Sarcopenia among Malaysian peritoneal dialysis patients using bio-electrical impedance analysis-derived phase angle in a tertiary hospital in the Klang Valley, Malaysia

Sarcopenia, characterized by the simultaneous reduction in both muscle mass and function, is prevalent among individuals undergoing peritoneal dialysis (PD). Early detection is vital, but universal screening in this population is often hindered by the intricate diagnostic algorithm and limited clinical resources. Phase angle (PhA), a parameter derived from bioelectrical impedance analysis (BIA), has emerged as a surrogate measure for identifying sarcopenia in various populations, but its validation in PD patients particularly in Southeast Asian population like Malaysia, is lacking. Hence, this study aimed to investigate the ability of PhA, a non-invasive and cost￾effective measure, in detecting sarcopenia among Malaysian PD patients. This was a single-center cross-sectional study conducted among 130 multi-ethnic PD patients in a tertiary government hospital in Klang Valley, Malaysia. Malaysian outpatients aged ≥18 years, who have been undergoing regular PD treatment for at least six months, free of terminal disease, recent history of infection, surgery or trauma, or any condition that could bias the study findings were consecutively recruited. Sarcopenia was assessed in complete adherence to the Asian Working Group for Sarcopenia (AWGS) 2019 diagnostic algorithm, encompassing the evaluation of muscle mass, muscle strength, and physical performance. PhA was assessed using a multi-frequency BIA at 50kHz. Nutrition status was evaluated by anthropometric measurement, BIA, and a 3-day diet history, whereas sociodemographic characteristics were collected via face￾to-face interviews. Statistical analysis was performed by using Statistical Package for Social Sciences software version 26.0. Multivariable logistic regression was used to determine the predictability of PhA on sarcopenia. Receiver operating characteristics (ROC) analysis was employed to assess the diagnostic accuracy of PhA in identifying sarcopenia. Optimal PhA cut-off value for sarcopenia detection was established based on desired sensitivity and specificity. Demographic characteristics of the subjects aligned with national data reflecting a representative sample. The subjects had an average age of 53.1 years, with 50.8% male and 49.2% female. The majority were Malays (68.5%), followed by Chinese (26.2%), and Indians (5.4%). Most subjects were married, unemployed, held secondary-level education, and belonged to the bottom 40% household income category. The median dialysis vintage and Kt/V were 26.5 months and 1.9, respectively. Sarcopenia was evident in 25.4% of PD patients according to the AWGS 2019 criteria. PhA emerged as an independent predictor of sarcopenia (adjOR=0.153; 95% CI = 0.044-0.457; p =0.003), with a lower reading observed in sarcopenic group than non-sarcopenic group (3.28° ± 0.80 versus 4.05° ± 0.94, p <0.001). Based on ROC analysis, PhA exhibited acceptable discriminative power in identifying sarcopenia in the raw model (AUC = 0.736; 95% CI: 0.639-0.832, p<0.001), and demonstrated excellent discriminative power after adjusting for covariates (adjAUC = 0.818; 95% CI: 0.737-0.899, p<0.001). The optimal PhA cut-off value for sarcopenia detection in PD patients was ≤3.95° (81.8% sensitivity and 52.6% specificity). In conclusion, sarcopenia is pervasive in Malaysian PD patients. PhA holds promise as a pragmatic screening tool for identifying multi-ethnic Malaysian PD patients at risk of sarcopenia.

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