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Significant Association of Diabetes With Mortality of Chronic Hemodialysis Patients, Independent of the Presence of Obesity, Sarcopenia, and Sarcopenic Obesity

Published:August 28, 2021DOI:https://doi.org/10.1053/j.jrn.2021.07.003

      Objectives

      This retrospective cohort study investigated the association of diabetes with mortality in hemodialysis patients with regard to obesity, sarcopenia, and sarcopenic obesity, along with examining the prevalence of each group and diabetes.

      Methods

      Muscle strength, muscle mass, and fat mass were evaluated using a hand dynamometer and dual-energy X-ray absorptiometry, respectively, in 308 chronic hemodialysis patients (age 58.0 ± 11.9 years, hemodialysis duration 6.5 ± 6.0 years, males 60.1%, diabetes 32.8%). Sarcopenia was defined according to the new criteria established by the Asian Working Group on Sarcopenia 2019. Obesity was defined by percent body fat mass (males ≥25%, females ≥35%).

      Results

      The enrolled patients were divided into the normal (38.7%), obesity (18.8%), sarcopenia (26.9%), and sarcopenic obesity (15.6%) groups. The prevalence of diabetes was significantly skewed among the 4 groups (χ2 test, P = .0057), being higher in the sarcopenic obesity group (54.2%) compared to the others (25.9-33.7%). Multivariate regression analysis revealed that diabetes was significantly and independently associated with sarcopenic obesity (odds ratio 3.495, 95% confidence interval 1.683-7.255, P = .0008) after adjustments for several cofounders, but not significantly associated with sarcopenia. During the follow-up period of 76 ± 35 months, 100 patients died. Those in the sarcopenia and sarcopenic obesity groups had significantly higher rates of all-cause mortality compared to patients in the normal and obesity groups (P = .0004, log-rank test). Furthermore, multivariate Cox proportional hazards analysis revealed that presence of diabetes was significantly associated with higher all-cause mortality in all 308 patients, after adjustments for several factors, including the presence of each group in 4 models.

      Conclusion

      Sarcopenic obesity is highly prevalent in chronic hemodialysis patients. Diabetes was found to be a significant and independent contributor to the presence of sarcopenic obesity. Diabetes was shown to be a significant predictor of all-cause mortality, independent of the present normal, obesity, sarcopenia, and sarcopenic obesity groups.
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      References

        • Roh E.
        • Choi K.M.
        Health consequences of sarcopenic obesity: a narrative review.
        Front Endocrinol (Lausanne). 2020; 11: 332
        • Honda H.
        • Qureshi A.R.
        • Axelsson J.
        • et al.
        Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality.
        Am J Clin Nutr. 2007; 86: 633-638
        • Fukuoka Y.
        • Narita T.
        • Fujita H.
        • et al.
        Importance of physical evaluation using skeletal muscle mass index and body fat percentage to prevent sarcopenia in elderly Japanese diabetes patients.
        J Diabetes Investig. 2019; 10: 322-330
        • Androga L.
        • Sharma D.
        • Amodu A.
        • et al.
        Sarcopenia, obesity, and mortality in US adults with and without chronic kidney disease.
        Kidney Int Rep. 2017; 2: 201-211
        • Cruz-Jentoft A.J.
        • Baeyens J.P.
        • Bauer J.M.
        • et al.
        Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people.
        Age Ageing. 2010; 39: 412-423
        • Chen L.K.
        • Liu L.K.
        • Woo J.
        • et al.
        Sarcopenia in Asia: consensus report of the Asian working group for sarcopenia.
        J Am Med Dir Assoc. 2014; 15: 95-101
        • Berrington de Gonzalez A.
        • Hartge P.
        • Cerhan J.R.
        • et al.
        Body-mass index and mortality among 1.46 million white adults.
        N Engl J Med. 2010; 363: 2211-2219
        • Cruz-Jentoft A.J.
        • Bahat G.
        • Bauer J.
        • et al.
        Sarcopenia: revised European consensus on definition and diagnosis.
        Age Ageing. 2019; 48: 16-31
        • Chen L.K.
        • Woo J.
        • Assantachai P.
        • et al.
        Asian working group for sarcopenia: 2019 consensus Update on sarcopenia diagnosis and treatment.
        J Am Med Dir Assoc. 2020; 21: 300-307.e302
        • Van Gaal L.F.
        • Mertens I.L.
        • De Block C.E.
        Mechanisms linking obesity with cardiovascular disease.
        Nature. 2006; 444: 875-880
        • Kahn S.E.
        • Hull R.L.
        • Utzschneider K.M.
        Mechanisms linking obesity to insulin resistance and type 2 diabetes.
        Nature. 2006; 444: 840-846
        • Batsis J.A.
        • Mackenzie T.A.
        • Emeny R.T.
        • et al.
        Low lean mass with and without obesity, and mortality: results from the 1999-2004 National Health and Nutrition Examination Survey.
        J Gerontol A Biol Sci Med Sci. 2017; 72: 1445-1451
        • Malhotra R.
        • Deger S.M.
        • Salat H.
        • et al.
        Sarcopenic obesity definitions by body composition and mortality in the hemodialysis patients.
        J Ren Nutr. 2017; 27: 84-90
        • Wang M.
        • Tan Y.
        • Shi Y.
        • et al.
        Diabetes and sarcopenic obesity: pathogenesis, diagnosis, and treatments.
        Front Endocrinol (Lausanne). 2020; 11: 568
        • Tabibi H.
        • As'habi A.
        • Najafi I.
        • et al.
        Prevalence of dynapenic obesity and sarcopenic obesity and their associations with cardiovascular disease risk factors in peritoneal dialysis patients.
        Kidney Res Clin Pract. 2018; 37: 404-413
        • Mori K.
        • Nishide K.
        • Okuno S.
        • et al.
        Impact of diabetes on sarcopenia and mortality in patients undergoing hemodialysis.
        BMC Nephrol. 2019; 20: 105
        • American Diabetes A.
        Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2004; 27: S5-S10
        • Watanabe Y.
        • Kawanishi H.
        • Suzuki K.
        • et al.
        Japanese society for dialysis therapy clinical guideline for "Maintenance hemodialysis: hemodialysis prescriptions".
        Ther Apher Dial. 2015; 19: 67-92
        • Inaba M.
        • Kurajoh M.
        • Okuno S.
        • et al.
        Poor muscle quality rather than reduced lean body mass is responsible for the lower serum creatinine level in hemodialysis patients with diabetes mellitus.
        Clin Nephrol. 2010; 74: 266-272
        • Yoda M.
        • Inaba M.
        • Okuno S.
        • et al.
        Poor muscle quality as a predictor of high mortality independent of diabetes in hemodialysis patients.
        Biomed Pharmacother. 2012; 66: 266-270
        • Batsis J.A.
        • Singh S.
        • Lopez-Jimenez F.
        Anthropometric measurements and survival in older Americans: results from the third National health and Nutrition Examination Survey.
        J Nutr Health Aging. 2014; 18: 123-130
        • Sugimoto K.
        • Tabara Y.
        • Ikegami H.
        • et al.
        Hyperglycemia in non-obese patients with type 2 diabetes is associated with low muscle mass: the Multicenter Study for Clarifying Evidence for Sarcopenia in Patients with Diabetes Mellitus.
        J Diabetes Investig. 2019; 10: 1471-1479
        • Jee S.H.
        • Sull J.W.
        • Park J.
        • et al.
        Body-mass index and mortality in Korean men and women.
        N Engl J Med. 2006; 355: 779-787
        • Lee D.C.
        • Shook R.P.
        • Drenowatz C.
        • et al.
        Physical activity and sarcopenic obesity: definition, assessment, prevalence and mechanism.
        Future Sci OA. 2016; 2: FSO127
        • Choi K.M.
        Sarcopenia and sarcopenic obesity.
        Korean J Intern Med. 2016; 31: 1054-1060
        • Batsis J.A.
        • Barre L.K.
        • Mackenzie T.A.
        • et al.
        Variation in the prevalence of sarcopenia and sarcopenic obesity in older adults associated with different research definitions: dual-energy X-ray absorptiometry data from the National Health and Nutrition Examination Survey 1999-2004.
        J Am Geriatr Soc. 2013; 61: 974-980
        • Gracia-Iguacel C.
        • Qureshi A.R.
        • Avesani C.M.
        • et al.
        Subclinical versus overt obesity in dialysis patients: more than meets the eye.
        Nephrol Dial Transpl. 2013; 28: iv175-181
        • Kim Y.S.
        • Lee Y.
        • Chung Y.S.
        • et al.
        Prevalence of sarcopenia and sarcopenic obesity in the Korean population based on the Fourth Korean National Health and Nutritional Examination Surveys.
        J Gerontol A Biol Sci Med Sci. 2012; 67: 1107-1113
        • Eckel R.H.
        • Kahn S.E.
        • Ferrannini E.
        • et al.
        Obesity and type 2 diabetes: what can be unified and what needs to be individualized?.
        J Clin Endocrinol Metab. 2011; 96: 1654-1663
        • Beaudart C.
        • Zaaria M.
        • Pasleau F.
        • et al.
        Health outcomes of sarcopenia: a systematic review and meta-analysis.
        PLoS One. 2017; 12: e0169548
        • Khadra D.
        • Itani L.
        • Tannir H.
        • et al.
        Association between sarcopenic obesity and higher risk of type 2 diabetes in adults: a systematic review and meta-analysis.
        World J Diabetes. 2019; 10: 311-323
        • Zhang X.
        • Xie X.
        • Dou Q.
        • et al.
        Association of sarcopenic obesity with the risk of all-cause mortality among adults over a broad range of different settings: a updated meta-analysis.
        BMC Geriatr. 2019; 19: 183