Prevalence and risk factors of sarcopenia and altered gut microbiota in maintenance hemodialysis patients: A multi-center study

Objective: To investigate the prevalence of malnutrition and sarcopenia and to identify potential risk factors associated with sarcopenia and with alterations in gut microbiota diversity among maintenance hemodialysis (MHD) patients. Methods: MHD patients undergoing regular hemodialysis for more than 3 months were recruited from four hospital hemodialysis centers. Dietary intake, anthropometric measures, body composition, and biochemical parameters were assessed. Nutritional status and sarcopenia were diagnosed using the GLIM criteria and the 2019 AWGS criteria, respectively. Gut microbiota composition was analyzed via 16S rRNA sequencing. Potential risk factors for both sarcopenia and altered gut microbiota diversity were analyzed using multivariate logistic regression. Results: The overall prevalence of malnutrition was 50.2 % (37 % mild, 13.2 % severe), and sarcopenia was 20.6 %. Depression symptom was significantly associated with an increased risk of sarcopenia (adjusted OR = 5.04, p = 0.004). In contrast, both hyperuricemia and higher BMI showed a protective association against sarcopenia (p < 0.001 and p = 0.004, respectively). Higher SGA score (aOR = 2.59, 95 % CI: 1.66–4.05, p < 0.001) and elevated BMI (aOR = 1.12, 95 % CI: 1.00–1.25, p = 0.038) were positively associated with gut microbial diversity, whereas increased triglyceride levels were negatively associated (aOR = 0.61, 95 % CI: 0.43–0.87, p = 0.006). Conclusion: Depressive status was an increased risk of sarcopenia, while moderately elevated uric acid levels may deem as a protective factor against sarcopenia. Better nutritional status and healthy BMI were beneficial for maintaining gut microbial diversity in MHD patients.