Association between cachexia indicators and metabolic syndromes in hemodialysis patients

Introduction: Muscle wasting (cachexia) is common in hemodialysis patients and links to several adverse outcomes. We examined the association between cachexia indicators and metabolic syndrome (MetS) and its components.Methods: A cross‐sectional study was conducted between September 2013 and April 2017 on 391 hemodialysis patients from seven hospital‐based dialysis centers. The dietary intake (3‐day dietary record), biochemical parameters (laboratory tests), body composition (bioimpedance analysis) was assessed. Cachexia indicators including BMI < 20 kg/m2, lowest tertile of handgrip strength, Anorexia (energy intake, EI < 20 kcal/kg/d), lowest quintile of appendicular skeletal muscle mass indexed to height, ASM/Ht2, high‐sensitivity C‐reactive protein, CRP > 0.5 mg/dL, Haemoglobin<12 g/dL, Albumin<3.2 g/dL. The MetS was diagnosed by the Harmonized Metabolic Syndrome criteria (HMetS). Logistic regression was utilized for association analysis.Results: The mean of age, hemodialysis vintage, Charlson comorbidity index (CCI), physical activity were 60.8 ± 11.7 years, 5.7 ± 5.0 years, 4.7 ± 1.6, 4920.9 ± 1873.9 minute/week, respectively, 58.1% men, and 59.3% HMetS. In the multiple logistic regression, weight loss (BMI < 20 kg/m2) less likely to have elevated‐waist circumference, WC (Odd ratio, OR = 0.05, 95%CI, [0.01–0.16]), high Triglyceride (OR = 0.22[0.11–0.44]), low high‐density lipoprotein cholesterol, HDL‐C (OR = 0.37[0.21–0.65]) and HMetS (OR = 0.23[0.13–0.41]). Anorexia (EI < 20 kcal/kg/d) associated with impaired fasting glucose, IFG (OR = 2.17[1.11–4.25]), elevated‐WC (OR = 3.99[2.25–7.07]), high Triglyceride (OR = 2.67 [1.57–4.55]), low HDL‐C (OR = 3.65 [1.81–7.34]) and HMetS (OR = 4.31 [2.22–8.36]). Low ASM/Ht2 associated with elevated‐WC (OR = 0.16[0.09–0.29]), high SBP (OR = 0.45[0.26–0.78]), and HMetS (OR = 0.62[0.40–0.97]). Inflammation linked to elevated‐WC (OR = 2.23[1.33–3.72]), high Triglyceride (OR = 1.65[1.04–2.60]), and HMetS (OR = 1.81[1.11–2.94]). Anaemia associated with high systolic blood pressure (OR = 2.49[1.18–5.25]). Low serum albumin associated with higher IFG (OR = 5.32[1.17–24.17]), high diastolic blood pressure (OR = 11.29[4.34–29.37]), but lower elevated‐WC (OR = 0.27[0.08–0.96]). Handgrip did not show the significant association with MetS and its components (p > 0.05).Conclusions: Cachexia indicators independently associated with HMetS and its components. Early identification of cachexia symptoms could contribute to MetS prevention and improve the dialysis outcomes.