Severe sarcopenia is strongly associated with dependency in activities of daily living (ADLs) among patients on hemodialysis, according to a new study.

In addition, the study revealed that gait speed is the most important determinant of dependency in ADLs in HD patients with sarcopenia, and it has good diagnostic accuracy for screening dependency.

“Therefore, we recommend that gait speed can be used as a screening tool for dependency in maintaining patients on hemodialysis,” Dongsheng Cheng, MD, of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital in Shanghai, China, and colleagues wrote in the Journal of Renal Nutrition.

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The findings are from a cross-sectional study that included 238 patients on HD. Investigators evaluated physical functioning using the Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) scales. The BADL scale included assessments of bathing, eating, dressing, indoor activities, using the toilet, and control of urination and bowel movement. The IADL scale looked at shopping, outdoor activities, food preparation, housekeeping, laundry, ability to use the telephone, taking medication, and ability to handle finances. For both BADL and IADL, evaluation results of each item were divided into 3 categories: requiring no assistance, requiring partial assistance, and requiring full assistance.

Investigators considered patients to have impaired BADL or IADL if they required partial or full assistance of any of the activities assessed in the scales.

Of the 238 patients, 117 (49.2%) had sarcopenia and 73 (30.7%) had severe sarcopenia. In addition, 50 patients (21%) and 98 patients (41.2%) demonstrated dependency in BADL and IADL, respectively.

The investigators used the following criteria to define sarcopenia: low grip strength (less than 28 kg in male patients and less than 18 kg in female patients); low gait speed (less than 1.0 m/s in male and female patients); and low muscle mass (appendicular skeletal muscle mass /height2 less than 7.0 kg/m2 in male patients and less than 5.7 kg/m2 in female patients. Patients with low muscle mass and who met either of the other criteria were diagnosed with sarcopenia. Patients who met all 3 criteria were diagnosed with severe sarcopenia.

Results showed that only severe sarcopenia was significantly associated with dependency in BADLs and IADLs. Compared with patients who did not have sarcopenia, those with severe sarcopenia had approximately 4.7-fold and 3.2-fold increased odds of dependency in BADLs and IADLs, respectively, after adjusting for age, sex, body mass index, history of diabetes and hypertension, and dialysis duration, Dr Cheng and colleagues reported.

Moreover, gait speed emerged as the strongest factor associated with dependency in patients with sarcopenia. Each 0.1 m/s increase in gait speed was significantly associated with 48% and 54% decreased odds of dependency in BADLs and IADLs, respectively.

“The results of this study expand the clinical value of sarcopenia and gait speed in patients on hemodialysis and provide a certain theoretical basis for further screening and prevention of dependency in ADLs in patients on dialysis,” the authors wrote.


Cheng D, Zhang Q, Wang Z, et al. Association between sarcopenia and its components and dependency in activities of daily living in patients on hemodialysis. Published online December 9, 2020. J Ren Nutr. doi:10.1053/j.jrn.2020.08.016