Association Between Sarcopenic Obesity and Worsening Physical Performance in Patients Undergoing Hemodialysis: The REPnet-HD Study

Abstract

Objective

Sarcopenic obesity, defined by excess fat mass with concurrent sarcopenia, is an emerging public health concern. In patients undergoing hemodialysis, reduced physical performance is associated with poor prognosis. This study aimed to investigate association between sarcopenic obesity and worsening physical performance over 1 year in patients undergoing hemodialysis.

Design and Methods

In this multicenter prospective cohort study, patients undergoing hemodialysis from 12 facilities were evaluated. Physical performance was measured using the Short Physical Performance Battery at baseline and after 1 year. Sarcopenic obesity was defined by the presence of both low muscle mass and strength (sarcopenia) and high body fat mass (obesity). Patients were categorized into four groups: no sarcopenia or obesity, obesity alone, sarcopenia alone, and sarcopenic obesity. Decline in physical performance was defined as a decrease in Short Physical Performance Battery score by ≥ 1 point, and associations were examined using multivariate logistic regression.

Results

Among 295 patients (median age 70 years; 123 females), the prevalence of no sarcopenia or obesity, obesity, sarcopenia, and sarcopenic obesity was 47%, 20%, 17%, and 16%, respectively. Univariate analysis showed that both sarcopenic obesity (odds ratio [OR]: 3.67, 95% confidence interval [CI]: 1.8-7.47, P < .001) and sarcopenia (OR: 2.12, 95% CI: 1.03-4.36, P = .04) were significantly associated with worsening performance. In multivariate analysis, only sarcopenic obesity remained significant (OR: 2.76, 95% CI: 1.06-7.19, P = .04).

Conclusion

Sarcopenic obesity was associated with decreased physical performance over 1 year in patients undergoing hemodialysis and may contribute to future physical dysfunction.