Calf circumference predicts sarcopenia and all-cause mortality in older patients undergoing maintenance hemodialysis: A prospective cohort study.

Background: The role of calf circumference (CC) in predicting sarcopenia and mortality of patients undergoing maintenance hemodialysis (MHD) remains debated. This study assessed CC's predictive value, optimal threshold, and mortality association in older patients undergoing MHD.

Methods: An observational cohort study was conducted on older adult patients undergoing MHD. Sarcopenia was defined by European Working Group on Sarcopenia in Older People. Logistic regression and receiver operating characteristic (ROC) analysis were used to explore the relationship between CC and sarcopenia. Kaplan-Meier and Cox regression analyses assessed survival over 2 years.

Results: A total of 979 older adult patients undergoing MHD treatment, with an average age of 73.4 years, were included in this study. The prevalence of sarcopenia was 61.1%. Male sex (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.04-0.45; P = 0.017) and CC (OR, 0.38; 95% CI, 0.26-0.56; P < 0.001) were identified as independent risk factors for sarcopenia through multifactorial logistic regression analysis. ROC curves for CC and sarcopenia indicated that the optimal cutoff value for men was 32.5 cm (area under the curve [AUC], 0.904; sensitivity, 0.958; specificity, 0.841), whereas for women, it was 31.9 cm (AUC, 0.884; sensitivity, 0.922; specificity: 0.756). Kaplan-Meier survival analysis demonstrated lower survival probabilities in patients with sarcopenia and low CC. After adjustment for multiple factors, Cox regression analysis revealed that patients in the sarcopenia group (hazard ratio [HR] = 2.411; P = 0.017) and those in the low-CC group (HR = 2.045; P = 0.046) had significantly shorter overall survival.

Conclusions: CC is an independent predictor of sarcopenia and mortality in older patients undergoing MHD.