Nutritional and Inflammatory Indicators for Identifying Sarcopenia in Hemodialysis Patients

Abstract

Objective: Sarcopenia represents a frequent clinical condition in patients receiving maintenance hemodialysis and is linked to adverse functional and health-related outcomes. Owing to its multifactorial nature, early identification of patients at risk remains challenging in routine practice. This study evaluated nutritional and inflammatory indicators associated with sarcopenia and their ability to identify patients with sarcopenia.

Methods: This cross-sectional study included 72 clinically stable adults receiving maintenance hemodialysis between August and September 2024. Sarcopenia was defined according to European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria, requiring low muscle strength and reduced muscle mass assessed by handgrip dynamometry and bioelectrical impedance analysis. Nutritional status was evaluated using the Subjective Global Assessment (SGA), and dietary energy and protein intake were assessed using 2 non-consecutive 24-hour recalls analyzed with BEBİS software. Serum albumin, C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio were measured. Multivariable logistic regression and receiver-operating characteristic analyses were performed.

Results: Sarcopenia was identified in 18 patients (25%). Sarcopenic individuals had significantly lower protein and energy intake, lower serum albumin levels, and higher CRP concentrations than non-sarcopenic patients. In multivariable analyses, low protein intake (<1.0 g/kg/day), inadequate energy intake (<25 kcal/kg/day), hypoalbuminemia (<3.5 g/dL), elevated CRP (>5 mg/L), and SGA category B/C were independently associated with sarcopenia, whereas adequate energy intake was inversely associated. Receiver-operating characteristic analysis showed acceptable discrimination for individual indicators, with the highest accuracy for serum albumin (area under the curve [AUC] = 0.77). A combined nutritional–inflammatory model integrating dietary intake, albumin, and CRP demonstrated the greatest discriminatory ability (AUC = 0.83).

Conclusion: Routinely available nutritional and inflammatory indicators are closely associated with sarcopenia in hemodialysis patients. Their combined assessment may facilitate early identification of individuals with sarcopenia and support timely nutritional evaluation and intervention.

Cite this article as: Doğan Akagündüz D, Şahin H, Kara AV. Nutritional and inflammatory indicators for identifying sarcopenia in hemodialysis patients. Cerrahpaşa Med J. 2026, 50, 0110, doi: 10.5152/cjm.2026.25110.