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Increased Predialysis Extracellular to Intracellular Water Ratio Is Associated With Sarcopenia in Hemodialysis Patients

  • Chaomin Zhou
    Correspondence
    Address correspondence to Chaomin Zhou, MD, and Yan Zha, MD, PhD, Renal Division, Department of Medicine, Guizhou Provincial People’ s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China.
    Affiliations
    Renal Division, Department of Medicine, Guizhou Provincial People’ s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China
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  • Xin Lin
    Affiliations
    Renal Division, Department of Medicine, Guizhou Provincial People’ s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China
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  • Guoying Ma
    Affiliations
    Renal Division, Department of Medicine, Qian dongnan People's Hospital, Qian Dongnan, Guizhou, China
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  • Jing Yuan
    Affiliations
    Renal Division, Department of Medicine, Guizhou Provincial People’ s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China
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  • Yan Zha
    Correspondence
    Address correspondence to Chaomin Zhou, MD, and Yan Zha, MD, PhD, Renal Division, Department of Medicine, Guizhou Provincial People’ s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China.
    Affiliations
    Renal Division, Department of Medicine, Guizhou Provincial People’ s Hospital, Guizhou Provincial Institute of Nephritic and Urinary Disease, Guiyang, Guizhou, China
    Search for articles by this author
Published:April 01, 2022DOI:https://doi.org/10.1053/j.jrn.2022.03.004

      Objective

      To explore the association between fluid overload, evaluated by a new fluid overload indicator, the bioelectrical impedance analysis–derived whole-body extracellular to intracellular water ratio (ECW/ICW), and sarcopenia in maintenance hemodialysis (MHD) patients.

      Methods

      A multicenter, cross-sectional study that included 3320 adult MHD patients was conducted in 20 hemodialysis centers of Guizhou Province, Southwest China from June 1, 2020, to September 30, 2020. The diagnosis of sarcopenia was based on the Asian Working Group's definition of sarcopenia. Multiple logistic regression models, stratified analyses, and interactive analyses were conducted.

      Results

      A total of 3196 participants were included in the final analysis. The prevalence of sarcopenia was 36.2% in the total population. The prevalence of sarcopenia was increased with increasing quartiles of ECW/ICW (18.1%, 33.3%, 37.8%, and 55.4% for the first, second, third, and fourth quartiles, respectively). Increased ECW/ICW was significantly associated with sarcopenia. The association remained statistically significant even after adjusting for age, sex, body mass index (BMI), dialysis vintage, C-reactive protein, and various medical histories. The odds ratios were 2.11 (1.41, 3.14), 1.83 (1.22, 2.76), and 3.45 (2.21, 5.39) for ECW/ICW quartiles 2–4, respectively (P for trend <.001). The interaction analysis showed that history of diabetes had an interactive role in the association between ECW/ICW and sarcopenia (P for interaction = .034). The association stably existed across subgroups and was more prominent in older patients and those with higher BMI and a history of diabetes.

      Conclusions

      Elevated ECW/ICW was associated with increased sarcopenia risk independent of BMI, prealbumin, C-reactive protein, and other potential confounders in MHD patients. The association was more prominent in older patients and those with higher BMI and a history of diabetes, suggesting that controlling volume balance may help to reduce the occurrence of sarcopenia in these populations.

      Keywords

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