Sarcopenia in Hemodialysis Patients: Prevalence, Independent Risk Factors, and Functional Implications—A Multicenter Cross-Sectional Study

<b>Background:</b> Sarcopenia is a critical complication in hemodialysis patients, associated with poor clinical outcomes, increased morbidity, and reduced quality of life. Despite this, its significance, prevalence, and risk factor data in developing countries remain limited. <b>Objective:</b> This study aimed to determine the prevalence of sarcopenia and identify its independent risk factors in patients undergoing maintenance hemodialysis, while evaluating its impact on physical performance, nutritional intake, and quality of life. <b>Methods:</b> A multicenter cross-sectional study was conducted across three hemodialysis units in Tunisia. Sarcopenia was diagnosed using EWGSOP2 (European Working Group on Sarcopenia in Older People 2) criteria based on muscle strength, muscle mass, and physical performance. Handgrip dynamometry, mid-arm and calf circumferences, gait speed, Short Physical Performance Battery (SPPB), and Timed Up and Go (TUG) test were employed. Nutritional intake was assessed using a 7-day food history. Quality of life and functional status were evaluated using the SF-36 and Barthel Index, respectively. Logistic regression was used to identify independent predictors of sarcopenia. <b>Results</b>: Among 118 patients (mean age 56.74 ± 14.44 years), the prevalence of sarcopenia was 42.4% (<i>n</i> = 50). Sarcopenic individuals exhibited significantly poorer physical performance than their non-sarcopenic counterparts. Marked reductions were observed in handgrip strength (<i>p</i> < 0.001, <i>d</i> = -1.60, very large), SPPB scores (<i>p</i> < 0.001, <i>d</i> = -1.55, very large), and increased TUG time (<i>p</i> < 0.001, <i>d</i> = 1.46, very large), indicating substantial functional impairment. Limb circumferences were also significantly lower in the sarcopenic group, including calf circumference (<i>p</i> = 0.002, <i>d</i> = -1.39, large) and mid-arm circumference (<i>p</i> = 0.013, <i>d</i> = -0.87, large). Gait speed was slower (<i>p</i> = 0.010, <i>d</i> = -0.40, small to moderate). Health-related quality of life was significantly compromised in sarcopenic individuals, with lower SF-36 total scores (<i>p</i> = 0.001, <i>d</i> = -1.96, very large) and reduced functional independence as measured by the Barthel Index (<i>p</i> = 0.010, <i>d</i> = -0.97, large). Hemoglobin levels were also significantly lower in the sarcopenic group (<i>p</i> = 0.048, <i>d</i> = -0.96, large). Dietary assessment revealed lower fiber intake (<i>p</i> = 0.006, <i>d</i> = 1.80, very large) and reduced magnesium consumption (<i>p</i> = 0.020, <i>d</i> = 0.94, large) among individuals with sarcopenia. In the multivariate logistic regression analysis, diabetes mellitus (OR = 2.14, 95% CI: 1.30-3.67, <i>p</i> < 0.001) and longer duration of hemodialysis (OR = 1.56, 95% CI: 1.20-2.71, <i>p</i> = 0.028) were identified as independent predictors of sarcopenia. A lower SPPB score (OR = 0.48, 95% CI: 0.35-0.65, <i>p</i> < 0.001) was associated with sarcopenia. <b>Conclusion:</b> Sarcopenia is highly common among hemodialysis patients and is independently linked to diabetes, treatment duration, and reduced physical performance. It significantly affects the quality of life and ability to perform daily activities. Routine screening with simple functional tests is crucial, especially in high-risk patients. Early intervention should include physical rehabilitation, nutritional support, and strict blood sugar management to decrease sarcopenia-related complications.