#2597 Dynapenia is associated with the frequency of fatigue in patients on hemodialysis: findings from the SARC-HD Study
Authors: Ribeiro Heitor , Duarte Marvery , Mondini Dário , Silva Maryanne , Disessa Henrique , Krug Rodrigo , Sant'helena Bruna , Bundchen Daiana , Bohlke Maristela , Adamoli Angélica , Nóbrega Otávio , Reboredo Maycon 
Published: May 2024

Abstract

Background and Aims
Dynapenia is a musculoskeletal disorder characterized by low levels of muscle strength; being highly prevalent in patients undergoing hemodialysis. It may cause dialysis-related unpleasant symptoms and increase the risk of clinical adverse outcomes. Fatigue, a common dialysis-related feature, has been recently recognized as one of the most important patient-reported outcomes. However, whether dynapenia is a risk factor for fatigue remains poorly understood. Thus, we investigated the association between sarcopenia and the frequency of fatigue in patients in hemodialysis of the SARC-HD Study.

Method
This is a cross-sectional report of the multicenter SARC-HD study that included 19 dialysis units across Brazil and enrolled adult patients undergoing maintenance hemodialysis. Muscle strength was evaluated by handgrip strength (HGS) and 5-time sit-to-stand (STS-5). Dynapenia (i.e., low levels of muscle strength) was defined based on the revised European Working Group on Sarcopenia in Older People. Patients were stratified into four groups: i) no dynapenia; ii) dynapenia by low HGS; iii) dynapenia by low STS-5; and iv) severe dynapenia (low HGS + low STS-5). The frequency of fatigue was self-reported by the patients, divided into three groups; i) never/rarely; ii) sometimes; and iii) most of the time/always. The chi-square test was used to compare the prevalence of fatigue among dynapenia groups; while binary logistic regression tested the association between dynapenia and high frequency of fatigue (sometimes + always) adjusted for age, male sex, and body mass index.

Results
Nine hundred and fifteen patients were included, the mean age was 57.5 ± 0.5 years, 61.4% were men, and 50.6% black. The prevalence of dynapenia by low HGS, by low STS-5, and both (i.e., severe dynapenia) was 13.9%, 18.8%, and 12.1%, respectively. The frequency of self-reported fatigue as never/rarely was 39.3%, sometimes was 29.8%, and most of the time/always was 30.9%. High frequency of fatigue (sometimes + always) prevalence was 25.9% in patients without dynapenia, 35.4% in dynapenia by low HGS, 37.2 in dynapenia by low STS-5, and 37.8% in severe dynapenia (P = 0.005). Binary logistic regression showed a significant association between dynapenia by low HGS (OR = 1.86; 95% CI: 1.20 - 2.89), dynapenia by low STS-5 (OR=1.71; 95% CI: 1.16 - 2.52), and severe dynapenia (OR=1.97; 95% CI: 1.23 - 3.17) with the high frequency of fatigue compared to the no dynapenia group (Fig. 1).

Conclusion
Our results showed that patients with dynapenia had a higher risk of self-reported fatigue compared to those without dynapenia. This highlights the importance of recognizing low muscle strength as a potential modifiable factor for fatigue in this population. Therefore, future research may explore interventions that mitigate the impact of dynapenia on the frequency of fatigue.