Abstract: Objective  To explore the correlation between sarcopenia and the levels of  homocysteine (Hcy), irisin and malnutrition-inflammation score (MIS) in maintenance hemodialysis (MHD) patients.  Methods  A total of 206 MHD patients treated in the Blood Purification Center of Jinan Eighth People’s Hospital from June 2019 to October 2021 were selected as the research subjects. Sarcopenia was diagnosed by handgrip strength, walking speed, and limb skeletal muscle mass index (ASMI). Serum levels of Hcy and irisin were measured by enzyme-linked immunosorbent assay. Nutrition-inflammation was assessed using the MIS scale. A nomogram model was constructed based on the multivariate logistic regression results.  Results Among the 206 MHD patients, 56 (27.2％) were diagnosed with sarcopenia. Logistic regression showed that dialysis age, combined cognitive dysfunction, Hcy and MIS were the independent risk factors for the development of sarcopenia in MHD patients (OR=1.423, 1.718, 1.728 and 2.104 respectively; 95% CI :1.111~1.820, 1.222~2.223, 1.348~2.446 and 1.424~3.442 respectively; P=0.038, 0.021, 0.026 and＜0.001 respectively). Irisin was an independent protective factor for sarcopenia in MHD patients (OR=0.488, 95% CI :0.089~0.762, P＜0.001). The prediction nomogram model constructed based on the above analyses and using Bootstrap internal verification indicates that this model has good accuracy and discrimination, with the C-index index of 0.822 (95% CI :0.734~0.887).  Conclusion  Higher MIS and elevated serum Hcy were the independent risk factors for sarcopenia in MHD patients. Elevated serum irisin was an independent protective factor for sarcopenia in MHD patients. The prediction nomogram model based on the independent influencing factors is useful to improve the predictive ability of sarcopenia complicated in MHD patients.

Key words: Maintenance hemodialysis, Sarcopenia, Homocysteinemia, Irisin, Malnutrition-inflammation score