Muscle ultrasound and shear wave elastography for screening sarcopenia in patients undergoing maintenance hemodialysis: a prospective study.

BACKGROUND

Sarcopenia is highly prevalent among patients undergoing maintenance hemodialysis (MHD) and is associated with adverse clinical outcomes. However, practical and reliable screening tools remain limited. This study aimed to evaluate the feasibility and diagnostic value of musculoskeletal ultrasound for sarcopenia assessment in MHD patients.

METHODS

In this prospective single-center study, 126 patients undergoing chronic hemodialysis were classified into sarcopenia and non-sarcopenia groups according to established diagnostic criteria. Musculoskeletal ultrasound and shear wave elastography (SWE) were performed to assess morphological and mechanical properties of multiple muscle groups, including the rectus femoris, vastus intermedius, rectus abdominis, medial gastrocnemius, and biceps brachii. Measurement repeatability was evaluated using intraclass correlation coefficients (ICCs). Independent predictors of sarcopenia were identified using multivariable logistic regression, and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.

RESULTS

Ultrasound measurements demonstrated excellent reproducibility, with ICCs ranging from 0.869 to 0.995. Compared with non-sarcopenic patients, those with sarcopenia exhibited significant alterations in several ultrasound-derived muscle parameters, particularly rectus femoris cross-sectional area (RF-CSA), rectus femoris shear wave velocity (RF-SWV), and biceps brachii measurements. In the conventional ultrasound model, sex, hemodialysis duration, RF-CSA, BB-SFT, and BB-CSA were identified as independent predictors of sarcopenia, achieving an area under the curve (AUC) of 0.944. After incorporating SWE parameters, duration of hemodialysis, RF-CSA, and RF-SWV remained significant predictors, and combined model demonstrated improved discriminative performance (AUC = 0.994).

CONCLUSION

Musculoskeletal ultrasound demonstrated good reproducibility and promising diagnostic performance for identifying sarcopenia in patients undergoing maintenance hemodialysis. The addition of shear wave elastography may further improve screening performance. These findings suggest that ultrasound-based assessment may serve as a practical and noninvasive screening approach for sarcopenia in this population, although further validation in larger multicenter cohorts is warranted.