Diabetes independently corelates with mortality in patients on hemodialysis
While diabetes is a contributor to the presence of sarcopenic obesity in patients on chronic hemodialysis, it is also a significant predictor of all-cause mortality independent of the presence of obesity, sarcopenia and sarcopenia obesity.
Previous studies have explored sarcopenia and obesity in patients with diabetes, but the effects of diabetes on mortality in this population were yet to be defined.
Eiji Ishimura, MD, PhD, professor in the department of nephrology at the Osaka City University Hospital in Japan, and colleagues investigated the link between diabetes and mortality in patients on hemodialysis. Investigators adjusted findings for obesity, sarcopenia and sarcopenic obesity in the retrospective cohort study.
Researchers observed 308 patients on hemodialysis from January 1997 to December 2005, with a follow-up period of about 76 months. All patients were treated in Japan. The mean age of patients was 58 years. The median hemodialysis duration was 4.1 years. Overall, 60.1% were men and 32.8% had diabetes.
Using a hand dynamometer and dual-energy X-ray absorptiometry, researchers measured patients’ muscle strength, muscle mass and fat mass. They defined sarcopenia using new criteria created by the Asian Working Group on Sarcopenia 2019 and categorized patients into the following groups: normal BMI (38.7%), obese (18.8%), sarcopenia (26.9%) and sarcopenic obesity (15.6%) groups.
Diabetes was significantly skewed among all four groups and was highest in the sarcopenic obesity group (54.2%). Although diabetes was not significantly correlated with sarcopenia, multivariate regression analysis results showed it was significantly and independently associated with sarcopenic obesity (OR= 3.495).
Among the 308 patients, 100 died during the follow-up. All-cause mortality was higher in the sarcopenia and sarcopenic obesity groups than the other two groups.
“The present findings also demonstrated that the presence of diabetes was independently associated with mortality in the normal, obesity, sarcopenia, and sarcopenic obesity groups,” Ishimura and colleagues wrote. “This suggests that diabetes is one of the strongest clinical factors affecting survival of hemodialysis patients, in addition to older age, independent of sarcopenia and sarcopenic obesity, though we also found that both the sarcopenia and sarcopenic obesity groups had worse survival compared to the normal and obesity groups.”
Researchers noted the findings may not be applicable to patients of other populations.
“A future investigation that includes other ethnicities undergoing dialysis, particularly Caucasian patients, examined based on the revised European consensus on definition and diagnosis would be helpful.”