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Background and Aims Frailty was known to be associated with higher rates of hospitalization and mortality in dialysis patients, and sarcopenia was documented as the biological substrate of physical frailty. Therefore, early-detecting sarcopenia in dialysis patients is important for improving prognosis. The aim of our study was to investigate the factors associated with low skeletal muscle mass in dialysis patients. Method We recruited 134 Japanese patients (male 94, female 40; 117 maintenance hemodialysis, 11 chronic peritoneal dialysis and 6 both HD and PD) who underwent maintenance dialysis at our hospital during April 2019. Computed tomography (CT) imaging at the third lumbar vertebrae level was used to measure the psoas muscle mass index (PMI, psoas muscle area (cm2)/ height (m2) ), and low skeletal muscle mass was defined as under 6.36 cm2/m2 in male and 3.92 cm2/m2 in female. Results The prevalence of low skeletal muscle mass was 19.4% in dialysis patients (26/134). The median values of PMI were 5.13 and 7.42 cm2/m2 in low skeletal muscle mass group and normal group, respectively. Univariate analysis identified variables associated with low skeletal muscle mass as follows: gender, age, body mass index, waist circumference, presence of coronary artery disease, total protein, albumin, asparate aminotransferase, γ-glutamyl transpeptidase, phosphorus, visceral fat area and subcutaneous fat area. Multiple logistic regression analysis using above significant factors identified independent variables associated with low skeletal muscle mass as follows: gender (male) (odds ratio [OR], 12.91; 95%confidence interval [CI], 2.50-66.57; p<0.01), age (per 1 year aging) (OR, 1.07; 95%CI, 1.00-1.14; p<0.05), waist circumference (per 1cm decrease) (OR, 1.11; 95%CI, 1.04-1.19; p<0.01), and albumin (per 1g/dL decrease) (OR, 5.55; 95%CI, 1.49-19.9; p<0.05). In sub-analysis targeting only male patients, age (per 1 year aging) (OR, 1.09; 95%CI, 1.01-1.17; p<0.05), waist circumference (per 1cm decrease) (OR, 1.13; 95%CI, 1.05-1.21; p<0.01) and albumin (per 1g/dL decrease) (OR, 5.88; 95%CI, 1.39-25.9; p<0.05) were independent factors associated with low skeletal muscle mass. Conclusion In patients who underwent maintenance dialysis, age, waist circumference and albumin could be predictive factors of low skeletal muscle mass. Dialysis patients with such factors are recommended to evaluate nutritional status and physical performance to identify sarcopenia earlier and prevent progressive course of sarcopenia and frailty.

Background Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by hypotension, hemoconcentration, and hypoalbuminemia associated with increased capillary endothelium permeability. Patients with a chronic form of SCLS present with persistent and progressive generalized edema. However, there have been no reports of chronic SCLS in patients undergoing hemodialysis. Herein, we report a case of chronic SCLS associated with an intravascular large B-cell lymphoma (IVLBCL) in a patient undergoing hemodialysis. Case presentation A 71-year-old male had been on hemodialysis for five years due to diabetic nephropathy. Difficulty in body fluid removal was observed during hemodialysis, and the patient was admitted to our hospital due to exacerbated weight gain and lower limb edema. He had elevated serum lactate dehydrogenase (LDH) levels and thrombocytopenia. His blood pressure was low, and his serum brain natriuretic peptide level was relatively low, despite the increase in body fluid volume. His clinical characteristics suggested a chronic form of SCLS. Random skin biopsy revealed IVLBCL; however, the association between IVLBCL and chronic SCLS remained unclear. He underwent chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone, followed by rituximab. After the treatment, his serum LDH level decreased, and the difficulty in body fluid removal during hemodialysis improved. The patient’s chronic SCLS seemed to be complicated by IVLBCL. Conclusions Patients with chronic SCLS who are undergoing hemodialysis seem to present with difficulties in fluid removal. The frequency of SCLS complications in cases with malignant lymphomas, including IVLBCL, is considered to be extremely low. However, clinicians should be aware of SCLS as a complication of malignant lymphomas.