Background and objectives: Metabolic syndrome (MetS) is a cluster of risk factors, such as abdominal obesity, insulin resistance, dyslipidemia and hypertension, that together increase the risk of cardiovascular disease. Chronic hemodialysis (HD) patients have multiple comorbidities and many metabolic disorders, causing the frequent occurrence of metabolic syndrome. The goal of this study was to assess the prevalence of MetS in HD patients, and its association with all-cause and cardiovascular (CV) mortality. Patients and methods: A total of 138 HD patients were included in this prospective study. We analyzed demographic, anthropometric and biochemical data. Outcome measures were all-cause and CV mortality during the three-year follow-up. Results: MetS was diagnosed in 57.24% of enrolled patients. During the 36 months of follow-up, 33 patients died. MetS patients showed a significantly higher mortality rate than non-MetS (30.4% versus 16.36%, p < 0.001). The association of different MetS components with cardiovascular mortality reached significance when a minimum of three components were present (1.81 (95% confidence interval CI = 1.21–2.33)), with a grouped increase in effect size for subjects with four or five MetS components. Subjects with MetS exhibited nearly twice as high risk for all-cause (hazard ratio HR = 1.99 (95%CI) = 1.42–2.97) and 2.5 times for CV (HR = 2.51 (95%CI) = 1.25–3.83) mortality compared with those without MetS, after adjustment for age, gender, and cardiovascular disease. Conclusions: The study demonstrates that MetS is widespread in HD patients. In future, the focus must be on an active screening approach, and treatment of cardiometabolic risk factors, aiming to reduce mortality.

Background and Objectives: Sarcopenia is common among patients receiving maintenance hemodialysis, although prevalence estimates vary according to the diagnostic approach. We assessed sarcopenia defined according to the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, its baseline correlates, and its association with 24-month all-cause mortality. Materials and Methods: In this single-center prospective cohort at a tertiary nephrology center, 176 patients enrolled in December 2022 were followed for 24 months. Confirmed sarcopenia required both low handgrip strength and a low appendicular skeletal muscle index assessed by bioelectrical impedance. Physical performance was not assessed. Because the proportional-hazards assumption was not satisfied, restricted mean survival time (RMST) was used as the primary measure of the survival difference. Results: Sarcopenia was present in 46 of 176 participants (26.1%, 95% CI 20.2–33.1). Older age, lower serum albumin and phosphorus concentrations, lower Kt/V, and longer time on maintenance hemodialysis were independently associated with sarcopenia. Thirty-one participants died during follow-up, and survival was lower among those with sarcopenia (log-rank p = 0.035). The adjusted RMST difference was −3.88 months (95% CI −6.49 to −1.28; p = 0.003). A Cox sensitivity analysis yielded a hazard ratio of 2.62 (95% CI 1.06–6.45). There was no evidence of a sarcopenia-by-sex interaction in the adjusted RMST analysis (p = 0.964). Conclusions: Confirmed sarcopenia was present in approximately one quarter of patients and was associated with approximately four months shorter restricted mean survival over 24 months. EWGSOP2-based assessment may provide prognostic information in this setting; whether routine screening or management based on sarcopenia status improves clinical outcomes remains to be determined.

Background: Cardiovascular disease (CVD) is the leading cause of mortality in peritoneal dialysis (PD) patients, with traditional risk factors failing to fully explain the accelerated atherosclerosis observed in this group. Hepcidin, a major regulator of iron metabolism and inflammation, has emerged as a potential contributor to vascular remodeling. Methods: We conducted a cross-sectional study of 82 PD patients to assess the relationship between serum hepcidin levels and carotid intima–media thickness (CIMT), a surrogate marker of subclinical atherosclerosis. Clinical, biochemical, and dialysis-related data were collected. Patients were stratified into tertiles by hepcidin levels, and correlation, regression, and ROC analyses were performed. Results: Serum hepcidin levels showed a strong positive correlation with CIMT (ρ = 0.788, p < 0.001). In multivariate linear regression, hepcidin (β = 0.0057, p = 0.012) and dialysis duration (β = 0.0018, p = 0.015) remained independent predictors of CIMT. ROC analysis demonstrated excellent discriminative ability of hepcidin for elevated CIMT (AUC = 0.922), which improved further with the inclusion of dialysis duration (AUC = 0.952). Conclusions: Serum hepcidin is a strong, independent predictor of subclinical atherosclerosis in PD patients. These findings suggest that iron dysregulation and inflammation may play a more prominent role than traditional cardiovascular risk factors in this population. Hepcidin may serve as a valuable biomarker for early vascular risk stratification and a potential therapeutic target.