Development and validation of a diagnostic nomogram for sarcopenia in Chinese hemodialysis patients

Danshu Xie; Qin Zhu; Jianxin Lu; Chun Hu; Jianying Niu; Chen Yu; Junli Zhao; Liming Zhang; Hualin Qi; Suhua Zhang; Qi Guo; Feng Ding; Wei Ding

doi:10.1093/ndt/gfac260

Development and validation of a diagnostic nomogram for sarcopenia in Chinese hemodialysis patients

Nephrol Dial Transplant. 2023 Mar 31;38(4):1017-1026. doi: 10.1093/ndt/gfac260.

Authors

Danshu Xie¹, Qin Zhu¹, Jianxin Lu¹, Chun Hu¹, Jianying Niu², Chen Yu³, Junli Zhao⁴, Liming Zhang⁵, Hualin Qi⁶, Suhua Zhang⁷, Qi Guo⁸, Feng Ding¹, Wei Ding¹

Affiliations

¹ Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Nephrology, Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China.
³ Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
⁴ Department of Nephrology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
⁵ Department of Nephrology, Zhabei Central Hospital of JingAn District of Shanghai, Shanghai, China.
⁶ Department of Nephrology, Shanghai Pudong New Area People's Hospital, Shanghai, China.
⁷ Department of Nephrology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China.
⁸ Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.

PMID: 36084001
DOI: 10.1093/ndt/gfac260

Abstract

Background: Sarcopenia is a clinical condition that is common in patients with chronic kidney disease (CKD), especially in those on dialysis. However, the relatively complicated diagnostic procedure limits its use in clinical situations. In this study we aimed to establish a simplified tool for the diagnosis of sarcopenia in patients on hemodialysis (HD).

Methods: Overall, 757 eligible patients from seven HD centers in Shanghai and Suzhou, China, were recruited from 2020 to 2021. The cross-sectional data were analyzed. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Among them, 511 consecutive patients (77 with and 434 without sarcopenia) from five centers were included in the training set for the establishment of a diagnostic nomogram. Ten investigative parameters including clinical characteristics, body measurements and physical performance were used to derive the diagnostic nomogram. A total of 246 consecutive patients (47 with and 199 without sarcopenia) were included for validation of the diagnostic model.

Results: The average age of the enrolled patients was 60.4 ± 12.1 years, 59.8% were males and 90.5% received dialysis using an arteriovenous fistula. Overall, the sarcopenia rate was 16.4%. The training and validation sets showed no significant differences in sarcopenia rate (15.1% and 19.1%, respectively; P = .160). The nomogram derived from the training set for sarcopenia, which was based on only four features-age, sex, body weight and grip strength-achieved high C-indexes of 0.929 [95% confidence interval (CI) 0.904-0.953] and 0.955 (95% CI 0.931-0.979) in the training and external sets, respectively, and had a well-fitted calibration curve. The cut-off value was 0.725, with a sensitivity of 0.909 and a specificity of 0.816. The nomogram accurately diagnosed sarcopenia with fewer variables and more simplified diagnostic procedures.

Conclusions: The nomogram had a good diagnostic capability for sarcopenia in patients on HD and may be a convenient tool for clinical use.

Keywords: CKD-PEW; handgrip strength; hemodialysis; physical performance; sarcopenia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
China / epidemiology
Cross-Sectional Studies
East Asian People
Female
Hand Strength
Humans
Male
Middle Aged
Nomograms
Renal Dialysis / adverse effects
Sarcopenia* / diagnosis
Sarcopenia* / etiology