Sarcopenia is prevalent in chronic hemodialysis patients. This prospective cohort study evaluated the impact of sarcopenia and its diagnostic criteria on hospitalization and mortality in 126 chronic hemodialysis patients. Skeletal muscle mass, handgrip strength (HGS), gait speed, and blood parameters were assessed. Sarcopenia was evaluated using the criteria of the European Working Group on Sarcopenia in Older People and the Taiwanese criteria for Sarcopenia. Muscle quality was defined as HGS divided by mid-arm muscle circumference. Prevalences of uremic sarcopenia were 8.7% and 13.5% according to Taiwanese and European criteria, respectively. Low HGS and gait speed were much more prevalent than low muscle mass. Within 3 years, 79 (62.7%) patients were hospitalized and 26 (20.6%) died. Low HGS and slow gait speed were associated with hospitalization and mortality, while sarcopenia was associated with mortality but not with hospitalization. Notably, in our patients without sarcopenia, close associations between increased hospitalization and mortality risk with low HGS and slow gait speed remained unchanged. In Cox proportional hazard analysis, muscle quality [hazard ratio (HR) = 0.42, 95% confidence interval (CI) = 0.19-0.93, p = 0.032] and serum creatinine (HR = 0.82, 95% CI = 0.71-0.95, p = 0.009) were independently associated with composite outcome of hospitalization or death. Muscle functionality and quality can predict hospitalization and overall survival in chronic hemodialysis patients, better than muscle mass.

Sarcopenia is frequently encountered in patients undergoing peritoneal dialysis (PD). We evaluated and compared the diagnostic performance of a strength, assistance walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire, SARC-F combined with calf circumference (SARC-CalF), and calf circumference (CC) for screening sarcopenia among patients undergoing PD. We measured the appendicular skeletal muscle mass, evaluated using a multifrequency bioimpedance spectroscopy device, handgrip strength, and 6-m gait speed. SARC-F, SARC-CalF, and CC were obtained in all participants. Sarcopenia was defined using four different diagnostic criteria, including the Asian Working Group for Sarcopenia (AWGS) 2019, revised European Working Group on Sarcopenia in Older People (EWGSOP2), Foundation for the National Institutes of Health (FNIH), and International Working Group on Sarcopenia (IWGS). Among 186 enrolled patients undergoing PD (mean age 57.5 ± 14.1 years), the sarcopenia prevalence was 25.8–38.2% using the four definitions. The discriminative powers of SARC-CalF (range 0.648–0.748) and CC (range 0.652–0.813) against the four definitions were better than those exhibited by SARC-F (range 0.587–0.625), which achieved significant difference, except when adopting the criteria of the FNIH. After stratification by gender, the superiority of SARC-CalF and CC over SARC-F was maintained when AWGS 2019, EWGSOP2, and IWGS were applied. In conclusion, CC and SARC-CalF outperformed SARC-F in the diagnostic accuracy of sarcopenia among patients undergoing PD.

Indoxyl sulfate (IS), a product metabolized from tryptophan, is negatively correlated with renal function and cardiovascular diseases in patients with chronic kidney disease (CKD). We investigated the association between serum IS levels and endothelial function in patients with CKD. Fasting blood samples were obtained from 110 patients with stages 3–5 CKD. The endothelial function, represented by vascular reactivity index (VRI), was measured non-invasively using digital thermal monitoring. Serum IS levels were determined using liquid chromatography–mass spectrometry. Twenty-one (19.1%), 36 (32.7%), and 53 (48.2%) patients had poor (VRI < 1.0), intermediate (1.0 ≤ VRI < 2.0), and good (VRI ≥ 2.0) vascular reactivity. By univariate linear regression analysis, a higher prevalence of smoking, advanced age, higher systolic, and diastolic blood pressure (DBP), elevated levels of serum phosphorus, blood urea nitrogen, creatinine, and IS were negatively correlated with VRI values, but estimated glomerular filtration rate negatively associated with VRI values. After being adjusted by using multivariate stepwise linear regression analysis, DBP and IS levels were significantly negatively associated with VRI values in CKD patients. We concluded that IS level associated inversely with VRI values and had a modulating role in endothelial function in patients with stages 3–5 CKD.

Sarcopenia, defined as the progressive loss of muscle mass, strength, and function, is largely prevalent but still clinically underrecognized among patients undergoing chronic dialysis therapy. The pathogenesis involves a complex interplay of chronic inflammation, oxidative stress, metabolic acidosis, hormonal imbalances, protein waste, malnutrition, and reduced physical activity. This multifactorial condition profoundly impairs quality of life and may lead to significant clinical consequences, including frailty, an increased risk of falls and hospitalization, and elevated mortality. Despite its clinical relevance, sarcopenia often remains underdiagnosed due to inconsistent diagnostic criteria and challenges in assessing body composition in dialysis populations. Therapeutic strategies, including tailored exercise programs, nutritional interventions, and pharmacological treatments, are essential to mitigate muscle loss and improve patient outcomes. Early identification and routine sarcopenia assessment in clinical practice could play a pivotal role in enhancing the management of dialysis patients. A multidisciplinary, personalized approach is necessary to address the diverse factors contributing to sarcopenia and to improve the overall prognosis and quality of life for this vulnerable population.

Sarcopenia, defined as low muscle mass and strength, is highly prevalent in patients undergoing chronic hemodialysis (HD). However, muscle function and muscle mass do not share the same clinical relevance. In fact, muscle strength was more closely associated with the risk of mortality in chronic HD patients than was muscle mass. Therefore, to identify the risk factors of muscle weakness is vital. Angiotensin II overexpression had been recognized to impair skeletal muscle strength. Accordingly, angiotensin II receptor blockers (ARBs) potentially possess a muscle protective effect. This cross-sectional study aimed to identify the factors associated with low muscle strength and to explore the relationship between ARB use and muscle strength in chronic HD patients. A total of 120 chronic HD patients, aged 63.3 ± 13.2 years, were included in this study. Basic characteristics, handgrip strength (HGS), body composition, and nutritional status were assessed, and blood samples for biochemical tests were obtained. We divided these participants into normal- and low HGS groups according to the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP). We observed that 78 (65.0%) patients had low HGS. In our cohort, we found that height (r = 0.653; P < 0.001), weight (r = 0.496; P < 0.001), body mass index (r = 0.215; P = 0.020), skeletal muscle index (r = 0.562; P < 0.001), albumin (r = 0.197; P = 0.032), and serum creatinine (r = 0.544; P < 0.001) were positively and age (r = − 0.506; P < 0.001), subjective global assessment (SGA) score (r = − 0.392; P < 0.001), fractional clearance index for urea (Kt/V) (r = − 0.404; P < 0.001) and urea reduction ratio (URR) (r = − 0.459; P < 0.001) were negatively correlated with HGS. According to our analysis, age (Odds ratio, OR = 1.11, 95% confidence interval, 95% CI = 1.05–1.17, P < 0.001), HD duration (OR = 1.01, 95% CI = 1.00–1.02, P = 0.010), diabetes (OR = 13.33, 95% CI = 3.45–51.53, P < 0.001), Kt/V (OR = 1.61, 95% CI = 1.06–2.46, P = 0.027), and SGA score (OR = 1.19, 95% CI = 1.03–1.38, P = 0.017) were regarded as independent predictors of low HGS. In contrast, ARB use (OR = 0.25, 95% CI = 0.07–0.93, P = 0.039) was independently associated with preserved HGS in chronic HD patients, after adjustment for multiple confounding factors. Our study is the first report in chronic HD patients to indicate a potentially protective effect of ARB on muscle strength. However, further longitudinal follow-up and intervention studies are needed to confirm this finding.