Association Between Sarcopenia and Sarcopenic Obesity With Metabolic and Cardiovascular Risk Factors in Taiwanese Dialysis Patients

Patients

The study is a cross-sectional analysis of all patients on hemodialysis patients treated at Tungs' Taichung Metroharbor hospital(500 patients). Patients ≥20 years of age and been on maintenance hemodialysis for at least 3 month before the study. The dialysis sessions were 3.5 to 4.5 h three times per week, with a blood flow greater than 300 mL/min, a dialysate flow of 600 mL/min, and a bicarbonate buffer.

Clinical assessments and data collection

The investigators collect baseline clinical data [such as age, sex, height, bodyweight, clinical etiology of Chronic Kidney Disease if possible, comorbidities, blood pressure, laboratory measures [such as serum creatinine, albumin, C-reactive protein (CRP), total cholesterol, complete blood counts, total carbon dioxide, anthropometric information and various potential indicators of PEW [such as body mass index, waist/hip ratio, mid-arm circumference (MAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), mid-arm muscle area (MAMA), SGA, BIA analyses, and hand grip Strength (HGS). For the laboratory tests, fasting blood samples are obtained from each patient and are performed in the Department of Clinical Pathology of the investigators hospital by means of routine methods. Interleukin-6 (IL-6) and tumour necrosis factor-α(TNF-α )levels are measured via immunometric enzyme immunoassay. Insulin is analyzed using human ELISA kits . Sensitivity is 2.88 pmol/L, and the upper limits of intra- and inter-assay coefficients of variation were 3.3 and 7.6, respectively. Homeostatic Model Assessment Insulin Resistance(HOMA-IR) was calculated as fasting insulin (U/l) × fasting glucose (mg/dl)/405, as described by Matthews et al.

All patients received echocardiograms studies performed within 3 months after enrollment, which were used to estimate Congestive Heart Failure (defined as an ejection fraction of <40%) or left ventricular hypertrophy (LVH, defined as left ventricle mass index 125 g/m2 in men and 100 g/m2 in women). Cardiovascular disease is defined as a previous history of Congestive Heart Failure, LVH, ischemic heart disease(including prior history of angina, myocardial infarction, coronary artery bypass grafting and percutaneous cardiac catheter intervention) or cerebrovascular disease (including prior history of transient ischemic attack and stroke).