Sarcopenia and Its Individual Traits Independently Predict Mortality in Patients on Dialysis: A Systematic Review and Meta-Analysis

IF 9.1 1区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Cachexia Sarcopenia and Muscle Pub Date : 2025-10-09 DOI:10.1002/jcsm.70089

Alice Sabatino, Alessandro Guerra, Kenia Mara Baiocchi de Carvalho, Lilian Cuppari, Juan Jesus Carrero, Peter Stenvinkel, Bengt Lindholm, Carla Maria Avesani

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Abstract

Background

Loss of muscle mass, muscle weakness and the combination of the two are commonly observed in patients on dialysis and may have a negative impact on their survival. In this systematic review and meta-analysis (MA), we evaluated the consistency and strength of the association between mortality risk and the presence of low muscle mass with adequate muscle strength, low muscle strength with adequate muscle mass and sarcopenia (low muscle mass and strength combined) in patients on dialysis. Ultimately, we aimed to grade which of these three conditions had the strongest association with increased mortality risk in this vulnerable group of patients.

Methods

We searched for studies published until 31 January 2024 that evaluated sarcopenia and its individual components in patients aged > 18 years on dialysis (haemodialysis and peritoneal dialysis) and that had a mean follow-up for mortality for ≥ 12 months. Included studies had to enable the evaluation of sarcopenia traits to identify patients with low muscle mass and adequate muscle strength, low muscle strength with adequate muscle mass, and sarcopenia. A systematic search was conducted in MEDLINE (by PubMed), Embase, Web of Science, Lilacs and grey literature (i.e., Google Scholar and ProQuest). We estimated consistency in the association between sarcopenia traits and death using random effects MA and reporting hazard ratio (HR) with a 95% confidence interval (95% CI).

Results

The electronic search retrieved 5712 records. After removing duplicated records and those that did not meet the eligibility criteria, 19 studies were included in the qualitative synthesis (4281 participants) and 17 studies (4024 participants) with extractable data for the MA. The MA showed low heterogeneity in the association between muscle parameters and sarcopenia with the risk of death: low muscle mass with adequate muscle strength, HR: 1.49; 95% CI: 1.04 to 2.13; I² = 0%; low muscle strength with adequate muscle mass, HR: 1.82; 95% CI: 1.38 to 2.41; I² = 0%; and sarcopenia, HR: 2.02; 95% CI: 1.61 to 2.54; I² = 40%.

Conclusion

Although being statistically significant, the association between low muscle mass and mortality seems to be less strong than the association between low muscle strength and mortality in patients on dialysis. Those presenting with a combination of the two traits, that is, sarcopenia, showed the highest risk of dying prematurely.

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肌肉减少症及其个体特征独立预测透析患者的死亡率：一项系统回顾和荟萃分析。

背景：在透析患者中经常观察到肌肉量减少、肌肉无力以及两者的结合，并可能对其生存产生负面影响。在这项系统回顾和荟萃分析（MA）中，我们评估了透析患者中存在低肌肉量和足够的肌肉量、低肌肉量和足够的肌肉量以及肌肉减少症（低肌肉量和力量相结合）之间的死亡率风险的一致性和强度。最终，我们的目标是对这三种情况中哪一种与这一脆弱患者群体的死亡风险增加有最强的关联进行分级。方法：我们检索了截至2024年1月31日发表的研究，这些研究评估了bb0 ~ 18岁透析（血液透析和腹膜透析）患者的肌肉减少症及其个体成分，平均死亡率随访时间≥12个月。纳入的研究必须能够评估肌肉减少症的特征，以识别低肌肉质量和足够肌肉力量的患者，低肌肉力量和足够肌肉质量的患者，以及肌肉减少症。系统检索MEDLINE （PubMed）、Embase、Web of Science、Lilacs和灰色文献（即谷歌Scholar和ProQuest）。我们使用随机效应MA和报告风险比（HR）（95%置信区间（95% CI））来估计肌肉减少症特征与死亡之间相关性的一致性。结果电子检索检索到5712条记录。在删除重复记录和不符合资格标准的记录后，定性综合纳入了19项研究（4281名参与者）和17项研究（4024名参与者），这些研究具有可提取的MA数据。MA显示肌肉参数和肌肉减少症与死亡风险之间的关联异质性较低：低肌肉质量但肌肉力量充足，HR: 1.49；95% CI: 1.04 ~ 2.13；i2 = 0%；肌肉强度低，但肌肉质量充足，HR: 1.82；95% CI: 1.38 ~ 2.41；i2 = 0%；肌肉减少症，HR: 2.02；95% CI: 1.61 ~ 2.54；i2 = 40%。结论在透析患者中，低肌肉质量与死亡率之间的相关性虽然具有统计学意义，但似乎不如低肌肉强度与死亡率之间的相关性强。那些同时表现出这两种特征的人，即肌肉减少症，过早死亡的风险最高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.