ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1628038
This article is part of the Research TopicSarcopenia and Nutrition in Chronic Kidney DiseaseView all 6 articles
The Association between Iron Deficiency and Muscle Mass/Strength in Patients Undergoing Maintenance Hemodialysis
Provisionally accepted- 1Department of Clinical Nutrition, Chengdu First People’s Hospital, Chengdu, China
- 2Department of Nephrology, Chengdu First People’s Hospital,, Chengdu, China
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Background: Patients with end-stage renal disease (ESRD) are at high risk of losing muscle mass and strength, especially those undergoing maintenance hemodialysis (MHD). Iron deficiency (ID) may exacerbate this condition, however, its relationship with muscle mass/strength remains largely unclear. Therefore, we aim to investigate the association between ID status and muscle mass/strength in Chinese patients undergoing hemodialysis hemodialysis . Methods: This cross-sectional study was conducted at a hemodialysis center in southwest China from September to December 2022. Iron status was assessed by plasma ferritin and transferrin saturation (TSAT). Muscle strength was measured by handgrip strength (HGS), and muscle mass was evaluated using the appendicular skeletal muscle index (ASMI). Linear regression and subgroup analysis with interaction terms were performed to explore the associations. Results: 269 participants on MHD aged 18-85 years were included, 21.9% (59/269) had ID. Participants with ID exhibited significantly lower handgrip strength, but similar ASMI, compared to those without ID (grip strength: 21.6 ± 8.7 vs. 24.3 ± 8.9, ASMI: 6.5 ± 1.2 vs. 6.5 ± 1.0). After adjusting for potential covariates, ID was negatively associated with handgrip strength (β = -2.21, 95% CI: -4.08 to -0.34, p = 0.021). Subgroup analysis confirmed the stability of this result. Interestingly, when stratified by overweight status, ID was significantly associated with ASMI in overweight participants (β = 0.50, 95% CI: 0.17 to 0.84, p = 0.004), while no association was observed in non-overweight participants (β = -0.20, 95% CI: -0.44 to 0.05, p = 0.240; p-value for interaction = 0.004). Conclusions: These findings demonstrate that ID is significantly associated with reduced muscle strength in patients on MHD in southwest China. Additionally, ID was significantly associated with muscle mass only in overweight participants. These results provide strong support for the importance of individualized iron - repletion strategies to preserve muscle health in patients on MHD, particularly those who are overweight, although further verification in prospective studies is needed.
Keywords: iron deficiency, Muscle Strength, muscle mass, Maintenance hemodialysis, Sarcopenia, transferrin saturation, bioelectrical impedance analysis
Received: 13 May 2025; Accepted: 18 Sep 2025.
Copyright: © 2025 Liu, Chen, Zhang, Luo, Chen, Zeng and Nie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huibin Nie, xinger_nhb@163.com
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