Association of diabetes with sarcopenia in patients on hemodialysis: a nationwide cross-sectional study in Portugal.

Background & aims: Diabetes mellitus is a leading cause of chronic kidney disease and has been linked to an increased risk of sarcopenia. However, evidence on the bidirectional relationships between these conditions remains inconclusive among patients on hemodialysis. This study aimed to investigate the association between diabetes and sarcopenia in this population.

Methods: This cross-sectional analysis used data from a nationwide cohort study conducted across 20 dialysis clinics in Portugal. Sarcopenia was diagnosed based on the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, and diabetes was defined using the American Diabetes Association guidelines.

Results: A total of 715 patients were included (median age: 63 years; 37% female). The prevalence of sarcopenia and diabetes was 16% and 27%, respectively. Sarcopenia was more than twice as common in patients with diabetes (27% vs. 12%, P < 0.001), who also exhibited poorer functionality (all P < 0.001). Adjusted multinomial logistic regression revealed an independent association between diabetes and confirmed sarcopenia (adjusted odds ratio [aOR] 2.41; 95% confidence interval [95% CI], 1.41-4.11). Subgroup analysis showed that this association was specifically observed in males (aOR: 2.64; 95% CI, 1.37-5.09).

Conclusions: In this nationwide cross-sectional and study, diabetes mellitus was independently associated with sarcopenia and its related traits in patients on hemodialysis. Notably, this association was specifically in males, suggesting a potential sex-related difference. These findings highlight the importance of early diabetes detection and the implementation of multidisciplinary strategies to mitigate adverse effects on physical function and muscle mass at a high-risk population.