#5269 THE NUTRITIONAL ASSESSMENT TOOLS TO IDENTIFY PATIENTS AT INCREASED SARCOPENIA RISK
Authors: Tsujimoto Naoyuki , Matsuzawa Ryota , Imai Hiroto , Kakita Daisuke , Shimokado Kiyoshi , Tamaki Akira 
Published: June 2023

Abstract

Background and Aims
Protein-energy wasting (PEW), debilitating nutritional and metabolic disorder marked by a systemic reduction in protein and energy store, is prevalent among patients with end stage renal disease (ESRD). The magnitude of malnutrition among patients undergoing hemodialysis has been positively associated with, the risk of all-cause mortality, particularly due to cardiovascular disease and infections. Additionally, inadequate nutritional status has been implicated in the development of sarcopenia, characterized by decreased muscle mass, weakened muscle strength, and impaired physical function. As such, routine management of nutritional status may be crucial aspect of care for these patients. In addition to the nutritional risk index for Japanese hemodialysis patients (NRI-JH), developed for the diagnosis of PEW, the geriatric nutritional risk index (GNRI) and mini nutritional assessment short-form (MNA-SF) are frequently utilized as nutritional indices in patients on hemodialysis. However, few studies have compared the magnitude of associations between these nutritional measure and sarcopenia in patients undergoing hemodialysis. This study aimed to evaluate the degree of association between nutritional assessments and sarcopenia in this patient population.

Method
The current cross-sectional study recruited outpatients receiving maintenance hemodialysis between June 2019 and December 2021. The study collected patient information, including age, gender, body mass index, dialysis duration, primary kidney diseases, 11 comorbid conditions, and laboratory parameters (such as serum albumin, serum creatinine, and total cholesterol), from medical records. Physical therapists assessed muscle mass (skeletal muscle index [SMI]), muscle strength (handgrip strength), and physical performance (short physical performance battery [SPPB]), and sarcopenia was diagnosed when patients presented with low muscle mass (SMI &lt;7.0 kg/m2 for males, &lt;5.7 kg/m2 for females) and low muscle strength (handgrip strength &lt;28.0kg for males, &lt;18 kg for females) or low physical performance (SPPB ≤9) based on the Asian Working Group for Sarcopenia 2019 criteria. The study employed the NRI-JH, GNRI, and MNA-SF as markers of nutritional status. The NRI-JH was calculated based on body mass index, serum albumin, serum creatinine, and total cholesterol. Logistic regression analysis was performed to examine the associations of NRI-JH, GNRI, and MNA-SF with sarcopenia among patients on hemodialysis.

Results
Sixty-five patients undergoing hemodialysis were analyzed in this study. The mean age of the patients was 78.3 ± 10.7 years, with 36.9% being female. The average duration of dialysis was 6.4 ± 3.9 years. The most frequently observed underlying kidney disease was diabetes mellitus, followed by hypertension. The prevalence of sarcopenia was found to be 60.0%. After adjustment for the effects of age, gender, dialysis duration, and comorbidity index, patients with a lower score on the NRI-JH were significantly more prone to sarcopenia (odds ratio per 1-point increase, 1.33; 95% confidence interval, 1.04–1.69). The NRI-JH was demonstrated to have a stronger association with sarcopenia compared to the others (Table 1).

Conclusion
The NRI-JH and GNRI were significantly associated with risk of sarcopenia. The NRI-JH demonstrated a stronger association with the risk of sarcopenia compared to the GNRI.