Prevalence and Overlap of Malnutrition, Sarcopenia and Related Nutritional Syndromes in a Large Haemodialysis Population.

Abstract

Background: Chronic kidney disease is a major global health burden linked to malnutrition, sarcopenia and related nutritional syndromes including protein-energy wasting (PEW)/cachexia and sarcopenic obesity (SO). Data from end-stage kidney disease (ESKD) populations in Saudi Arabia and the wider Middle East are scarce. This study assessed the prevalence and factors associated with malnutrition and sarcopenia risk in a large haemodialysis (HD) cohort and the co-occurrence of PEW/cachexia risk and SO.

Methods: Multicentre, cross-sectional study in 40 dialysis clinics across Saudi Arabia (June-August 2024). Adults on maintenance HD ≥ 90 days were screened using the malnutrition-inflammation score (MIS; high risk > 5), SARC-F (sarcopenia risk ≥ 4) high risk, calf circumference (CC; cut-offs ≤ 34-cm males, ≤ 33-cm females), CC adjusted for body mass index (BMI) and oedema (Adj. CC) and SARC-CalF (sarcopenia risk ≥ 11). SO was defined as sarcopenia risk by SARC-CalF (Adj. CC) plus BMI > 30 kg/m². Routine blood chemistry (e.g., total iron-binding capacity [TIBC] and albumin) and screening tools were collected for physical function (Karnofsky), falls risk (Morse fall) and comorbidity (Charlson index). Univariate and multivariate logistic regression (adjusted for age, sex, diabetes, dialysis vintage and Kt/V) identified factors associated with each outcome.

Results: Of 3722 HD patients (56.8% male; age 53.6 ± 15.8 years; BMI 26.8 ± 6.4 kg/m²), 48% had diabetes and 35% had high/very high Charlson comorbidity index. High nutritional risk (MIS > 5) was found in 44.5% (n = 1657) and sarcopenia risk (SARC-CalF [Adj. CC]) in 53.1% (n = 1978); 31.6% (n = 1175) had combined malnutrition and sarcopenia (M + S) and 7.7% (n = 285) had SO. Versus the no-risk group, M + S patients had lower albumin, TIBC, Karnofsky score and higher comorbidity index and Morse fall risk score (all p < 0.001). Independent factors associated with high nutritional risk included lower BMI, higher Charlson index, longer dialysis vintage, lower serum creatinine and higher triglycerides (all p < 0.05). Shared independent factors for sarcopenia risk were older age, higher comorbidity index, longer dialysis duration, lower creatinine and higher triglycerides (all p < 0.05).

Conclusions: This is the first large-scale study to fully characterise a Saudi and Middle Eastern HD cohort. There was a very high risk of malnutrition and sarcopenia. Furthermore, a high number had both conditions and overlapping features of PEW/cachexia, which included high comorbidity and disability risk. Findings support routine, multitool nutritional and muscle screening in HD care, including younger patients.