Kidney Week

Abstract: FR-PO0331

Longitudinal Coupling of Bone and Muscle Loss in Patients on Hemodialysis

Session Information

• CKD-MBD: Mechanistic Insights and Management
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Yoon, Ho-Joong, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea (the Republic of)

Ho-Joong Yoon, MD

• Kim, Jwa-kyung, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea (the Republic of)

Jwa-kyung Kim, MD, PhD

• Kim, Ji Hwan, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea (the Republic of)

Ji Hwan Kim, MD, MS

• Min, Sei hong, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea (the Republic of)

Sei hong Min, MD

• An, Jung Nam, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea (the Republic of)

Jung Nam An, MD, PhD

• Kim, Sung Gyun, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea (the Republic of)

Sung Gyun Kim, MD, PhD

Background

Bone loss and muscle wasting frequently coexist in patients undergoing maintenance hemodialysis (HD). However, it remains unclear whether baseline body composition predicts subsequent skeletal deterioration or if the losses of bone and muscle progress concurrently over time.

Methods

In this prospective cohort study, 273 stable maintenance HD patients underwent dual-energy X-ray absorptiometry and bioimpedance spectroscopy at baseline and after a mean follow-up of approximately 2 years. Annualized percentage changes in total hip bone mineral density (BMD) and lean tissue index (LTI) were calculated. Bidirectional associations between temporal changes in BMD and LTI were assessed using multivariable linear regression models, with additional analyses stratified by baseline serum albumin levels.

Results

Baseline LTI was positively correlated with baseline hip BMD (r = 0.346, P < 0.001). Over follow-up, temporal changes in bone and muscle were closely coupled in both directions. Each 1% annual decrease in hip BMD was associated with a 0.68% decrease in LTI (95% CI, 0.32–1.04; P < 0.001), whereas each 1% annual decrease in LTI was associated with a 0.07% decrease in hip BMD (95% CI, 0.03–0.11; P < 0.001). In contrast to the clear coupling of temporal changes, baseline tissue status did not significantly predict subsequent longitudinal decline in the counterpart compartment. The association between bone and muscle changes appeared more pronounced in patients with hypoalbuminemia.

Conclusion

In hemodialysis patients, bone and muscle loss occur in parallel over time rather than as a directional or predictive process. This synchronized decline, which appears more pronounced in patients with hypoalbuminemia, supports the concept of a shared catabolic mechanism underlying uremic osteosarcopenia.