Severity of Cognitive Dysfunction Associates With Sarcopenia in Patients on Hemodialysis: Findings From the SARC-HD Study.

OBJECTIVE

This study investigated the association between cognitive dysfunction and sarcopenia in patients on hemodialysis.

METHODS

This is a cross-sectional analysis of the SARC-HD study. Cognitive function was assessed using the Mini-Mental State Examination, adjusted for literacy level. Patients were categorized with normal cognition, mild-to-moderate dysfunction, or severe cognitive dysfunction. Sarcopenia was diagnosed and staged according to the adapted European Working Group on Sarcopenia in Older People criteria, assessing handgrip strength or sit-to-stand test, calf circumference, and usual gait speed. For regression analyses (adjusted for clinically relevant confounders), confirmed and severe sarcopenia stages were combined into a binary outcome.

RESULTS

A total of 946 patients were analyzed (48% ≥ 60 years, 61% male, and median dialysis vintage of 33 months). Mild-to-moderate and severe cognitive dysfunctions were observed in 38% and 18% of the cohort, respectively. Patients with cognitive dysfunction exhibited poorer physical function and lower calf circumference, higher prevalence of all sarcopenia traits, and higher rate of severe sarcopenia. In the adjusted logistic regression, only severe cognitive dysfunction was significantly associated with sarcopenia, showing 87% higher odds (adjusted odds ratio = 1.87, 95% confidence interval: 1.11-3.16) compared to the normal cognition group. In the fully adjusted model including malnutrition, this association did not remain significant (adjusted odds ratio= 1.55, 95% confidence interval: 0.86-2.82).

CONCLUSIONS

In patients on hemodialysis, severe cognitive dysfunction was associated with sarcopenia, although this may be mediated by malnutrition. These findings underscore the need for integrated assessment strategies targeting both cognitive and physical declines in this population.