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Increased pre-dialysis extracellular to intracellular water ratio is associated with sarcopenia in hemodialysis patients.

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


METHODS
A multicenter, cross-sectional study included 3320 adult MHD patients was conducted in XX from June 1, 2020 to September 30, 2020. The diagnosis of sarcopenia was based on the Asian Working Group's definition of sarcopenia (AWGS). 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. 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, BMI, dialysis vintage, C-reactive protein (CRP) and various medical histories. The ORs 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＜0.001). The interaction analysis showed that history of diabetes had an interactive role in the association between ECW/ICW and sarcopenia (P for interaction = 0.034). The association stably existed across subgroups and was more prominent in older patients, those with higher BMI and a history of diabetes.


CONCLUSIONS
Elevated ECW/ICW was associated with increased sarcopenia risk independent of BMI, prealbumin, CRP 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.