Sarcopenia and 24-Month All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: A Prospective Observational Cohort Study Applying the Revised European Working Group on Sarcopenia in Older People Criteria

Background and Objectives: Sarcopenia is common among patients receiving maintenance hemodialysis, although prevalence estimates vary according to the diagnostic approach. We assessed sarcopenia defined according to the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, its baseline correlates, and its association with 24-month all-cause mortality. Materials and Methods: In this single-center prospective cohort at a tertiary nephrology center, 176 patients enrolled in December 2022 were followed for 24 months. Confirmed sarcopenia required both low handgrip strength and a low appendicular skeletal muscle index assessed by bioelectrical impedance. Physical performance was not assessed. Because the proportional-hazards assumption was not satisfied, restricted mean survival time (RMST) was used as the primary measure of the survival difference. Results: Sarcopenia was present in 46 of 176 participants (26.1%, 95% CI 20.2–33.1). Older age, lower serum albumin and phosphorus concentrations, lower Kt/V, and longer time on maintenance hemodialysis were independently associated with sarcopenia. Thirty-one participants died during follow-up, and survival was lower among those with sarcopenia (log-rank p = 0.035). The adjusted RMST difference was −3.88 months (95% CI −6.49 to −1.28; p = 0.003). A Cox sensitivity analysis yielded a hazard ratio of 2.62 (95% CI 1.06–6.45). There was no evidence of a sarcopenia-by-sex interaction in the adjusted RMST analysis (p = 0.964). Conclusions: Confirmed sarcopenia was present in approximately one quarter of patients and was associated with approximately four months shorter restricted mean survival over 24 months. EWGSOP2-based assessment may provide prognostic information in this setting; whether routine screening or management based on sarcopenia status improves clinical outcomes remains to be determined.