The clinical applicability of ultrasound technique for diagnosis of sarcopenia in hemodialysis patients

Abstract

Background & aims: We examined the validity of ultrasound technique assessing muscle mass and reflecting muscle strength and physical performance, and the clinical applicability of ultrasound as a diagnostic tool of sarcopenia in patients on hemodialysis.

Methods: This study included outpatients who were undergoing maintenance hemodialysis 3-time a week. Muscle mass, muscle strength and physical performance were assessed at the time of the patients' entry into the study. Ultrasound technique and bioelectrical impedance analysis (BIA) were used to estimate muscle mass. The cross-sectional area (CSA) of the rectus femoris was calculated using an ultrasound device built-in planimeter.

Results: A total of 58 hemodialysis patients were included in the analyses. Ultrasound-derived muscle mass was strongly correlated with BIA-derived measurements and independently associated with handgrip strength (β = 4.22, 95% confidence interval [CI] = 2.23-6.20, P < 0.001), gait speed (β = 0.15, 95% CI = 0.05-0.26, P = 0.006), chair stand time (β = -4.33, 95% CI = -7.34 to -1.31, P = 0.006), and SPPB score (β = 1.81, 95% CI = 0.46-3.15, P = 0.010) even after adjustment of patient characteristics. The discrimination ability of CSA of rectus femoris for muscle loss was high. Of the patients who were diagnosed with sarcopenia by the ultrasound-based criteria, 96% met the BIA-based criteria.

Conclusions: Ultrasound identified the patients at higher risk of skeletal muscle loss and sarcopenia with good discriminatory power. Ultrasound could be a valid and feasible technique for dialysis populations in clinical settings.

Keywords: CKD; Frailty; Muscle mass; Physical function; Sarcopenia.