Knowledge, attitudes, and practice toward sarcopenia among maintenance dialysis patients in Anhui, China

Abstract

Background

To explore the knowledge, attitudes, and practice (KAP) toward sarcopenia among maintenance dialysis (MHD) patients in Anhui.

Methods

This multicenter cross-sectional study was conducted in November 2022 among MHD patients in the Anhui Province, China. A self-administered questionnaire was used to collect their demographic characteristics and KAP toward sarcopenia.

Results

A total of 1548 questionnaires were collected, with 909 (58.72%) being valid. The average knowledge, attitude, and practice scores were 4.45 ± 4.21 (possible range: 0–12), 28.21 ± 3.71 (possible range: 8–40), and 18.04 ± 4.28 (possible range: 7–35) points, respectively. The multivariable logistic regression showed that 5.1–10 years of dialysis (OR = 0.38, 95% CI: [0.15, 0.97]) and attitude scores (OR = 1.36, 95% CI: [1.25, 1.48]) were independently associated with practice. The structural equation model showed that knowledge had a direct effect on attitudes (β = 0.38, 95% CI: [0.33, 0.44]) and practice (β = 0.18, 95% CI: [0.11, 0.24]) and had an indirect effect on practice though attitudes (β = 0.42, 95% CI: [0.35, 0.50]).

Conclusion

The MHD patients in Anhui showed insufficient knowledge and moderate attitudes and practices toward sarcopenia. Proactive practice might be facilitated and achieved by improving knowledge and attitudes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-21198-x.

Background

Renal failure due to chronic kidney disease is increasing yearly [1], leading to a higher demand for renal replacement therapy. Maintenance peritoneal dialysis (MPD) or maintenance hemodialysis (MHD) are the primary methods of renal replacement therapy [2–4], which can effectively remove water and toxins from the patient’s body, promoting good quality of life and long-term survival [5, 6]. Despite advancements in dialysis technology, protein-calorie malnutrition remains prevalent in patients with end-stage renal disease (ESRD) undergoing MHD [7, 8], characterized by reduced serum protein levels, body weight, and muscle mass. As renal function deteriorates, patients with ESRD and protein-calorie malnutrition develop reduced muscle strength, selective muscle structural changes, and significant muscle atrophy [9–12], leading to a higher incidence of sarcopenia [10]. Sarcopenia is a degenerative disease characterized by decreased skeletal muscle mass, strength, and function. It causes difficulty performing daily activities such as walking, sitting, climbing, and lifting, difficulty standing, and increases the risk of falls [13]. A meta-analysis [14] involving 6162 patients revealed that 28.5% of dialysis patients had sarcopenia. The association was not affected by age or dialysis duration, but sarcopenia was associated with an increased risk of death. Therefore, the prevention of sarcopenia is of crucial importance among MHD patients.

Knowledge, attitude, and practice (KAP) is a structured survey method widely used in health promotion [15]. It is based on the premise that knowledge will improve attitudes, and attitudes will improve disease care practices [16]. The screening and education of sarcopenia among patients with MHD are relatively uncommon in China, but an increase has been reported [17]. KAP studies can raise health awareness and provide baseline data for planning, implementing, and evaluating disease control. Indeed, gaps in knowledge, attitudes, and practices regarding sarcopenia among patients with MHD might be emerging factors attributed to disease prevention failure.

Therefore, this study aimed to explore the KAP toward sarcopenia among patients with MHD in Anhui, China. It was hypothesized that (1) experience of education on sarcopenia would lead to higher knowledge, (2) patients with higher knowledge toward sarcopenia are more likely to have a positive attitude, (3) patients with more positive attitudes toward sarcopenia are more likely to have a proactive practice, and (4) patients with higher knowledge toward sarcopenia are more likely to have a proactive attitude.

Methods

Study design and patients

This multicenter cross-sectional study was conducted in November 2022 in Anhui Province among MHD patients. Anhui Province is situated in Eastern China. The province’s total area is over 139,000 square kilometers, with a population of about 60 million. Sixteen cities in Anhui Province are defined by administrative divisions. The patients were recruited across hospitals in Anhui Province, including southern Anhui (i.e., Huangshan, Chizhou, Xuancheng, Anqing, Tongling, Wuhu), central Anhui (i.e., Hefei, Maanshan, Liuan), and northern Anhui (i.e., Bozhou, Fuyang, Suzhou, Huaibei, Huainan, Chuzhou, Bengbu) (Fig. 1). The inclusion criteria were (1) patients ≥ 18 years of age and (2) receiving MHD for over 3 months. The exclusion criteria were (1) patients with cognitive impairment or (2) unable to answer the questionnaire. The study was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (PJ-YX2020-006). Written informed consent was obtained from all patients.

Fig. 1.

Geographical distribution of the patient

Questionnaire

The questionnaire was designed based on relevant literature [18] and sarcopenia guidelines [19, 20], modified by incorporating the comments made by one senior expert (30 years of experience in kidney disease). A pilot study was conducted among 35 patients, revealing a Cronbach’s α of 0.861 (0.866 for knowledge, 0.797 for attitudes, and 0.664 for practice), indicating good internal consistency. The Cronbach’s α for the whole study population was 0.870 (0.927 for knowledge, 0.852 for attitudes, and 0.675 for practice).

The final questionnaire contained 42 questions across four dimensions: demographic characteristics, knowledge dimension, attitude dimension, and practice dimension. The demographic characteristics included age, gender, ethnicity, body mass index (BMI), medical-related careers, residence, education, monthly income, duration of dialysis, underlying disease, medical insurance, sarcopenia, experience of publicity or education on sarcopenia, and experience of screening for sarcopenia. The knowledge dimension included 13 questions. Questions 1–12 were scored as 1 point for each “correct” answer and 0 points for “wrong” or “unclear” responses. Question 13 was used to verify the questionnaire’s validity (questionnaires with conflicted responses for questions 8 and 13 were considered invalid). The attitude dimension comprised eight questions utilizing a 5-point Likert scale. All questions were scored from strongly agree (5 points) to strongly disagree (1 point), except for Question 2, which was reverse-scored. The practice dimension consisted of seven questions using a 5-point Likert scale ranging from always/strongly agree (5 points) to never/strongly disagree (1 point) to evaluate their actual practice (Questions 1–5) and willingness (Questions 6–7). Patients’ overall knowledge, attitude, and practice scores were categorized using a modified Bloom’s criteria cutoff point [21]: respondents who scored 80-100% were considered to have good knowledge, positive attitude, and appropriate practice, respectively, 60–79% as moderate KAP, and < 60% as poor knowledge, negative attitude, and inappropriate practice, respectively.

Data collection and quality control

The questionnaire was distributed both in paper- and web-based formats. The paper-based questionnaire was distributed by selected hospitals or department heads, and the web-based questionnaire was established using the “Sojump” platform (https://www.wjx.cn/) and distributed by the doctor-patient WeChat group (Tencent). In addition, a quick response (QR) code was displayed at the clinic entrance. Investigators, consisting of specialized doctors and healthcare staff, could assist patients during questionnaire completion. In cases of incomplete questionnaires, patients were contacted through their hospital for clarification of their responses. Questionnaires with conflicting responses for questions 8 and 13 were considered invalid.

Statistical analysis

SPSS 26.0 (IBM, Armonk, NY, USA) and STATA 17.0 (Stata Corporation, College Station, TX, USA) were used for statistical analysis. The continuous variables were expressed as mean ± SD and analyzed by one-way ANOVA. The categorical variables were expressed as n (%). KAP scores were transformed into dichotomic variables according to 70% of their distribution. Variables with P < 0.05 in univariable analyses were included in the multivariable logistic regression to explore the variables independently associated with the KAP dimensions toward sarcopenia. The variables included in the multivariable models were tested for multicollinearity using variance inflation factors (VIF). A VIF > 4 or tolerance < 0.25 indicated that multicollinearity might exist, while a VIF > 10 or tolerance < 0.1 indicated significant multicollinearity that needs to be corrected. The distribution map was produced using web pages (https://dycharts.com/appv2/#/pages/home/index). The structural equation model (SEM) analysis was conducted to evaluate the relationships among the knowledge, attitude, and practice scores. A two-sided P < 0.05 was considered statistically significant.

Results

A total of 1548 questionnaires were collected, with 909 (58.72%) being valid. The patients were mainly from Hefei (30.3%) and Bozhou (22.88%) (Fig. 1). The patients were between 40 and 69 years old, and the majority were male (61.17%). More than half of the patients (54.24%) were from non-urban residences, and more than two-thirds (74.59%) had low family monthly income. The duration of MHD treatment ranged from < 1 year to > 10 years (Table 1).

Table 1.

Knowledge, attitude, practice, and demographic characteristics

	N (%)	Knowledge score		Attitude score		Practice score
		Mean ± SD	P	Mean ± SD	P	Mean ± SD	P
Total		4.45 ± 4.21		28.21 ± 3.70		18.04 ± 4.28
Age, years old			0.955		0.687		0.111
≤ 40	134 (14.74)	4.48 ± 4.48		28.07 ± 3.63		18.81 ± 4.43
41–50	186 (20.46)	4.42 ± 4.19		28.16 ± 3.85		18.17 ± 4.37
51–60	310 (34.10)	4.36 ± 4.13		28.41 ± 3.83		17.89 ± 4.05
> 60	279 (30.69)	4.56 ± 4.19		28.08 ± 3.49		17.76 ± 4.38
Gender			0.603		0.205		0.040
Male	556 (61.17)	4.51 ± 4.25		28.08 ± 3.86		18.28 ± 4.42
Female	353 (38.83)	4.36 ± 4.15		28.40 ± 3.42		17.68 ± 4.04
Ethnicity			0.427		0.726		0.456
Han	898 (98.79)	4.44 ± 4.20		28.21 ± 3.71		18.03 ± 4.29
Others	11 (1.21)	5.45 ± 5.30		27.82 ± 3.28		19.00 ± 3.32
BMI, kg/m2			0.367		0.919		0.576
Low (≤ 18.5)	124 (13.64)	4.82 ± 4.31		28.29 ± 3.70		17.77 ± 4.02
Normal	498 (54.79)	4.50 ± 4.26		28.16 ± 3.61		18.00 ± 4.41
Overweight or obese (≥ 24)	287 (31.57)	4.21 ± 4.08		28.25 ± 3.86		18.23 ± 4.18
Medical-related careers			0.068		0.306		0.704
Yes	17 (1.87)	6.29 ± 3.26		29.12 ± 3.81		19.88 ± 4.57
No	892 (98.13)	4.42 ± 4.22		28.19 ± 3.70		18.01 ± 4.27
Residence			< 0.001		0.001		0.754
Non-urban	493 (54.24)	3.97 ± 4.16		27.85 ± 3.73		18.00 ± 4.41
Urban	416 (45.76)	5.02 ± 4.21		28.63 ± 3.62		18.09 ± 4.14
Education			< 0.001		0.018		0.008
Primary school and below	340 (37.40)	3.92 ± 4.15		27.91 ± 3.82		17.74 ± 4.60
Middle school, high school, and technical secondary school	457 (50.28)	4.47 ± 4.14		28.22 ± 3.59		17.99 ± 3.99
College and above	112 (12.32)	5.97 ± 4.33		29.05 ± 3.67		19.17 ± 4.32
Monthly income, CNY			0.249		0.302		0.021
≤ 5000	678 (74.59)	4.29 ± 4.19		28.08 ± 3.68		17.81 ± 4.38
5001–10,000	151 (16.61)	4.82 ± 4.16		28.52 ± 3.31		18.91 ± 3.75
> 10,000	53 (5.83)	5.00 ± 4.60		28.62 ± 4.81		18.04 ± 4.58
Duration of dialysis, years			0.146		0.560		0.346
≤ 1	100 (11.00)	4.58 ± 4.17		28.32 ± 3.46		18.88 ± 4.48
1.1–3	208 (22.88)	3.97 ± 4.06		28.56 ± 3.87		18.01 ± 4.73
3.1–5	196 (21.56)	4.28 ± 4.22		28.09 ± 3.87		17.96 ± 4.08
5.1–10	236 (25.96)	4.53 ± 4.27		28.01 ± 3.55		17.94 ± 3.85
> 10	169 (18.59)	5.07 ± 4.29		28.11 ± 3.63		17.83 ± 4.39
Underlying disease			0.294		0.832		0.527
Yes	732 (80.53)	4.52 ± 4.211		28.19 ± 3.67		18.00 ± 4.04
None	177 (19.47)	4.15 ± 4.208		28.26 ± 3.83		18.23 ± 5.17
Type of medical insurance			0.699		0.256		0.137
Social medical insurance	881 (96.92)	4.46 ± 4.23		28.24 ± 3.66		18.05 ± 4.25
Commercial medical insurance	6 (0.66)	3.00 ± 2.97		27.17 ± 8.93		20.83 ± 6.59
No insurance	22 (2.42)	4.45 ± 3.84		27.05 ± 3.30		16.95 ± 4.64
Sarcopenia			< 0.001		< 0.001		0.558
Yes	69 (7.59)	7.01 ± 3.86		29.70 ± 3.32		18.33 ± 3.97
None	840 (92.41)	4.24 ± 4.17		28.08 ± 3.70		18.02 ± 4.31
Publicity and education on sarcopenia			< 0.001		0.730		0.006
Yes	53 (5.83)	7.02 ± 3.87		28.38 ± 3.99		19.60 ± 3.61
None	856 (94.17)	4.29 ± 4.18		28.20 ± 3.68		17.95 ± 4.31
Screening for sarcopenia			< 0.001		0.879		0.005
Yes	45 (4.95)	6.93 ± 3.89		28.29 ± 4.08		19.78 ± 3.59
None	864 (95.05)	4.32 ± 4.19		28.20 ± 3.68		17.95 ± 4.30
Hospital type			0.004		0.056		0.061
Public tertiary hospitals	579 (63.70)	4.58 ± 4.16		28.34 ± 3.60		18.12 ± 4.04
Public secondary hospitals	232 (25.52)	3.88 ± 4.36		27.66 ± 3.72		17.58 ± 4.82
Public primary hospitals	37 (4.07)	6.46 ± 3.88		28.86 ± 3.73		19.51 ± 4.47
Private hospitals	61 (6.71)	4.18 ± 3.90		28.57 ± 4.36		18.17 ± 4.11

BMI: body mass index; CNY: Chinese Yuan

The mean knowledge score was 4.45 ± 4.21. The knowledge on “Sarcopenia increases the risk of falls, fractures, cardiovascular disease” demonstrated the highest correctness rate for all patients (47.19%), and only a few patients were aware of the description of “Aerobic exercise (e.g., jogging, swimming, etc.) is more effective in preventing sarcopenia than resistance training (e.g., sit-ups, plank support, etc.)” was incorrect (4.73%). The patients generally had good knowledge of the sarcopenia risk and its manifestations, with proportions above 40.0%. However, patients’ knowledge of the questions related to the prevention and treatment of the disease was low (Supplementary Table S1). Patients with urban residence, higher education, sarcopenia, experience of publicity or education on sarcopenia, and experience of sarcopenia screening were more likely to have higher knowledge scores (all P < 0.05) (Table 1).

The attitude score was 28.21 ± 3.71. A total of 12.65% of these patients either strongly agreed or agreed that sarcopenia was not their primary health concern. The agreement for the other seven statements was below 10% (Supplementary Figure S1). Patients with urban residence, higher education, and sarcopenia were more likely to have higher attitude scores (all P < 0.05) (Table 1).

The mean practice score was 18.04 ± 4.28. Most patients (66.11%) admitted, “I perform regular resistance training”. While a few patients (14.96%) agreed, “I eat protein-rich foods such as meat, eggs, and milk regularly” (Supplementary Figure S2). Patients with male gender, higher education, higher monthly income, experience of publicity or education on sarcopenia, and experience of sarcopenia screening were more likely to have higher practice scores (all P < 0.05) (Table 1).

No significant multicollinearity was observed among the variables included in the multivariable analyses (Supplementary Table S2). The multivariable logistic regression analysis showed that higher education (OR = 2.696; 95% CI: [1.578, 4.603]), higher monthly income (OR = 1.688; 95% CI: [1.011, 2.818]), experience of publicity or education on sarcopenia (OR = 2.262; 95% CI: [1.121, 4.563]), and sarcopenia (OR = 2.809; 95% CI: [1.677, 4.703]) were independently associated with knowledge. The knowledge scores (OR = 1.228; 95%CI: [1.184, 1.274]) were independently associated with attitude. Finally, 5.1–10 years of dialysis (OR = 0.383; 95% CI: [0.151, 0.967]) and the attitude scores (OR = 1.361; 95% CI: [1.252, 1.479]) were independently associated with the practice (Table 2).

Table 2.

Multivariable analysis

	Variables	Multivariable logistic regression
		OR (95%CI)	P
Knowledge
	Residence
	Non-urban	REF
	Urban	1.066 (0.747–1.521)	0.726
	Education
	Primary school and below	REF
	Middle school, high school, and technical secondary school	1.172 (0.811–1.692)	0.399
	College and above	2.696 (1.578–4.603)	< 0.001
	Monthly income, CNY
	< 5000	REF
	5001–10,000	0.869 (0.558–1.352)	0.533
	> 10,000	1.688 (1.011–2.818)	0.045
	Sarcopenia
	Yes	2.809 (1.677–4.703)	< 0.001
	None	REF
	Publicity and education on sarcopenia
	Yes	2.262 (1.121–4.563)	0.023
	None	REF
	Screening for sarcopenia
	Yes	1.114 (0.506–2.450)	0.789
	None	REF
Attitude
	Knowledge score	1.228 (1.184–1.274)	< 0.001
	Residence
	Non-urban	REF
	Urban	0.931 (0.677–1.301)	0.677
	Education
	Primary school and below	REF
	Middle school, high school, and technical secondary school	1.022 (0.740–1.412)	0.893
	College and above	1.254 (0.742–2.120)	0.398
	Patients with sarcopenia
	Yes	1.119 (0.642–1.948)	0.692
	No	REF
	Hospital type
	Public tertiary hospitals	REF
	Public secondary hospitals	0.698 (0.486–1.002)	0.051
	Public primary hospitals	0.888 (0.426–1.852)	0.752
	Private hospitals	1.192 (0.673–2.109)	0.547
Practice
	Knowledge score	0.978 (0.915–1.046)	0.518
	Attitude score	1.361 (1.252–1.479)	< 0.001
	Duration of dialysis, years
	≤ 1	REF
	1.1–3	0.602 (0.260–1.394)	0.237
	3.1–5	0.415 (0.165–1.043)	0.061
	5.1–10	0.383 (0.151–0.967)	0.042
	> 10	0.736 (0.297–1.823)	0.508
	Hospital type
	Public tertiary hospitals	REF
	Public secondary hospitals	1.069 (0.555–2.059)	0.841
	Public primary hospitals	4.672 (1.797–12.142)	0.002
	Private hospitals	0.555 (0.154–1.996)	0.367

CNY: Chinese Yuan

The SEM analysis confirmed the hypothesis of the theoretical framework. Experience of publicity and education on sarcopenia had a positive effect on knowledge (β = 2.73, 95% CI: [1.57, 3.88]). Knowledge had direct effects on attitudes (β = 0.38, 95% CI: [0.33, 0.44]) and practice (β = 0.18, 95% CI: [0.11, 0.24]), and the attitude also had a direct effect on practice (β = 0.42, 95% CI: [0.31, 0.51]) (Table 3; Fig. 2). The root mean standardized error of approximation (RMSEA), standardized root mean residual (SRMR), Tucker-Lewis index (TLI), and comparative fit index (CFI) indicated good fitness (Supplementary Table S3).

Table 3.

Structural equation model analysis

Model paths			Total effects		Direct effect		Indirect effect
			β (95% CI)	P	β (95% CI)	P	β (95% CI)	P
K	<---	Participated in a sarcopenia-related education session	2.727 (1.738, 3.626)	0.009	2.727 (1.738, 3.626)	0.009	/	/
A	<---	Participated in a sarcopenia-related education session	1.046 (0.630, 1.403)	0.012	/	/	1.046 (0.630, 1.403)	0.012
P	<---	Participated in a sarcopenia-related education session	0.485 (0.285, 0.782)	0.005	/	/	0.485 (0.285, 0.782)	0.005
A	<---	K	0.384 (0.338, 0.432)	0.010	0.384 (0.338, 0.432)	0.010	/	/
P	<---	K	0.178 (0.127, 0.235)	0.005	0.015 (-0.052, 0.104)	0.621	0.163 (0.126, 0.204)	0.009
P	<---	A	0.424 (0.314, 0.514)	0.019	0.424 (0.314, 0.514)	0.019	/	/

Fig. 2.

The structural equation model (SEM)

Discussion

This study showed insufficient knowledge and moderate attitudes and practices toward sarcopenia among MHD patients in Anhui Province, China. The findings confirmed the initial hypothesis theoretical framework based on the KAP model, suggesting that knowledge of sarcopenia shapes attitudes and practice. These findings provide an overview of existing knowledge, attitudes, and practices toward sarcopenia among MHD patients in Anhui, China.

With the global increase in the prevalence of sarcopenia, assessing the KAP is considered important for guiding behavioral change in MHD patients [22]. In line with a previous study [23], patients’ knowledge of sarcopenia appeared superficial and presented a low level of awareness, indicating that they lacked an in-depth understanding of the condition. To the best of the authors’ knowledge, the research on KAP of sarcopenia is limited; therefore, only limited conclusions can be drawn from comparisons with the literature. In a study conducted in China [24], 0.19% of nurses demonstrated adequate understanding of sarcopenia, while 65.72% failed the test, 81.53% exhibited positive attitudes, and 56.72% did not have appropriate practice. Such results might be due to the early development stage of geriatrics in China, the lack of specialized geriatric departments in hospitals [25], and the limited dissemination of geriatric syndrome [26]. The unsatisfactory results highlight the need for enhanced sarcopenia awareness and education. For healthcare providers, such interventions could take the form of continuing education provided through lectures, workshops, videos, or reading materials. Since healthcare providers are a primary source of health-related information for many individuals [27], improving the KAP of healthcare providers toward sarcopenia is critical. Healthcare providers with adequate knowledge of sarcopenia can then transfer their knowledge to the patients.

The decline in muscle quantity and quality can be delayed or even reversed by timely lifestyle interventions involving exercise training and nutrition management targeting the older population [28, 29]. Therefore, it is important to improve the practices to maintain and improve muscle function in individuals at risk of sarcopenia. However, the findings suggest that patient’s practices are often suboptimal, impairing prevention and perpetuating a cycle that threatens patients’ physical function. Based on the SEM results, better knowledge may increase attitude, eventually resulting in increased uptake of sarcopenia screening. It suggests that one potential pathway to take precautions to prevent and control sarcopenia and improve attitude among dialysis patients is to increase knowledge. This study also revealed that residence, education, sarcopenia diagnosis, exposure to sarcopenia education, and screening for the condition influenced patients’ knowledge. Rural areas in China are generally associated with poor economic status and poor access to healthcare resources [30, 31]. Furthermore, the socioeconomic status is a well-known factor influencing health literacy [32]. Therefore, individuals with low education and living in rural households should be the primary targets of training on sarcopenia to improve patients’ overall level of knowledge. There is potential to strengthen practice through publicity and education on sarcopenia and screening for sarcopenia. Such educational intervention must be adapted to the general population level and could be provided as pamphlets, websites, videos, or TV shows, for example.

This study has some limitations. The patients were recruited from Anhui province, which may not represent the entire population of MHD patients in China, thus potentially limiting the generalizability of the findings. In addition, the data were collected by a self-reported questionnaire, and the results may be subject to recall bias. Moreover, the internal consistency of the practice dimension was relatively low, possibly due to the limited number of questions in this dimension and the broad scope of the practices it encompassed. Therefore, the findings and conclusions should be interpreted cautiously regarding generalization. Future research should be performed across various institutions and regions and explore the patients’ perceptions to obtain a more comprehensive understanding.

Conclusions

MHD patients in Anhui province have insufficient knowledge and moderate attitudes and practices. The patients’ knowledge and attitudes might affect their practice, indicating that enhancing knowledge and attitudes could facilitate better practices. It will require more attention and comprehensive support from healthcare professionals for MHD patients, helping them develop individualized exercise programs that address barriers to exercise and strengthen the motivators to increase compliance with exercise and maintain physical function.

Electronic supplementary material

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Abbreviations

MPD

Maintenance peritoneal dialysis

MHD

Maintenance hemodialysis

ESRD

End-stage renal disease

KAP

Knowledge, attitude, and practice

QR

Quick response

RMSEA

Root Mean Standardized Error of Approximation

SRMR

Standardized Root Mean Residual

TLI

Tucker–Lewis Index

CFI

Comparative Fit Index

Author contributions

QY Z and XY Y carried out the studies, participated in collecting data, and drafted the manuscript. MZ B and M Z performed the statistical analysis and participated in its design. D G W participated in acquisition, analysis, or interpretation of data and draft the manuscript. All authors read and approved the final manuscript.

Funding

This study was supported by the Anhui Medical University Research Clinical Science Fund project (2022) and the Clinical study on the diagnostic value of QCT for sarcopenia in patients with low-maintenance dialysis (2022xkj199).

Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Declarations

Ethics approval and consent to participate

All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The study has been approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University (PJ-YX2020-006), and written informed consent was obtained from all patients. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.