Risk factors and survival analysis of sarcopenia in elderly maintenance hemodialysis patients
Zhang Xiaoran
Huang Lijuan
Lin Xiangyun
Sun Qing
Ma Le
Zhou Hui
Xu Meichang
Zhang Xiaoyang
Lin Cuiping
Abstract：Objective To investigate the risk factors for sarcopenia in elderly patients undergoing maintenance hemodialysis(MHD)and to analyze their survival status,thereby providing a theoretical basis for early identification of highrisk patients and the development of individualized treatment strategies.Methods From December 2022 to December 2023,80 elderly MHD patients treated at the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chi-nese Medicine,were enrolled and assigned to a nonsarcopenia group(n=54)and a sarcopenia group(n=26)based on the presence or absence of sarcopenia.Serum levels of irisin,tumor necrosis factor-α(TNF-α),and homocysteine(Hcy)were measured by enzymelinked immunosorbent assay(ELISA).Spearman correlation analysis was used to assess relationships be-tween these biomarkers and sarcopenia risk,multivariate logistic regression was adopted to identify influencing factors for sar-copenia,and Kaplan-Meier survival curves were employed to compare survival between groups.Results Among the 80 elderly MHD patients,26 were diagnosed with sarcopenia,with an incidence of 32.50％.There were no significant differences be-tween the two groups in gender distribution,age,underlying disease types,proportions of smoking and drinking history,he-moglobin,blood urea nitrogen,serum uric acid,calcium,or phosphorus levels(P＞0.05).However,the sarcopenia group had significantly higher body mass index(BMI),longer dialysis vintage,and higher serum creatinine levels,and lower serum albumin levels than the nonsarcopenia group(P＜0.05).Serum irisin was significantly lower,while TNF-α and Hcy were sig-nificantly higher in the sarcopenia group compared with the nonsarcopenia group(P＜0.05).Spearman analysis showed that irisin levels were negatively correlated with sarcopenia risk among patients with MHD,whereas TNF-α and Hcy levels were positively correlated with risk(P＜0.001).Multivariate logistic regression indicated that higher serum albumin level(OR=0.421,95％CI:0.229-0.786)and higher irisin level(OR=0.351,95％CI:0.198-0.621)were protective factors against sarcopenia,while higher TNF-α level(OR=2.670,95％CI:1.471-4.844)and higher Hcy level(OR=3.187,95％CI:1.729-5.874)were independent risk factors(P＜0.05).The oneyear survival rate was significantly higher in the nonsarcope-nia group than in the sarcopenia group(88.89％[48/54]vs.65.38％[17/26];x2=16.402,P＜0.001).Conclusion Sar-copenia is common in elderly MHD patients and is closely associated with serum irisin,TNF-α,and Hcy levels.Those with sarcopenia have lower survival rates.Closely monitoring of these biomarkers clinically is recommended for early identification and active intervention in highrisk patients to reduce sarcopenia incidence and improve prognosis among this population.
Keywords：Maintenance hemodialysisSarcopeniaElderly patientsIrisinTumor necrosis factor-αHomocysteinePrognosis
Publication Date：2025-05-20
Online Publishing Date：2025-09-04(First online date of this platform, not the publication date of the document)
Pages：7( 31-37 )