Kidney Medicine · Nov 2026
Calf Circumference to Identify Sarcopenia Onset and Progression in Patients Undergoing Hemodialysis: A Multicenter Retrospective Cohort Study
By Tsujimoto N, Matsuzawa R, Harada M et al.
Rationale & Objective Sarcopenia is prevalent among patients undergoing hemodialysis and associated with adverse outcomes. Calf circumference (CC) is a simple, low-cost anthropometric measure reflecting lower-limb muscle mass and function; however, its ability to predict sarcopenia onset or progression remains unclear. This study evaluated the prognostic value of CC and compared it with other screening instruments. Study Design Multicenter retrospective cohort study (THRIVE-D). Setting & Participants 337 outpatients undergoing hemodialysis (2018-2025). Predictors CC, SARC-F, and SARC-CalF. Outcomes Sarcopenia onset or progression. Sarcopenia was defined by the Asian Working Group for Sarcopenia 2019 criteria using bioelectrical impedance analysis (BIA) for muscle mass, alongside muscle strength, and physical function. Analytical Approach Receiver operating characteristic and Cox proportional hazards analyses assessed predictive performance and risk, adjusted for patient characteristics and baseline sarcopenia status. Results Over a mean 745-day follow-up, 53 participants (15.7%) experienced sarcopenia onset (12.2%) or progression (3.6%). The area under the curve values were 0.750 (95% confidence interval [CI], 0.681–0.818) for CC, 0.606 (95% CI, 0.522–0.690) for SARC-F, and 0.718 (95% CI, 0.639–0.797) for SARC-CalF. CC outperformed SARC-F (p = 0.01) and was comparable to SARC-CalF (p = 0.68).Sex-specific CC cutoff points (men, 33.5 cm; women, 30.2 cm) identified a higher risk of sarcopenia or progression (adjusted HR, 3.39; 95% CI, 1.62–7.12). Limitations Limited by a small, low-BMI Japanese cohort from a limited region. Fluid retention/multiyear intervals may cause measurement bias. Standing BIA requirement potentially introduced selection bias toward healthier patients. Conclusions CC demonstrated moderate accuracy and was more strongly associated with sarcopenia onset and progression than SARC-F, with performance comparable to SARC-CalF. Incorporating CC measurement into routine dialysis practice may facilitate early risk stratification and timely referral for exercise and nutritional interventions in facilities without dedicated rehabilitation staff.