Abstract: Objective  To clarify the overall prevalence of sarcopenic obesity (SO) in patients undergoing maintenance hemodialysis (MHD) by means of systematic review and meta-analysis, so as to provide evidence-based support for clinical screening and intervention.  Methods   A systematic search was conducted in databases including PubMed, Web of Science, Medline, Scopus, Embase, CBM, Cochrane Library, CNKI, VIP, and WanFang, with the search period ranging from the establishment of the database to January 2025. Study screening, data extraction, and quality assessment were independently carried out by two researchers respectively. In case of judgment discrepancies during the process, a unified conclusion was reached through joint discussion and negotiation between the two researchers. Stata 18.0 software was used for meta-analysis.  Results  A total of 9 studies were finally included, among which 3 were cohort studies and 6 were cross-sectional studies, with a total sample size of 9 946 cases. The overall prevalence of SO in MHD patients was 20% (95% CI: 17%～23%). High heterogeneity occurred among the studies (I²=90.52%, P＜0.001). Subgroup analysis showed that there was no significant difference in prevalence between cohort studies (21.5%, 95% CI: 14.9%～28.2%) and cross-sectional studies (19.1%, 95% CI: 15.3%～22.9%) (P=0.536); there was no significant difference in prevalence between the group with mean age ＜60 years (22.1%, 95% CI: 19.3%～24.9%) and the group with mean age ≥60 years (17.7%, 95% CI: 9.0%～26.4%) (P=0.342); the prevalence corresponding to different diagnostic criteria for sarcopenia ranged from 15.4% to 21.7%, and the difference between subgroups did not reach statistical significance (P=0.178); in terms of obesity diagnosis, there were significant differences in prevalence corresponding to different diagnostic methods (P=0.002). Among them, the studies using body fat percentage (BFP%) combined with body mass index (BMI) to diagnose obesity had the highest prevalence, reaching 24.7% (95% CI: 20.2%～29.2%), followed by studies using visceral fat area (VFA) for diagnosis (19.8%, 95% CI: 14.4%～25.2%), studies using BFP alone for diagnosis (17.7%, 95% CI: 10.5%～24.9%), and studies using BMI alone for diagnosis (16.9%, 95% CI: 12.6%～21.2%).  Conclusions  The prevalence of SO is higher among MHD patients. Although most subgroup differences were not statistically significant, the higher overall prevalence suggests that routine SO screening and intervention should be implemented as part of the standard care protocol for all MHD patients.

Key words: Maintenance hemodialysis, Sarcopenic obesity, Prevalence