• Shantasaroopini Sathia Moorthy School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang. Malaysia
  • Parthiban Sivasamy School of Medicine, KPJ Healthcare University College, 71800 Nilai, Negeri Sembilan. Malaysia
  • Balamurugan Tangiisuran School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang. Malaysia



Pre-dialysis, Chronic Kidney Disease, Sarcopenia, Associated factors


Sarcopenia is an ageing condition characterised by a progressive and generalised loss of skeletal muscle mass and function. However, sarcopenia is not always related to advanced age in chronic kidney disease (CKD) but rather a consequence of accelerated protein catabolism. This study aimed to identify the prevalence of sarcopenia and its associated risk factors in pre-dialysis CKD patients. This cross-sectional study was conducted among 250 pre-dialysis CKD patients aged 18 years or older who attended the outpatient Renal Clinic in a tertiary hospital between  April to November 2019.  It was found that 59.2% of pre-dialysis CKD patients had slow gait speed, 52% had low handgrip strength, and 5.2% had low appendicular skeletal muscle mass index. The prevalence of sarcopenia in the studied group based on AWGS criteria was 5.2%, for which CKD stage 3-5 accounts for 0.4%, 0.8%, and 4% of the prevalence, respectively. Body mass index (AOR: 0.39, 95% CI: 0.166-0.912) and Modified Barthel Index score (AOR: 0.64, 95% CI: 0.470-0.884) were significantly associated with conclude, sarcopenia is prevalent in advanced-stage CKD and is related to low body mass index and a lack of functional independence. Controlling these two factors may delay sarcopenia progression in CKD patients. Given this, there is an urgent need to develop preventative and therapeutic approaches given the detrimental effects of sarcopenia on significant health outcomes in the CKD population. The effectiveness of dietary and exercise therapies to prevent sarcopenia in CKD should be explored.


Rosenberg IH. Symposium: Sarcopenia: Diagnosis and Mechanisms Sarcopenia: Origins and Clinical Relevance 1. J Nutr. 1997;127:990–991.

Petermann-Rocha F, Balntzi V, Gray SR, Lara J, Ho FK, Pell JP, et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13(1):86–99.

Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: Consensus report of the Asian working group for sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101.

Köller M. Sarcopenia—a geriatric pandemic. A narrative review. Wiener Medizinische Wochenschrift. 2022 (accessed 20th July 2022)

Pereira RA, Cordeiro AC, Avesani CM, Carrero JJ, Lindholm B, Amparo FC, et al. Original Article Sarcopenia in chronic kidney disease on conservative therapy : prevalence and association with mortality. Nephro Dial Transplant 2015;30(10)1–7.

Gungor O, Ulu S, Hasbal NB, Anker SD, Kalantar-Zadeh K. Effects of hormonal changes on sarcopenia in chronic kidney disease: where are we now and what can we do? J Cachexia Sarcopenia Muscle. 2021;12(6):1380–1392.

Moon SJ, Kim TH, Yoon SY, Chung JH, Hwang HJ. Relationship between stage of chronic kidney disease and sarcopenia in Korean aged 40 years and older using the Korea National Health and Nutrition Examination Surveys (KNHANES IV-2, 3, and V-1, 2), 2008-2011. PLoS One. 2015;10(6):1–11.

Dubey AK, Sahoo J, Vairappan B, Parameswaran S, PS P. Prevalence and determinants of sarcopenia in Indian patients with chronic kidney disease stage 3 & 4. Osteoporos Sarcopenia. 2021;7(4):153–8.

Chen Z, Ho M, Chau PH. Prevalence, Incidence, and Associated Factors of Possible Sarcopenia in Community-Dwelling Chinese Older Adults: A Population-Based Longitudinal Study. Front Med. 2022;8(January):1–9.

Robinson SM, Reginster JY, Rizzoli R, Shaw SC, Kanis JA, Bautmans I, et al. Does nutrition play a role in the prevention and management of sarcopenia? Clin Nutr. 2018;37(4):1121–1132.

De Souza VA, Oliveira D, Barbosa SR, Corrêa JODA, Colugnati FAB, Mansur HN, et al. Sarcopenia in patients with chronic kidney disease not yet on dialysis: Analysis of the prevalence and associated factors. PLoS One. 2017;12(4):1–13.

Clinical Practice Guideline, Management of Chronic Kidney Disease (Second edition).2018. Available from: (accessed 27 July 2022)

Puteh SEBW, Bakar IMA, Borhanuddin B, Latiff K, Amin RM, Sutan R. A Prevalence Study of the Activities of Daily Living ( ADL ) Dependency among the Elderly in Four Districts in Selangor , Malaysia. J Epidemiol Prev Med.2015;1(2)1–8.

Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: A symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016;7(1):28–36.

Hashemi R, Shafiee G, Dorosty A, Pasalar P, Esmailzadeh A, Siassi F, et al. Sarcopenia and its associated factors in Iranian older individuals : Results of SARIR study. Arch Gerontol Geriatr.2016;66:18–22.

Wu IC, Lin CC, Hsiung CA, Wang CY, Wu CH, Chan DCD, et al. Epidemiology of sarcopenia among community-dwelling older adults in Taiwan: A pooled analysis for a broader adoption of sarcopenia assessments. Geriatr Gerontol Int. 2014;14(Suppl 1):52–60.

Alessandro CD, Piccoli GB, Barsotti M, Tassi S, Giannese D, Morganti R, et al. Prevalence and Correlates of Sarcopenia among Elderly CKD Outpatients on Tertiary Care. Nutrients.2018;10(12)1–13.

Carrero JJ, Qureshi AR, Nakashima A, Arver S, Parini P, Lindholm B, et al. Prevalence and clinical implications of testosterone deficiency in men with end-stage renal disease. Nephrol Dial Transplant. 2011;26(1):184–90.

Yang R, Zhang Y, Shen X, Yan S. Sarcopenia associated with renal function in the patients with type 2 diabetes. Diabetes Research and Clinical Practice. 2016;118:121-129.

Souza VA de, Oliveira D de D, Mansur HN, Fernandes NM da S, Bastos MG. Sarcopenia in chronic kidney disease. J Bras Nefrol. 2015;37(1):98–105.

Tomlinson DJ, Erskine RM, Morse CI, Winwood K, Onambele-Pearson G. The impact of obesity on skeletal muscle strength and structure through adolescence to old age. Biogerontology 2016; 17(3):467–83.

Miranda C, Oliveira D, Mansur H, Fernandes N, Cupolilo E, Souza V, et al. Rectus femoris muscle mass evaluation by ultrasound: facilitating sarcopenia diagnosis in pre-dialysis chronic kidney disease stages. Clinics. 2018;73(9):1–5.

Fernandes JFR, Barreto Silva MI, Loivos CP, Menna Barreto APM, Meira V da S, Kaiser SE, et al. Obstructive sleep apnea in non-dialyzed chronic kidney disease patients: Association with body adiposity and sarcopenia. Nutrition. 2019;57:282–9.

Ziolkowski SL, Long J, Baker JF, Chertow GM, Leonard MB. Chronic Kidney Disease and the Adiposity Paradox : Valid or Confounded ? J Ren Nutr. 2019;1999–2006.

Vandewoude MFJ, Alish CJ, Sauer AC, Hegazi RA. Malnutrition-Sarcopenia Syndrome : Is This the Future of Nutrition Screening and Assessment for Older Adults? J Aging Res.2012;2012:651570 (June 2014).

Schaap LA, Koster A, Visser M. Adiposity , Muscle Mass , and Muscle Strength in Relation to Functional Decline in Older Persons. Epidemiol Rev. 2013;35(1):51–65.

Clark BC, Manini TM. Sarcopenia =/= Dynapenia. J Gerontol A Biol Sci Med Sci. 2008;63(8):829–34.

Brennan-Olsen SL, Bowe SJ, Kowal P, Naidoo N, Quashie NT, Eick G, et al. Functional Measures of Sarcopenia : Prevalence , and Associations with Functional Disability in 10 , 892 Adults Aged 65 Years and Over from Six Lower ‑ and Middle ‑ Income Countries. Calcif Tissue Int. 2019; 105(6):609-18.

Zeng P, Han Y, Pang J, Wu S, Gong H, Zhu J, et al. Sarcopenia-related features and factors associated with lower muscle strength and physical performance in older Chinese : a cross sectional study. BMC Geriatr. 2016;16(1):45.

Siparsky PN, Kirkendall DT, Garrett WE. Muscle Changes in Aging: Understanding Sarcopenia. Sports Health. 2014;6(1):36–40.

Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2018;(1):1–16.

Chen L-K, Lee W-J, Peng L-N, Liu L-K, Arai H, Akishita M. Recent advances in Sarcopenia Research in Asia: 2016 update from the Asian Working Group for sarcopenia. Journal of the American Medical Directors Association. 2016;17(8).

Saminathan TA, Hooi LS, Mohd Yusoff MF, Ong LM, Bavanandan S, Rodzlan Hasani WS, et al. Prevalence of chronic kidney disease and its associated factors in Malaysia; findings from a nationwide population-based cross-sectional study. BMC Nephrology. 2020;21(1).




How to Cite

Sathia Moorthy, S., Sivasamy, P., & Tangiisuran, B. (2023). DETERMINANT FACTORS OF SARCOPENIA AMONG PRE-DIALYSIS OUTPATIENTS IN A MALAYSIAN TERTIARY CARE CENTRE. Malaysian Journal of Public Health Medicine, 23(1), 227–237.