Malnutrition, protein-energy wasting, sarcopenia and sarcopenic obesity in hemodialysis patients

Nutrition disorders and nutrition related conditions contribute to increased morbidity, mortality, and poor quality of life in hemodialysis (HD) patients. This study investigates the prevalence and overlap between these conditions in HD patients.

This cross-sectional multicenter study included adult HD patients from the Netherlands. Body composition was assessed using single-frequency bioimpedance analysis (SF-BIA), multi-frequency bioimpedance analysis (MF-BIA), or bioimpedance spectroscopy (BIS). Muscle strength was estimated by handgrip strength. Nutrition disorders and nutrition related conditions were assessed using: Global Leadership Initiative on Malnutrition (GLIM), Protein-Energy Wasting (PEW), Subjective Global Assessment (SGA), Patient-Generated SGA (PG-SGA), European Working Group on Sarcopenia in Older People (EWGSOP2) and the Sarcopenic Obesity Global Leadership Initiative (SOGLI) consensus. Overlap was identified using VENN diagrams.

Of the 128 HD patients included, 59% were classified as malnourished based on GLIM criteria, with reduced muscle mass being the most prevalent phenotypic indicator (83%). PEW was present in 38%, sarcopenia according to EWGSOP2 in 23%, and sarcopenic obesity per SOGLI in 5%. Moderate-to-severe malnutrition was present in 47% of patients using the SGA (n = 89) and in 98% using PG-SGA (n = 39). GLIM showed the greatest overlap with other frameworks.

This study reveals a high prevalence of malnutrition, PEW, and sarcopenia among HD patients. These results highlight the need for muscle-oriented screening and provide novel insight into the coexistence of nutrition disorders and nutrition related conditions in this population. Given the overlap with other frameworks, GLIM appears to be a promising approach for diagnosing malnutrition in HD patients.