ArticleKidney3602026
Combined Assessment of Skeletal Muscle Mass Index and Extracellular-to-Intracellular Water Ratio Predicts Mortality and Health-Related Quality of Life in Hemodialysis Patients.
Article in Kidney360, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
key pointsBoth low skeletal muscle mass index and high extracellular and intracellular water independently predicted mortality; risk was highest when both abnormalities were present. Extracellular and intracellular water ≥0.66 indicated impaired muscle tissue integrity and helped identify vulnerable patients. Combining skeletal muscle mass index with extracellular and intracellular water identified patients with lower health-related quality of life across multiple domains.
backgroundDecreased skeletal muscle mass is common in hemodialysis patients and contributes to adverse outcomes. However, muscle mass alone does not fully capture muscle health. An imbalance between extracellular and intracellular water (ECW/ICW ratio) may reflect tissue-level integrity of skeletal muscle. This study examined the combined prognostic significance of the skeletal muscle mass index (SMI) and ECW/ICW ratio for mortality and health-related quality of life (HRQoL) in hemodialysis patients.
methodsIn this multicenter cohort study, 295 maintenance hemodialysis patients (208 men, 87 women) underwent multifrequency bioelectrical impedance analysis. Low SMI was defined according to the Asian Working Group for Sarcopenia (men <7.0 kg/m 2 , women <5.7 kg/m 2 ), and high ECW/ICW was defined as ≥0.66. Patients were categorized into four groups based on SMI and ECW/ICW status. HRQoL was assessed using the Kidney Disease Quality of Life Short Form, and mortality was recorded through March 2024.
resultsAmong the cohort, 93 patients (31.5%) had low SMI and 38 (12.9%) had both low SMI and high ECW/ICW. These patients were older and demonstrated lower intracellular water, poorer nutritional status, chronic inflammation, and higher natriuretic peptide levels. During a median follow-up of 3.7 years, 34 patients died. Low SMI (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.11 to 3.65) and high ECW/ICW (HR, 2.21; 95% CI, 1.34 to 4.08) independently predicted mortality, while their coexistence conferred the highest risk (HR, 3.95; 95% CI 2.01 to 7.72). Both indices were associated with impaired HRQoL across multiple domains, particularly those related to physical functioning.
conclusionsCombined assessment of SMI and ECW/ICW identifies muscle vulnerability and predicts mortality and HRQoL in hemodialysis patients. This simple, noninvasive approach may improve early detection of high-risk individuals and inform targeted interventions addressing nutrition, inflammation, and fluid management.
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