients without sarcopenia were classified as the control (n = 206), and those with possible or confirmed sarcopenia as the case group (n = 242).1

At baseline, patients with sarcopenia had a significantly higher proportion of female participants (47.1% vs 34.0%; P = .005), a longer median dialysis vintage (55.5 [26.0–83.0] months vs 35.0 [16.75–56.0] months; P <.001), and a lower basal metabolic rate (1294 kcal/d vs 1503 kcal/d; P <.001) compared to patients without sarcopenia.1

In the multivariable model, several factors were independently protective against sarcopenia. Although more women appeared in the sarcopenia group in unadjusted analyses, this reversed after adjustment, with female sex emerging as a protective factor (OR, 0.023; 95% CI, 0.001-0.402; P = .010). Higher self-efficacy (OR, 0.129; 95% CI, 0.062-0.269; P <.001), higher basal metabolic rate (OR, 0.987; 95% CI, 0.976-0.998; P = .023), and higher BMI (OR, 0.738; 95% CI, 0.565-0.962; P = .025) were also protective.

Investigators also quantified risk increases associated with declines in these factors. Each 1-point decrease in SES6 score increased the risk of sarcopenia progression by approximately 44% (OR, 0.558; 95% CI, 0.344-0.903; P = .018). For every 100-kcal/d increase in BMR, the risk increased by about 4.8% (OR, 1.048; 95% CI, 1.004-1.092; P = .042). A 1-kg/m² decrease in BMI increased the risk by approximately 51% (OR, 0.492; 95% CI, 0.378-0.646; P <.001).1

The identified significant risk factors for sarcopenia included comorbid diabetes (OR, 4.639; 95% CI, 1.061-20.275; P = .041), longer dialysis vintage (OR, 1.025; 95% CI, 1.005-1.045; P = .013), poorer nutritional status based on MQSGA score (OR, 2.778; 95% CI, 1.710-5.450; P <.001), and low physical activity level (IPAQ) (low vs high: OR, 26.307; 95% CI, 2.802-247.004; P = .004).1

Notably, the risk associated with low physical activity exceeded a 50-fold increase compared with high activity levels (OR, 54.722; 95% CI, 2.224-962.841; P = .007).1

“The findings collectively demonstrate significant associations between sarcopenia in MHD patients and nutritional, behavioral, and psychosocial factors. MQSGA, IPAQ-SF, and SES6 reflect these distinct dimensions, together providing a multidimensional understanding of sarcopenia risk,” Li and colleagues concluded.1 “Although the cross-sectional design precludes causal inferences, these findings offer valuable insights: incorporating these assessment tools into routine clinical monitoring may facilitate early identification and risk stratification of high-risk populations.”

References

1. Li J, Wang F, Song L, Fang F, Shen M, Wang H. Stage-specific prevalence and progression of sarcopenia among aging hemodialysis patients: a multicenter cross-sectional study. Frontiers in Public Health. 2025;13:1676139-1676139. doi:https://doi.org/10.3389/fpubh.2025.1676139

2. ‌Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. Journal of the American Medical Directors Association. 2020;21(3):300-307.e2. doi:https://doi.org/10.1016/j.jamda.2019.12.012