SP621POOR PROGNOSIS LINKED TO REDUCED MUSCLE MASS IN HEMODIALYSIS PATIENTS IS MAINLY CONFINED TO ELDERLY MEN

Abstract

Introduction and Aims: Reduced muscle mass, an independent risk factor for mortality in the general population, is prevalent in hemodialysis (HD) patients but its impact on survival in HD patients is not clear. Here we investigated relations between age, gender, systemic inflammation, nutritional status including muscle mass [assessed by bio-electrical impedance analysis, BIA] in HD patients and analyzed how these factors associated with clinical outcome. Methods: In 221 HD patients (137 men, mean age 65.5 years and median dialysis vintage time 5.8 (2.9-9.8) years) recruited during 2009-2015 and then followed prospectively for up to 5-years, low muscle mass (by BIA-appendicular muscle mass index, ASMI) was defined according to criteria postulated by the AsianWorking Group for Sarcopenia (AWGS) in Older People: ASMI cutoffs for low muscle mass were defined as values two standard deviations (SD) below sex-specific means in a young reference population (7.0 kg/m2 in men and 5.7 kg/m2 in women). During follow-up for up to 65 months, 62 HD patients died (including 13 deaths due to cancer). Associations between low muscle mass and subsequent mortality risk over a mean follow-up period of 45 months were assessed. Results: 50.8% of HD patients had low muscle mass and 60.3% of those were above 65 years. Old age, low GNRI (Geriatric Nutritional Risk Index), low albumin and presence of inflammation associated with low muscle mass. Whereas low muscle mass associated with mortality, when comparing patients with age above or below 65 years, and men with women, low muscle mass associated with increased risk of mortality mainly in those above 65 years (hazard ratio, HR 12.7, 95% CI, 3.75-80.5) and in men (HR 2.08, 95% CI, 1.10-4.14), see figure. Multivariate logistic regression analysis showed that non-cancer death in men above 65 years, associated mainly with low muscle mass (Odds ratio, OR 3.44, 95% CI, 1.26-10.2, p=0.015). Conclusions: In HD patients, low muscle mass carries an increased mortality risk which is mainly confined to men above 65 years of age. Therapeutic strategies targeting low muscle mass therefore need to be stratified according to age and gender in HD patients. (Figure presented).