Validity of cachexia diagnosed using AWGC criteria in outpatients with chronic kidney disease undergoing hemodialysis: a cross-sectional study

Validity of cachexia diagnosed using AWGC criteria in outpatients with chronic kidney disease undergoing hemodialysis: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validity of cachexia diagnosed using AWGC criteria in outpatients with chronic kidney disease undergoing hemodialysis: a cross-sectional study Takuma Yagi, Tatsuro Inoue, Masato Ogawa, Masatsugu Okamura, Kengo Shirado, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7958646/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cachexia worsens the long-term prognosis of patients with chronic kidney disease (CKD) undergoing hemodialysis. The Asian Working Group for Cachexia (AWGC) has proposed diagnostic criteria tailored to Asian populations. In this study, we aimed to validate the AWGC criteria for diagnosing cachexia in patients with CKD undergoing hemodialysis by focusing on the prevalence, diagnostic accuracy, health-related quality of life (HRQoL), and instrumental activities of daily living (IADL). Methods This cross-sectional study included 93 outpatients with CKD undergoing hemodialysis. Cachexia was diagnosed using the AWGC and Evans criteria. HRQoL was assessed using the European Quality of Life 5 Dimensions 5-level (EQ-5D-5L), and IADL was evaluated using the Lawton IADL scale. Statistical analyses included evaluation of sensitivity and specificity and multiple regression to examine the associations of cachexia definitions with HRQoL, and IADL. Results Cachexia prevalence was 30.1% and 24.7% according to the AWGC and Evans criteria, respectively. All patients diagnosed with cachexia based on the Evans criteria were also identified as having the condition based on the AWGC criteria. The AWGC criteria demonstrated superior diagnostic accuracy (κ = 0.865), with a sensitivity of 1.000 and specificity of 0.929. Associations of cachexia (as defined by each criterion) with HRQoL and IADL were similar. Conclusions In contrast to the Evans criteria, the AWGC criteria demonstrated high validity and superior applicability for diagnosing cachexia in outpatients with CKD undergoing hemodialysis. These findings highlight the practicality of the AWGC criteria. Their use may facilitate early detection and help prevent cachexia progression, thereby improving patient outcomes. hemodialysis cachexia Asian Working Group for Cachexia diagnostic accuracy chronic kidney disease Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Background Chronic kidney disease (CKD) is recognized as a public health issue associated with increased mortality, decreased quality of life (QoL), and rising healthcare costs [ 1 ]. As CKD progresses toward end-stage renal disease, renal replacement therapy becomes inevitable [ 2 ]. In 2010, the number of individuals undergoing renal replacement therapy were reportedly 262 million globally, and this number is expected to rise to 543.9 million by 2030 [ 3 ]. Although renal replacement therapy improves survival, the 5-year survival rate for patients undergoing hemodialysis or peritoneal dialysis is only 42.3%, which is an exceptionally high mortality rate compared with that of the general population [ 4 ]. Cachexia is a complex metabolic syndrome associated with underlying diseases, such as CKD, and is characterized by muscle loss, with or without fat loss [ 5 ]. The international diagnostic criteria proposed by Evans et al. are commonly used for the diagnosis of cachexia [ 5 ]. Cachexia, as defined by the Evans criteria, affects 16% of patients with CKD undergoing hemodialysis and negatively impacts their long-term prognosis [ 6 ]. However, Konishi et al. suggested that existing international criteria emphasizing body composition and muscle loss might underestimate the prevalence of cachexia in Asians owing to differences in their body physique, compared with Western populations [ 7 ]. In 2023, the Asian Working Group for Cachexia (AWGC) released a consensus statement regarding the diagnostic criteria for cachexia in Asian populations [ 8 ]. However, the utility of AWGC criteria for diagnosing cachexia in patients with CKD undergoing hemodialysis remains invalid. In the AWGC consensus statement, QoL and instrumental activities of daily living (IADL) were highlighted as critical clinical outcomes of cachexia [ 8 ]. Patient-reported outcomes, particularly QoL indicators, are increasingly recognized as essential and meaningful endpoints in the context of severe and treatment-resistant conditions such as cachexia [ 8 ]. Patients with CKD undergoing hemodialysis may experience decreased health-related QoL (HRQoL) owing to fatigue and malnutrition [ 9 ] and often experience a heavy burden of physical and psychological symptoms, often linked to the lower HRQoL [ 10 ]. Additionally, IADL is used to assess advanced functional abilities in daily life beyond basic activities, including cognitive and physical capabilities [ 11 ]. A cross-sectional study revealed that approximately 80% of patients with CKD undergoing hemodialysis had IADL dependence, with a higher degree of IADL dependence associated with lower HRQoL [ 12 ]. IADL and QoL are closely related, and a decline in IADL can directly lead to difficulties in independent living and a deterioration in QoL [ 12 ]. It is essential to investigate the relationship of cachexia definitions with HRQoL, and IADL as key clinical outcomes for validating the diagnostic utility of the cachexia criteria. This study aimed to assess cachexia using the AWGC and Evans definitions, compare their diagnostic accuracy and the detected prevalences of cachexia, and examine their associations with HRQoL and IADL, thereby evaluating the validity of diagnosing cachexia based on the AWGC criteria. 2. Methods 2.1 Participants This was a single-center cross-sectional study conducted at Hattori Hospital in Hyogo, Japan. A survey was conducted from May to June 2022 among outpatients with CKD undergoing hemodialysis three times per week at the hospital. According to data from the Japanese Society for Dialysis Therapy, this frequency of outpatient hemodialysis is the most common in Japan [ 13 ]. Inclusion criterion was consent to participate, whereas exclusion criteria included missing data and cognitive decline that hindered the ability to respond to the questionnaire. Written informed consent was obtained from all participants or their legal guardians. The study was approved by the ethics committee of Hattori Hospital (Hyogo, Japan) (Approval No. : 2022–02) and was conducted in accordance with the principles of the 1964 Declaration of Helsinki and its later amendments. 2.2 Data collection We collected data on the following parameters: age, sex, height, weight (dry weight), body mass index (BMI), comorbidities (Charlson comorbidity index, CCI) [ 14 ], history of falls, blood biochemical data (albumin [Alb], C-reactive protein [CRP], hemoglobin [Hb], blood urea nitrogen [BUN], and creatinine [Cre] levels), and hemodialysis data (dialysis duration and time and the standardized dialysis dose [Kt/V]). Blood biochemical data were collected before dialysis. Fall history was evaluated using a questionnaire. Malnutrition risk was assessed using the geriatric nutritional risk index (GNRI) [ 15 ]. Falls were defined according to the Prevention of Falls Network Europe consensus criteria as a situation in which a person's body part other than the sole touched the floor or ground [ 16 ]. Physical function was assessed using the short physical performance battery (SPPB), which comprises three sub-items: standing balance test, walking test, and chair stand test. Each item is scored from 0 to 4 points, with a total of 0 to 12 points [ 17 ]. The standing test measures the holding times in closed-leg standing, semi-tandem standing, and tandem standing. The walking test measures the time required to walk 4 m at a normal walking speed. The chair stand test measures the time required to stand five times with maximum effort [ 17 ]. 2.3 Definition of cachexia Cachexia was diagnosed based on Evans criteria, following the consensus guidelines for cachexia [ 5 ]. Evans diagnostic criteria for cachexia include the presence of chronic disease and either > 5% body weight loss within 12 months or a BMI 0.5 mg/dL, Hb < 12.0 g/dL, Alb < 3.2 g/dL) [ 5 ]. Muscle strength was measured using a Smedley hand dynamometer (TKK5401, TAKEI, Niigata). Measurements were taken twice on each side for 3 seconds at maximum effort in a standing or sitting position, with the upper limb relaxed along the body, and the highest value was recorded. Based on the Asian Working Group for Sarcopenia 2019 definition, the cutoff values for decreased muscle strength were < 28 kg for male individuals and < 18 kg for female individuals, with values below these thresholds considered indicative of muscle weakness [ 18 ]. Fatigue was assessed using the revised Japanese Cardiovascular Health Study criteria for diagnosis of frailty, where individuals who experienced "feeling tired for no reason in the past 2 weeks" were classified as those experiencing fatigue [ 19 ]. Anorexia was assessed using the simplified nutrition assessment questionnaire (SNAQ) [ 20 ], which comprises four appetite-related questions, each scored on a five-point scale (maximum of 20 points in total). A cutoff score ≤ 14 indicated anorexia [ 20 ]. Skeletal muscle mass was measured using dual-energy X-ray absorptiometry (DEXA) and calculated as appendicular skeletal muscle mass index (ASMI, kg/m²). The cutoff values were < 7.25 kg/m² for male individuals and < 5.45 kg/m² for female individuals, and values below these thresholds were defined as low muscle mass index [ 5 ]. The AWGC developed cachexia diagnostic criteria to establish a consensus on cachexia in the Asian population and its clinical outcomes [ 8 ]. Based on these criteria, cachexia was defined as the presence of chronic disease and either ≥ 2% weight loss over 3–6 months or a BMI < 21 kg/m², with at least one of the following: anorexia, reduced grip strength (< 28 kg for male individuals, 0.5 mg/dL. 2.4 HR-QoL HRQoL was assessed using the European Quality of Life 5 Dimensions 5-level (EQ-5D-5L) [ 21 ], a standardized measure developed by the EuroQoL Group for clinical and economic evaluations and population health surveys [ 22 ]. The EQ-5D-5L comprises five dimensions: "mobility," "self-care," "usual activities," "pain/discomfort," and "anxiety/depression," each with five levels and scores ranging from 0 (death) to 1 (perfect health). The scores were converted into an EQ-5D-5L index using the EQ-5D-5L index calculator downloaded from the EuroQoL website [ 23 ]. The index score ranges from 0.111 to 1, with higher values indicating better health status. The Japanese version of EQ-5D-5L has been validated and is reliable [ 24 ]. 2.5 IADL IADL was assessed using the Lawton IADL scale [ 11 ], which is the most widely used measure for evaluating IADL in older adult populations. It comprises eight items: "telephone use," "shopping," "meal preparation," "housekeeping," "laundry," "transportation use," "medication management," and "financial management" [ 11 ]. Each item is scored as 0 (unable or partially able to perform) or 1 (fully able to perform), with a total score ranging from 0 (low function, dependence) to 8 (high function, independence) [ 25 ]. 2.6 Statistical analysis Data are presented as mean standard deviation for parametric data and median (25–75% percentile) for non-parametric data. Comparisons between groups with and without cachexia were performed using t-tests, Mann–Whitney U tests, and χ² tests. Comparisons of the EQ-5D-5L indices based on the presence or absence of each cachexia diagnostic criterion were conducted using t-tests and Mann–Whitney U tests. To assess the agreement between the AWGC and Evans criteria for cachexia diagnosis, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen’s kappa (κ) coefficient were calculated. Multiple regression analysis was performed using the EQ-5D-5L index and IADL score as dependent variables and cachexia (assessed based on the AWGC and Evans criteria) as explanatory variables. From a clinical perspective, age, sex, BMI, CCI, history of falls, standardized dialysis dose, and dialysis duration were included as confounding factors in the regression model. Statistical significance was set at p < 0.05. All analyses were performed using EZR Ver.1.38 (Saitama Medical Center, Jichi Medical University, Saitama, Japan) [ 26 ], a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria). 3. Results A total of 119 outpatients with CKD were undergoing hemodialysis during the study period. Of these, 100 were included after excluding those who refused to participate (n = 19). Patients with missing data (n = 4) and cognitive impairment (n = 3) were also excluded from the analysis. Finally, 93 patients were enrolled in the study (Fig. 1 ). The mean age of the participants was 69.4 ± 11.0 years, and 46 patients (49.5%) were female. The median duration of hemodialysis was 6.3 years (interquartile range: 2.8–12.5), and the mean time per hemodialysis session was 3.9 ± 0.4 h. The mean BMI was 23.0 ± 4.5 kg/m², and 68.8% of the patients were identified as being at risk of malnutrition, based on the GNRI (Table 1 ). Table 1 Baseline characteristics of patients Factors Total N 93 Age, years 69.4 (11.0) Sex Female, n 46 (49.5) BMI, kg/m² 23.0 (4.5) Laboratory test data Alb, g/dL 3.8 (0.4) CRP, g/dL 0.09 (0.05 − 0.24) Hb, mg/dL 11.1 (1.2) BUN, mg/dL 63.2 (14.0) Cre, mg/dL 10.7 (3.0) Dialysis-related factors Duration of dialysis, years 6.3 (2.8 − 12.5) Dialysis time, time 3.9 (0.4) Kt/V 1.4 (0.2) CCI, points 5.1 (1.7) SNAQ With loss of appetite, n 39 (41.9) GNRI With malnutrition risk, n 64 (68.8) ASM, kg 17.2 (4.4) ASMI, kg/m² 6.6 (1.1) Fat mass, kg 16.0 (8.8) History of falls, n 30 (32.3) EQ-5D-5L index, points 0.832 (0.734 − 0.938) BI, points 98.8 (4.9) IADL score, points 7.0 (7.0–8.0) Handgrip strength, kg 23.7 (9.8) Walking speed, m/s 0.91 (0.3) SPPB score, points 10.0 (9.0 − 11.0) Data are presented as n (%), mean ± SD, or median (first– fourth percentile). Statistical analyses were performed using t-tests, Mann–Whitney U, or χ ² tests. SD: standard deviation; BMI: body mass index; Alb: albumin; CRP: C-reactive protein; Hb: hemoglobin; BUN: blood urea nitrogen; Cre: creatinine; Kt/V: standardized dialysis dose; CCI: Charlson comorbidity index; SNAQ: simplified nutrition assessment questionnaire; GNRI: geriatric nutritional risk index; ASM: appendicular skeletal muscle mass; ASMI: appendicular skeletal muscle mass index; EQ-5D-5L: European Quality of Life 5 Dimensions 5-level; BI: Barthel index; IADL: instrumental activities of daily living; SPPB: short physical performance battery. [Insert Table 1 here] The prevalence of cachexia was 30.1% (identified in 28 patients) according to the AWGC criteria and 24.7% (identified in 23 patients) according to the Evans criteria. All patients diagnosed with cachexia based on the Evans criteria were also classified as having the condition based on the AWGC criteria (Fig. 2 ). Figures 3 and 4 show the distribution of patients identified as having cachexia (cachexia group) and those identified as not having cachexia (non-cachexia group) using each individual component in the AWGC and Evans criteria. Among the AWGC criteria, the mandatory requirement of BMI < 21 kg/m² was met by 31 patients (33.3%). In addition, the diagnostic criteria components included abnormal biochemistry, which was met by 3 patients (3.2%); decreased muscle strength, met by 24 patients (25.8%); and fatigue, met by 13 patients (14.0%). Among the Evans criteria, the mandatory requirement of BMI < 20 kg/m² was met by 24 patients (25.8%). The diagnostic criteria components included abnormal biochemistry, which was met by 21 patients (22.6%); anorexia, met by 11.8% (11 patients); decreased muscle strength, met by 21 patients (22.6%); low fat-free mass index, met by 18 patients (19.4%); and fatigue, met by 13 patients (14.0%). The diagnostic accuracy metrics of the AWGC criteria compared with the Evans criteria were as follows: sensitivity, 1.00 (95% confidence interval [CI]: 0.79–1.00); specificity, 0.93 (95% CI: 0.84–0.98); PPV, 0.82 (95% CI: 0.63–0.94); and NPV, 1.00 (95% CI: 0.92–1.00). In addition, the kappa coefficient (κ) was 0.87 (95% CI: 0.75–0.98) (Table 2 ). Table 2 Performance metrics of AWGC criteria compared with Evans criteria for the diagnosis of cachexia Metric Value 95% confidence interval Sensitivity 1.00 0.79–1.00 Specificity 0.93 0.84–0.98 Positive predictive value 0.82 0.63–0.94 Negative predictive value 1.00 0.92–1.00 Kappa Coefficient (κ) 0.87 0.75–0.98 Sensitivity, specificity, positive predictive value, negative predictive value, and the kappa coefficient with 95% confidence intervals are reported. Table 3 presents a comparison of patients categorized in the cachexia and non-cachexia groups using the AWGC and Evans criteria. The patients who were categorized in the cachexia group using both criteria were significantly older ( p < 0.001) and had significantly lower BMI ( p < 0.001), Cre levels ( p = 0.004 vs. 0.002), ASM ( p = 0.004 vs. 0.019), and ASMI ( p < 0.001 vs. 0.004). Moreover, malnutrition risk was higher in the cachexia group than in the non-cachexia group ( p < 0.001 vs. 0.028). Handgrip strength ( p < 0.001), walking speed ( p = 0.002 vs. < 0.001), and SPPB scores ( p < 0.001) were significantly lower in the cachexia group than in the non-cachexia group. Table 3 Comparison of cachexia classification according to the AWGC and Evans criteria Evans criteria AWGC criteria Factors Cachexia group Non-cachexia group p -values Cachexia group Non-cachexia group p -values N 23 (24.7) 70 (75.3) 28 (30.1) 65 (69.9) Age, years 77.6 (8.7) 66.7 (10.3) < 0.001 76.6 (9.8) 66.3 (10.0) < 0.001 Sex Female, n 12 (52.2) 35 (50.0) 14 (50.0) 32 (49.2) BMI, kg/m² 19.5 (2.5) 24.2 (4.4) < 0.001 19.5 (2.3) 24.6 (4.4) < 0.001 Laboratory test data Alb, g/dL 3.7 (0.4) 3.8 (0.5) 0.458 3.7 (0.4) 3.8 (0.5) 0.444 CRP, g/dL 0.10 (0.04 − 0.24) 0.09 (0.06 − 0.24) 0.721 0.11 (0.04 − 0.36) 0.08 (0.06 − 0.21) 0.612 Hb, mg/dL 10.7 (1.4) 11.2 (1.1) 0.100 10.9 (1.4) 11.1 (1.1) 0.308 BUN, mg/dL 62.6 (18.5) 63.4 (12.4) 0.824 61.8 (17.8) 63.8 (12.2) 0.523 Cre, mg/dL 9.1 (3.0) 11.3 (2.8) 0.002 9.4 (3.0) 11.3 (2.8) 0.004 Dialysis-related factors Duration of dialysis, years 6.0 (2.2 − 12.2) 6.4 (3.3 − 14.4) 0.457 6.2 (2.2 − 11.4) 6.5 (3.1 − 14.8) 0.329 Dialysis time, hours 3.8 (0.4) 4.0 (0.4) 0.013 3.8 (0.4) 4.0 (0.4) 0.014 Kt/V 1.5 (0.2) 1.4 (0.2) 0.298 1.4 (0.2) 1.4 (0.2) 0.435 CCI, points 4.9 (1.8) 5.1 (1.6) 0.575 5.2 (1.8) 5.0 (1.6) 0.634 SNAQ With loss of appetite, n 11 (47.8) 28 (40.0) 0.918 13 (46.4) 26 (40.0) 0.649 GNRI With malnutrition risk, n 20 (87.0) 44 (62.9) < 0.001 24 (85.7) 40 (61.5) 0.028 ASM, kg 15.4 (2.4) 17.8 (4.7) 0.019 15.3 (2.8) 18.0 (4.6) 0.004 ASMI, kg/m² 6.0 (0.8) 6.8 (1.2) 0.004 6.0 (0.8) 6.9 (1.2) < 0.001 Fat mass, kg 14.4 (8.3) 17.8 (9.1) 0.058 10.2 (6.1) 18.5 (8.7) < 0.001 History of falls, n 9 (39.1) 21 (30.0) 0.448 9 (32.1) 21 (32.3) 1 EQ-5D-5L index, points 0.721 (0.613 − 0.786) 0.850 (0.757 − 0.938) < 0.001 0.731 (0.638 − 0.842) 0.860 (0.754 − 0.938) < 0.001 IADL score, points 7.0 (5.0–8.0) 8.0 (7.0–8.0) 0.001 7.0 (5.0–8.0) 8.0 (7.0–8.0) 0.006 Handgrip strength, kg 19.5 (6.5) 28.4 (10.6) < 0.001 18.4 (5.8) 26.0 (10.2) < 0.001 Walking speed, m/s 0.83 (0.22) 1.08 (0.27) < 0.001 0.81 (0.28) 1.01 (0.25) 0.002 SPPB score, points 9.5 (8.0 − 9.5) 11.0 (10.0 − 12.0) < 0.001 8.0 (5.0 − 10.0) 11.0 (10.0 − 12.0) < 0.001 Data are shown n (%), mean ± SD, or median (first percentile – fourth percentile). Statistical analyses were performed using t-tests, Mann–Whitney U tests, or χ ² tests. SD: standard deviation; AWGC: Asian Working Group for Cachexia; BMI: body mass index; Alb: albumin; CRP: C-reactive protein; Hb: hemoglobin; BUN: blood urea nitrogen; Cre: creatinine; Kt/V: standardized dialysis dose; CCI: Charlson comorbidity index; SNAQ: simplified nutrition assessment questionnaire; GNRI: geriatric nutritional risk index; ASM: appendicular skeletal muscle mass; ASMI: appendicular skeletal muscle mass index; EQ-5D-5L: European Quality of Life 5 Dimensions 5-level; IADL: instrumental activities of daily living; SPPB: short physical performance battery Evans criteria AWGC criteria Factors Cachexia group Non-cachexia group p -value Cachexia group Non-cachexia group p -value N 23 (24.7) 70 (75.3) 28 (30.1) 65 (69.9) EQ-5D-5L index, points 0.72 (0.61 − 0.79) 0.85 (0.76 − 0.94) < 0.001 0.73 (0.64 − 0.84) 0.86 (0.75 − 0.94) < 0.001 IADL score, points 7.0 (5.0–8.0) 8.0 (7.0–8.0) 0.001 7.0 (5.0–8.0) 8.0 (7.0–8.0) 0.006 Data are presented as n (%), mean ± SD, or median (first– fourth percentile). Statistical analyses were performed using t-tests and Mann–Whitney U tests. SD: standard deviation; AWGC: Asian Working Group for Cachexia; EQ-5D-5L: European Quality of Life 5 Dimensions 5-level; IADL: instrumental activities of daily living [Insert Table 3 here] Table 4 presents the comparison of the EQ-5D-5L indices and IADL scores between cachexia and non- cachexia groups according to the AWGC and Evans criteria. When using the AWGC criteria, the EQ-5D-5L indices ( p < 0.001) and IADL scores ( p = 0.006) were significantly lower in the cachexia group than in the non-cachexia group. Similarly, when using the Evans criteria, the EQ-5D-5L indices ( p < 0.001) and IADL scores ( p = 0.001) were significantly lower in the cachexia group than in the non-cachexia group. Table 4 Comparison between the cachexia and non-cachexia groups categorized according to the AWGC and Evans criteria Evans criteria AWGC criteria β 95% CI Standardized β p -value β 95% CI Standardized β p -value Constant 0.994 0.715 − 1.273 < 0.001 0.978 0.694 − 1.262 < 0.001 Cachexia −0.112 −0.183− −0.040 0.036 0.003 −0.099 −0.167− −0.031 0.034 0.005 Age −0.003 −0.006− −0.000 0.001 0.024 −0.003 −0.006− −0.000 0.001 0.023 Sex (female) 0.005 −0.055–0.066 0.030 0.859 0.010 −0.050–0.071 0.030 0.735 CCI 0.001 −0.018–0.019 0.009 0.935 0.004 −0.014–0.023 0.009 0.637 Kt/V 0.069 −0.079–0.217 0.074 0.355 0.073 −0.076–0.222 0.075 0.334 History of falls −0.036 −0.099–0.027 0.032 0.260 −0.048 −0.112–0.016 0.032 0.141 Duration of dialysis −0.002 −0.006− −0.000 0.001 0.105 −0.002 −0.006− −0.001 0.002 0.103 AWGC: Asian Working Group for Cachexia; CI: confidence interval, CCI: Charlson comorbidity index, Kt/V: standardized dialysis dose Additional file 1 presents comparisons between patients with cachexia diagnosed using the AWGC criteria alone and those diagnosed using the AWGC and Evans criteria. No significant intergroup differences existed in the EQ-5D-5L indices (0.83 vs. 0.72, p = 0.126) or IADL scores (8.0 vs. 7.0, p = 0.198). Table 5 presents the results of multiple regression analysis for identifying factors associated with the HRQoL assessed using EQ-5D-5L. According to the AWGC criteria, cachexia (β = -0.099, p = 0.005) and age (β = -0.003, p = 0.023) were independently associated with HRQoL (R² = 0.26). Similarly, according to the Evans criteria, cachexia (β = -0.112, p = 0.003) and age (β = -0.003, p = 0.024) were independently associated with HRQoL (R² = 0.27). These results were consistent between the AWGC and Evans criteria. Table 5 Multiple linear regression analysis of factors associated with HRQoL: A comparison between the AWGC and Evans criteria Evans criteria AWGC criteria β 95% CI Standardized β p -value β 95% CI Standardized β p -value Constant 8.189 5.164–11.213 < 0.001 8.123 5.024–11.223 < 0.001 Cachexia −1.102 −1.680− −0.328 0.391 0.005 −0.894 −1.636− −0.152 0.373 0.019 Age −0.045 −0.077− −0.013 0.016 0.006 −0.047 −0.080− −0.015 0.016 0.004 Sex (female) −0.203 −0.855–0.449 0.328 0.537 −0.155 −0.814–0.504 0.331 0.641 CCI −0.149 −0.350–0.053 0.101 0.147 −0.113 −0.316–0.090 0.102 0.272 Kt/V 2.182 0.578–3.787 0.807 0.008 2.211 0.586–3.836 0.817 0.008 History of falls 0.140 −0.546–0.827 0.345 0.685 0.031 −0.667–0.731 0.351 0.928 Duration of dialysis −0.002 −0.036 − 0.033 0.016 0.893 −0.003 −0.037 − 0.034 0.018 0.893 AWGC: Asian Working Group for Cachexia; CI: confidence interval; CCI: Charlson comorbidity index, Kt/V: standardized dialysis dose Table 6 presents the results of multiple regression analysis for identifying factors associated with IADL. According to the AWGC criteria, cachexia (β = -0.894, p = 0.019), age (β = -0.047, p = 0.004), and Kt/V (β = 2.211, p = 0.008) were independently associated with IADL (R² = 0.30). Similarly, using the Evans criteria, cachexia (β = -1.102, p = 0.005), age (β = -0.045, p = 0.006), and Kt/V (β = 2.182, p = 0.008) showed similar associations (R² = 0.31). The consistency of these findings across both criteria reinforces the robustness of the observed relationships. Table 6 Multiple linear regression analysis of factors associated with IADL: A comparison between the AWGC and Evans criteria Evans AWGC β 95% CI Standardized β p -value β 95% CI Standardized β p -value Constant 8.189 5.164–11.213 < 0.001 8.123 5.024–11.223 < 0.001 Cachexia −1.102 −1.680− −0.328 0.391 0.005 −0.894 −1.636− −0.152 0.373 0.019 Age −0.045 −0.077− −0.013 0.016 0.006 −0.047 −0.080− −0.015 0.016 0.004 Sex (female) −0.203 −0.855–0.449 0.328 0.537 −0.155 −0.814–0.504 0.331 0.641 CCI −0.149 −0.350–0.053 0.101 0.147 −0.113 −0.316–0.090 0.102 0.272 Kt/V 2.182 0.578–3.787 0.807 0.008 2.211 0.586–3.836 0.817 0.008 History of falls 0.140 −0.546–0.827 0.345 0.685 0.031 −0.667–0.731 0.351 0.928 Duration of dialysis −0.002 −0.036 − 0.033 0.016 0.893 −0.003 −0.037 − 0.034 0.018 0.893 AWGC: Asian Working Group for Cachexia; CI: confidence interval; CCI: Charlson comorbidity index, Kt/V: standardized dialysis dose 4. Discussion This study evaluated two definitions of cachexia based on the AWGC and Evans criteria, in outpatients with CKD undergoing hemodialysis. We compared their diagnostic accuracy, the detected prevalences of cachexia, and its association with HRQoL and IADL. The AWGC criteria demonstrated higher diagnostic accuracy than the Evans criteria did, and the associations of two definitions of cachexia with HRQoL and IADL were nearly identical. These findings indicate the diagnostic potential of the AWGC criteria and suggest that its ease of clinical application may facilitate early detection and prevention of cachexia progression in outpatients with CKD undergoing hemodialysis. Among outpatients with CKD undergoing hemodialysis, those diagnosed with cachexia according to the Evans criteria were invariably identified by the AWGC criteria. The AWGC criteria demonstrated a high level of agreement with the Evans criteria, showing a well-balanced sensitivity and specificity. These findings suggest that the AWGC criteria may serve as a reliable indicator for diagnosing cachexia. These results suggest that the AWGC criteria exhibit high concordance with the Evans criteria, highlighting their use in cachexia diagnosis. Moreover, the AWGC criteria demonstrated high sensitivity in detecting cachexia while maintaining high accuracy in identifying patients without cachexia. The relatively high PPV and extremely high NPV further support the reliability of the AWGC criteria as a diagnostic tool closely aligned with the Evans criteria. As the AWGC criteria comprise anorexia, decreased handgrip strength, and abnormal CRP, they enable a simple and convenient assessment of cachexia. Considering their ease of clinical implementation, the AWGC criteria may facilitate convenient detection and timely intervention for cachexia in outpatients with CKD undergoing hemodialysis. Cachexia prevalence among outpatients with CKD undergoing hemodialysis was 30.1% when using the AWGC criteria and 24.7% when using the Evans criteria. In a previous study on Japanese outpatients with CKD undergoing hemodialysis, the prevalence of cachexia was reported as 21.3% using the Evans criteria and 35.2% using the AWGC criteria [ 17 ]. Our findings are comparable to those of this previous study, suggesting consistency across different definitions. The prevalence of cachexia determined using the AWGC criteria was higher than that determined using the Evans criteria. This discrepancy may be attributed to the BMI threshold difference, where the Evans criteria use a criterion of BMI < 20 kg/m², whereas the AWGC criteria use BMI < 21 kg/m². Moreover, the AWGC criteria do not include muscle mass assessment or fatigue evaluation. These factors may have contributed to the higher prevalence of cachexia detected when using the AWGC criteria. The discrepancies between our study and previous studies may be attributed to differences in muscle mass assessment methods. The previous study used the modified Cre index to assess muscle mass, whereas our study employed DEXA to calculate the skeletal muscle mass index. Given that cachexia is characterized by muscle mass loss [ 5 ], variations in assessment methods may yield different results despite applying the same cachexia definitions. Consequently, this factor should be carefully considered in future studies. The clinical significance of this study is that the AWGC criteria provide a simple and highly sensitive diagnostic tool for cachexia, enabling convenient diagnosis, risk stratification, and timely intervention in patients with CKD undergoing hemodialysis. The AWGC criteria utilize standardized and easily assessable indicators, such as CRP and handgrip strength [ 8 ], facilitating practical application in clinical settings. In this study, the AWGC criteria included all patients diagnosed with cachexia using the Evans criteria and additionally identified those with mild cachexia. Cachexia involves multiple factors and significantly worsens patient prognosis [ 6 ]. Appropriate assessment of patients with CKD and early intervention are essential in clinical practice for improving patient outcomes [ 6 ]. The AWGC criteria allow for the identification of patients with mild cachexia not detected by the Evans criteria, thereby enabling early intervention. Additionally, HRQoL and IADL are critical clinical outcomes of cachexia [ 8 ], and in this study, cachexia diagnosed by the AWGC criteria was significantly associated with decreased HRQoL and IADL. In a previous study, patients undergoing hemodialysis were found to have lower health-related QoL compared with that before hemodialysis and that in patients receiving kidney transplant [ 9 ]. Moreover, hemodialysis has been reported to affect HRQoL physically, psychologically, and socially [ 27 ]. Furthermore, patients with CKD undergoing hemodialysis demonstrate a decline in IADL and ADL [ 28 ]. It has been reported that up to 50% of older patients with CKD undergoing hemodialysis experience impairments in ADL and IADL [ 29 ]. These findings underscore the prognostic value of the AWGC criteria. Further studies are warranted to examine the long-term impact of cachexia diagnosis using the AWGC criteria on patient outcomes. This study has some limitations. First, as this was an observational study conducted at a single center, the generalizability of the results may be limited. Therefore, multicenter collaborative studies should determine whether similar findings can be obtained in different clinical settings. Second, the relatively small sample size resulted in low coefficients of determination, leading to a lower goodness-of-fit in multiple regression analyses. Future studies with larger sample sizes should explore additional confounding factors. Third, this study was cross-sectional, which does not allow for causal inferences. Therefore, more detailed longitudinal studies are warranted. 5. Conclusions Our findings showed that the AWGC criteria demonstrated higher diagnostic accuracy than the Evans criteria did, with both criteria demonstrating nearly identical associations with HRQoL and IADL. These findings suggest the usefulness of the AWGC criteria, and considering their ease of clinical application, they may facilitate the convenient detection of cachexia and help prevent its progression in outpatients with CKD undergoing hemodialysis. Abbreviations Alb albumin ASMI appendicular skeletal muscle mass index AWGC Asian Working Group for Cachexia BMI body mass index CCI Charlson comorbidity index CI confidence interval CKD chronic kidney disease Cre creatinine CRP C-reactive protein DEXA dual-energy X-ray absorptiometry EQ-5D-5L European Quality of Life 5 dimensions 5-level GNRI geriatric nutritional risk index Hb hemoglobin HRQoL health-related quality of life IADL instrumental activities of daily living NPV negative predictive value PPV positive predictive value QoL quality of life SNAQ simplified nutrition assessment questionnaire SPPB short physical performance battery Declarations Ethics approval and consent to participate The study was approved by the ethics committee of Hattori Hospital (Hyogo, Japan) (Approval No.: 2022–02). Written informed consent was obtained from all participants or their legal guardians. Consent for publication Not applicable Availability of data and materials Not applicable Competing interests The authors declare that they have no competing interests Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions T.Y., S.K., T.K., Y.I., Y.H., N.T., R.O., and S.N. conceived the idea of the study. T.Y. and T.I. developed the statistical analysis plan and conducted statistical analyses. T.Y., T.I., M.O., M.O., K.S., N.S., and S.N. contributed to the interpretation of the results. T.Y., T.I., M.O., M.O., and S.I. drafted the original manuscript. T.Y. supervised the conduct of this study. All authors reviewed the manuscript draft and revised it critically on intellectual content. All authors approved the f inal version of the manuscript to be published. 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16:08:01","extension":"html","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":162582,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7958646/v1/68e19b3f2e559502e6f5d736.html"},{"id":96245055,"identity":"f5c9da43-4384-4960-af1f-497f7a718427","added_by":"auto","created_at":"2025-11-19 07:19:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27839,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart showing the selection, inclusion, and follow-up of participants\u003c/p\u003e\n\u003cp\u003eCKD: chronic kidney disease\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7958646/v1/ffe2489cb038638cb6d2d2ab.png"},{"id":95939485,"identity":"62a035ba-98c5-474d-a67b-d4f0fbf53e1e","added_by":"auto","created_at":"2025-11-14 16:08:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38250,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalences of cachexia according to the AWGC and Evans criteria\u003c/p\u003e\n\u003cp\u003eAWGC: Asian Working Group for Cachexia, BMI: body mass index, CRP: C-reactive protein\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7958646/v1/0415d40d23818e9390b516d2.png"},{"id":95939483,"identity":"1cfcec63-f9a4-4e75-b431-8e60fc83b3e9","added_by":"auto","created_at":"2025-11-14 16:08:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":32828,"visible":true,"origin":"","legend":"\u003cp\u003eThe distribution of patients categorized into the cachexia and non-cachexia groups according to each individual component of the AWGC criteria\u003c/p\u003e\n\u003cp\u003eBMI: body mass index, CRP: C-reactive protein\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7958646/v1/2c20a90ede023e704578a8e5.png"},{"id":96245752,"identity":"6fbd0f6e-749e-4f28-95b0-ff4538cc30af","added_by":"auto","created_at":"2025-11-19 07:22:21","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":81272,"visible":true,"origin":"","legend":"\u003cp\u003eThe distribution of patients categorized into the cachexia and non-cachexia groups according to each individual component of Evans criteria\u003c/p\u003e\n\u003cp\u003eBMI: body mass index\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7958646/v1/a855156f520ff90e82807e4a.png"},{"id":96602839,"identity":"30780991-8bae-4fbb-a403-d6e57514fc73","added_by":"auto","created_at":"2025-11-24 09:03:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1212427,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7958646/v1/f396cde4-7109-4b3f-9acf-08c8c616c636.pdf"},{"id":96244737,"identity":"69ecaf27-9f2b-47b1-9128-72115375c1e7","added_by":"auto","created_at":"2025-11-19 07:19:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":17492,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7958646/v1/68cb391560906ca2077d6a96.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validity of cachexia diagnosed using AWGC criteria in outpatients with chronic kidney disease undergoing hemodialysis: a cross-sectional study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eChronic kidney disease (CKD) is recognized as a public health issue associated with increased mortality, decreased quality of life (QoL), and rising healthcare costs [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As CKD progresses toward end-stage renal disease, renal replacement therapy becomes inevitable [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In 2010, the number of individuals undergoing renal replacement therapy were reportedly 262\u0026nbsp;million globally, and this number is expected to rise to 543.9\u0026nbsp;million by 2030 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although renal replacement therapy improves survival, the 5-year survival rate for patients undergoing hemodialysis or peritoneal dialysis is only 42.3%, which is an exceptionally high mortality rate compared with that of the general population [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCachexia is a complex metabolic syndrome associated with underlying diseases, such as CKD, and is characterized by muscle loss, with or without fat loss [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The international diagnostic criteria proposed by Evans et al. are commonly used for the diagnosis of cachexia [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Cachexia, as defined by the Evans criteria, affects 16% of patients with CKD undergoing hemodialysis and negatively impacts their long-term prognosis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, Konishi et al. suggested that existing international criteria emphasizing body composition and muscle loss might underestimate the prevalence of cachexia in Asians owing to differences in their body physique, compared with Western populations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In 2023, the Asian Working Group for Cachexia (AWGC) released a consensus statement regarding the diagnostic criteria for cachexia in Asian populations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the utility of AWGC criteria for diagnosing cachexia in patients with CKD undergoing hemodialysis remains invalid.\u003c/p\u003e\u003cp\u003eIn the AWGC consensus statement, QoL and instrumental activities of daily living (IADL) were highlighted as critical clinical outcomes of cachexia [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Patient-reported outcomes, particularly QoL indicators, are increasingly recognized as essential and meaningful endpoints in the context of severe and treatment-resistant conditions such as cachexia [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Patients with CKD undergoing hemodialysis may experience decreased health-related QoL (HRQoL) owing to fatigue and malnutrition [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and often experience a heavy burden of physical and psychological symptoms, often linked to the lower HRQoL [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Additionally, IADL is used to assess advanced functional abilities in daily life beyond basic activities, including cognitive and physical capabilities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A cross-sectional study revealed that approximately 80% of patients with CKD undergoing hemodialysis had IADL dependence, with a higher degree of IADL dependence associated with lower HRQoL [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. IADL and QoL are closely related, and a decline in IADL can directly lead to difficulties in independent living and a deterioration in QoL [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It is essential to investigate the relationship of cachexia definitions with HRQoL, and IADL as key clinical outcomes for validating the diagnostic utility of the cachexia criteria.\u003c/p\u003e\u003cp\u003eThis study aimed to assess cachexia using the AWGC and Evans definitions, compare their diagnostic accuracy and the detected prevalences of cachexia, and examine their associations with HRQoL and IADL, thereby evaluating the validity of diagnosing cachexia based on the AWGC criteria.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Participants\u003c/h2\u003e\u003cp\u003eThis was a single-center cross-sectional study conducted at Hattori Hospital in Hyogo, Japan. A survey was conducted from May to June 2022 among outpatients with CKD undergoing hemodialysis three times per week at the hospital. According to data from the Japanese Society for Dialysis Therapy, this frequency of outpatient hemodialysis is the most common in Japan [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Inclusion criterion was consent to participate, whereas exclusion criteria included missing data and cognitive decline that hindered the ability to respond to the questionnaire. Written informed consent was obtained from all participants or their legal guardians. The study was approved by the ethics committee of Hattori Hospital (Hyogo, Japan) (Approval No. : 2022\u0026ndash;02) and was conducted in accordance with the principles of the 1964 Declaration of Helsinki and its later amendments.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Data collection\u003c/h2\u003e\u003cp\u003eWe collected data on the following parameters: age, sex, height, weight (dry weight), body mass index (BMI), comorbidities (Charlson comorbidity index, CCI) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], history of falls, blood biochemical data (albumin [Alb], C-reactive protein [CRP], hemoglobin [Hb], blood urea nitrogen [BUN], and creatinine [Cre] levels), and hemodialysis data (dialysis duration and time and the standardized dialysis dose [Kt/V]). Blood biochemical data were collected before dialysis. Fall history was evaluated using a questionnaire. Malnutrition risk was assessed using the geriatric nutritional risk index (GNRI) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Falls were defined according to the Prevention of Falls Network Europe consensus criteria as a situation in which a person's body part other than the sole touched the floor or ground [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Physical function was assessed using the short physical performance battery (SPPB), which comprises three sub-items: standing balance test, walking test, and chair stand test. Each item is scored from 0 to 4 points, with a total of 0 to 12 points [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The standing test measures the holding times in closed-leg standing, semi-tandem standing, and tandem standing. The walking test measures the time required to walk 4 m at a normal walking speed. The chair stand test measures the time required to stand five times with maximum effort [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Definition of cachexia\u003c/h2\u003e\u003cp\u003eCachexia was diagnosed based on Evans criteria, following the consensus guidelines for cachexia [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Evans diagnostic criteria for cachexia include the presence of chronic disease and either \u0026gt;\u0026thinsp;5% body weight loss within 12 months or a BMI\u0026thinsp;\u0026lt;\u0026thinsp;20 kg/m\u0026sup2;, plus meeting at least three of the following five criteria: (1) decreased muscle strength, (2) fatigue, (3) anorexia, (4) low fat-free mass, or (5) abnormal biochemical markers (CRP\u0026thinsp;\u0026gt;\u0026thinsp;0.5 mg/dL, Hb\u0026thinsp;\u0026lt;\u0026thinsp;12.0 g/dL, Alb\u0026thinsp;\u0026lt;\u0026thinsp;3.2 g/dL) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Muscle strength was measured using a Smedley hand dynamometer (TKK5401, TAKEI, Niigata). Measurements were taken twice on each side for 3 seconds at maximum effort in a standing or sitting position, with the upper limb relaxed along the body, and the highest value was recorded. Based on the Asian Working Group for Sarcopenia 2019 definition, the cutoff values for decreased muscle strength were \u0026lt;\u0026thinsp;28 kg for male individuals and \u0026lt;\u0026thinsp;18 kg for female individuals, with values below these thresholds considered indicative of muscle weakness [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Fatigue was assessed using the revised Japanese Cardiovascular Health Study criteria for diagnosis of frailty, where individuals who experienced \"feeling tired for no reason in the past 2 weeks\" were classified as those experiencing fatigue [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Anorexia was assessed using the simplified nutrition assessment questionnaire (SNAQ) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], which comprises four appetite-related questions, each scored on a five-point scale (maximum of 20 points in total). A cutoff score\u0026thinsp;\u0026le;\u0026thinsp;14 indicated anorexia [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Skeletal muscle mass was measured using dual-energy X-ray absorptiometry (DEXA) and calculated as appendicular skeletal muscle mass index (ASMI, kg/m\u0026sup2;). The cutoff values were \u0026lt;\u0026thinsp;7.25 kg/m\u0026sup2; for male individuals and \u0026lt;\u0026thinsp;5.45 kg/m\u0026sup2; for female individuals, and values below these thresholds were defined as low muscle mass index [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe AWGC developed cachexia diagnostic criteria to establish a consensus on cachexia in the Asian population and its clinical outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Based on these criteria, cachexia was defined as the presence of chronic disease and either \u0026ge;\u0026thinsp;2% weight loss over 3\u0026ndash;6 months or a BMI\u0026thinsp;\u0026lt;\u0026thinsp;21 kg/m\u0026sup2;, with at least one of the following: anorexia, reduced grip strength (\u0026lt;\u0026thinsp;28 kg for male individuals, \u0026lt; 18 kg for female individuals), or a CRP level\u0026thinsp;\u0026gt;\u0026thinsp;0.5 mg/dL.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 HR-QoL\u003c/h2\u003e\u003cp\u003eHRQoL was assessed using the European Quality of Life 5 Dimensions 5-level (EQ-5D-5L) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], a standardized measure developed by the EuroQoL Group for clinical and economic evaluations and population health surveys [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The EQ-5D-5L comprises five dimensions: \"mobility,\" \"self-care,\" \"usual activities,\" \"pain/discomfort,\" and \"anxiety/depression,\" each with five levels and scores ranging from 0 (death) to 1 (perfect health). The scores were converted into an EQ-5D-5L index using the EQ-5D-5L index calculator downloaded from the EuroQoL website [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The index score ranges from 0.111 to 1, with higher values indicating better health status. The Japanese version of EQ-5D-5L has been validated and is reliable [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 IADL\u003c/h2\u003e\u003cp\u003eIADL was assessed using the Lawton IADL scale [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], which is the most widely used measure for evaluating IADL in older adult populations. It comprises eight items: \"telephone use,\" \"shopping,\" \"meal preparation,\" \"housekeeping,\" \"laundry,\" \"transportation use,\" \"medication management,\" and \"financial management\" [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Each item is scored as 0 (unable or partially able to perform) or 1 (fully able to perform), with a total score ranging from 0 (low function, dependence) to 8 (high function, independence) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Statistical analysis\u003c/h2\u003e\u003cp\u003eData are presented as mean standard deviation for parametric data and median (25\u0026ndash;75% percentile) for non-parametric data. Comparisons between groups with and without cachexia were performed using t-tests, Mann\u0026ndash;Whitney U tests, and χ\u0026sup2; tests. Comparisons of the EQ-5D-5L indices based on the presence or absence of each cachexia diagnostic criterion were conducted using t-tests and Mann\u0026ndash;Whitney U tests.\u003c/p\u003e\u003cp\u003eTo assess the agreement between the AWGC and Evans criteria for cachexia diagnosis, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen\u0026rsquo;s kappa (κ) coefficient were calculated.\u003c/p\u003e\u003cp\u003eMultiple regression analysis was performed using the EQ-5D-5L index and IADL score as dependent variables and cachexia (assessed based on the AWGC and Evans criteria) as explanatory variables. From a clinical perspective, age, sex, BMI, CCI, history of falls, standardized dialysis dose, and dialysis duration were included as confounding factors in the regression model. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eAll analyses were performed using EZR Ver.1.38 (Saitama Medical Center, Jichi Medical University, Saitama, Japan) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 119 outpatients with CKD were undergoing hemodialysis during the study period. Of these, 100 were included after excluding those who refused to participate (n\u0026thinsp;=\u0026thinsp;19). Patients with missing data (n\u0026thinsp;=\u0026thinsp;4) and cognitive impairment (n\u0026thinsp;=\u0026thinsp;3) were also excluded from the analysis. Finally, 93 patients were enrolled in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe mean age of the participants was 69.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0 years, and 46 patients (49.5%) were female. The median duration of hemodialysis was 6.3 years (interquartile range: 2.8\u0026ndash;12.5), and the mean time per hemodialysis session was 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 h. The mean BMI was 23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 kg/m\u0026sup2;, and 68.8% of the patients were identified as being at risk of malnutrition, based on the GNRI (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69.4 (11.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (49.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI, kg/m\u0026sup2;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.0 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaboratory test data\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlb, g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.8 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP, g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.09 (0.05\u0026thinsp;\u0026minus;\u0026thinsp;0.24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHb, mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBUN, mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63.2 (14.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCre, mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.7 (3.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis-related factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of dialysis, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.3 (2.8\u0026thinsp;\u0026minus;\u0026thinsp;12.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis time, time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.9 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKt/V\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.4 (0.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.1 (1.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNAQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith loss of appetite, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (41.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGNRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith malnutrition risk, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (68.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASM, kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.2 (4.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASMI, kg/m\u0026sup2;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.6 (1.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFat mass, kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.0 (8.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of falls, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (32.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEQ-5D-5L index, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.832 (0.734\u0026thinsp;\u0026minus;\u0026thinsp;0.938)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBI, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98.8 (4.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIADL score, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.0 (7.0\u0026ndash;8.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHandgrip strength, kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.7 (9.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalking speed, m/s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.91 (0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSPPB score, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.0 (9.0\u0026thinsp;\u0026minus;\u0026thinsp;11.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eData are presented as n (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, or median (first\u0026ndash; fourth percentile). Statistical analyses were performed using t-tests, Mann\u0026ndash;Whitney U, or χ\u003csup\u003e\u0026sup2;\u003c/sup\u003e tests.\u003c/p\u003e\u003cp\u003eSD: standard deviation; BMI: body mass index; Alb: albumin; CRP: C-reactive protein; Hb: hemoglobin; BUN: blood urea nitrogen; Cre: creatinine; Kt/V: standardized dialysis dose; CCI: Charlson comorbidity index; SNAQ: simplified nutrition assessment questionnaire; GNRI: geriatric nutritional risk index; ASM: appendicular skeletal muscle mass; ASMI: appendicular skeletal muscle mass index; EQ-5D-5L: European Quality of Life 5 Dimensions 5-level; BI: Barthel index; IADL: instrumental activities of daily living; SPPB: short physical performance battery.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here]\u003c/p\u003e\u003cp\u003eThe prevalence of cachexia was 30.1% (identified in 28 patients) according to the AWGC criteria and 24.7% (identified in 23 patients) according to the Evans criteria. All patients diagnosed with cachexia based on the Evans criteria were also classified as having the condition based on the AWGC criteria (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFigures \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e show the distribution of patients identified as having cachexia (cachexia group) and those identified as not having cachexia (non-cachexia group) using each individual component in the AWGC and Evans criteria. Among the AWGC criteria, the mandatory requirement of BMI\u0026thinsp;\u0026lt;\u0026thinsp;21 kg/m\u0026sup2; was met by 31 patients (33.3%). In addition, the diagnostic criteria components included abnormal biochemistry, which was met by 3 patients (3.2%); decreased muscle strength, met by 24 patients (25.8%); and fatigue, met by 13 patients (14.0%). Among the Evans criteria, the mandatory requirement of BMI\u0026thinsp;\u0026lt;\u0026thinsp;20 kg/m\u0026sup2; was met by 24 patients (25.8%). The diagnostic criteria components included abnormal biochemistry, which was met by 21 patients (22.6%); anorexia, met by 11.8% (11 patients); decreased muscle strength, met by 21 patients (22.6%); low fat-free mass index, met by 18 patients (19.4%); and fatigue, met by 13 patients (14.0%).\u003c/p\u003e\u003cp\u003eThe diagnostic accuracy metrics of the AWGC criteria compared with the Evans criteria were as follows: sensitivity, 1.00 (95% confidence interval [CI]: 0.79\u0026ndash;1.00); specificity, 0.93 (95% CI: 0.84\u0026ndash;0.98); PPV, 0.82 (95% CI: 0.63\u0026ndash;0.94); and NPV, 1.00 (95% CI: 0.92\u0026ndash;1.00). In addition, the kappa coefficient (κ) was 0.87 (95% CI: 0.75\u0026ndash;0.98) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePerformance metrics of AWGC criteria compared with Evans criteria for the diagnosis of cachexia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetric\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.79\u0026ndash;1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecificity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.84\u0026ndash;0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive predictive value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.63\u0026ndash;0.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative predictive value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.92\u0026ndash;1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKappa Coefficient (κ)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.75\u0026ndash;0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eSensitivity, specificity, positive predictive value, negative predictive value, and the kappa coefficient with 95% confidence intervals are reported.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents a comparison of patients categorized in the cachexia and non-cachexia groups using the AWGC and Evans criteria. The patients who were categorized in the cachexia group using both criteria were significantly older (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and had significantly lower BMI (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Cre levels (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004 vs. 0.002), ASM (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004 vs. 0.019), and ASMI (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 vs. 0.004). Moreover, malnutrition risk was higher in the cachexia group than in the non-cachexia group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 vs. 0.028). Handgrip strength (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), walking speed (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002 vs. \u0026lt; 0.001), and SPPB scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly lower in the cachexia group than in the non-cachexia group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of cachexia classification according to the AWGC and Evans criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eEvans criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eAWGC criteria\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCachexia group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-cachexia group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-values\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCachexia group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNon-cachexia group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-values\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (24.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (75.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28 (30.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65 (69.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77.6 (8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.7 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e76.6 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e66.3 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32 (49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI, kg/m\u0026sup2;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.5 (2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.2 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19.5 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.6 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaboratory test data\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlb, g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.7 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.8 (0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.7 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.8 (0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP, g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.10 (0.04\u0026thinsp;\u0026minus;\u0026thinsp;0.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.09 (0.06\u0026thinsp;\u0026minus;\u0026thinsp;0.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.721\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.11 (0.04\u0026thinsp;\u0026minus;\u0026thinsp;0.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.08 (0.06\u0026thinsp;\u0026minus;\u0026thinsp;0.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.612\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHb, mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.7 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.2 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.9 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.1 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.308\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBUN, mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62.6 (18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.4 (12.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.824\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61.8 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63.8 (12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.523\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCre, mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.1 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.3 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.4 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.3 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis-related factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of dialysis, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.0 (2.2\u0026thinsp;\u0026minus;\u0026thinsp;12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.4 (3.3\u0026thinsp;\u0026minus;\u0026thinsp;14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.457\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.2 (2.2\u0026thinsp;\u0026minus;\u0026thinsp;11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.5 (3.1\u0026thinsp;\u0026minus;\u0026thinsp;14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.329\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis time, hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.8 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.0 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.8 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.0 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKt/V\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.5 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.298\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.4 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.4 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.435\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.9 (1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.575\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.2 (1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.0 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.634\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSNAQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith loss of appetite, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.918\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13 (46.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26 (40.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.649\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGNRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWith malnutrition risk, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (87.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (62.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24 (85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASM, kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.4 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.8 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.3 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18.0 (4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASMI, kg/m\u0026sup2;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.0 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.8 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.0 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.9 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFat mass, kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.4 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.8 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.2 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18.5 (8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of falls, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (39.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.448\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9 (32.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21 (32.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEQ-5D-5L index, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.721 (0.613\u0026thinsp;\u0026minus;\u0026thinsp;0.786)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.850 (0.757\u0026thinsp;\u0026minus;\u0026thinsp;0.938)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.731 (0.638\u0026thinsp;\u0026minus;\u0026thinsp;0.842)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.860 (0.754\u0026thinsp;\u0026minus;\u0026thinsp;0.938)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIADL score, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.0 (5.0\u0026ndash;8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.0 (7.0\u0026ndash;8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.0 (5.0\u0026ndash;8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.0 (7.0\u0026ndash;8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHandgrip strength, kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.5 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.4 (10.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18.4 (5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26.0 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalking speed, m/s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.83 (0.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.08 (0.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.81 (0.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.01 (0.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSPPB score, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.5 (8.0\u0026thinsp;\u0026minus;\u0026thinsp;9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.0 (10.0\u0026thinsp;\u0026minus;\u0026thinsp;12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.0 (5.0\u0026thinsp;\u0026minus;\u0026thinsp;10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.0 (10.0\u0026thinsp;\u0026minus;\u0026thinsp;12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eData are shown n (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, or median (first percentile \u0026ndash; fourth percentile). Statistical analyses were performed using t-tests, Mann\u0026ndash;Whitney U tests, or χ\u003csup\u003e\u0026sup2;\u003c/sup\u003e tests.\u003c/p\u003e\u003cp\u003eSD: standard deviation; AWGC: Asian Working Group for Cachexia; BMI: body mass index; Alb: albumin; CRP: C-reactive protein; Hb: hemoglobin; BUN: blood urea nitrogen; Cre: creatinine; Kt/V: standardized dialysis dose; CCI: Charlson comorbidity index; SNAQ: simplified nutrition assessment questionnaire; GNRI: geriatric nutritional risk index; ASM: appendicular skeletal muscle mass; ASMI: appendicular skeletal muscle mass index; EQ-5D-5L: European Quality of Life 5 Dimensions 5-level; IADL: instrumental activities of daily living; SPPB: short physical performance battery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eEvans criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eAWGC criteria\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCachexia group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-cachexia group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCachexia group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNon-cachexia group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (24.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (75.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28 (30.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65 (69.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEQ-5D-5L index, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.72 (0.61\u0026thinsp;\u0026minus;\u0026thinsp;0.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.85 (0.76\u0026thinsp;\u0026minus;\u0026thinsp;0.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.73 (0.64\u0026thinsp;\u0026minus;\u0026thinsp;0.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.86 (0.75\u0026thinsp;\u0026minus;\u0026thinsp;0.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIADL score, points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.0 (5.0\u0026ndash;8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.0 (7.0\u0026ndash;8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.0 (5.0\u0026ndash;8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.0 (7.0\u0026ndash;8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eData are presented as n (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, or median (first\u0026ndash; fourth percentile). Statistical analyses were performed using t-tests and Mann\u0026ndash;Whitney U tests. SD: standard deviation; AWGC: Asian Working Group for Cachexia; EQ-5D-5L: European Quality of Life 5 Dimensions 5-level; IADL: instrumental activities of daily living\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e here]\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the comparison of the EQ-5D-5L indices and IADL scores between cachexia and non- cachexia groups according to the AWGC and Evans criteria. When using the AWGC criteria, the EQ-5D-5L indices (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and IADL scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006) were significantly lower in the cachexia group than in the non-cachexia group. Similarly, when using the Evans criteria, the EQ-5D-5L indices (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and IADL scores (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) were significantly lower in the cachexia group than in the non-cachexia group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison between the cachexia and non-cachexia groups categorized according to the AWGC and Evans criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eEvans criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e\u003cp\u003eAWGC criteria\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandardized β\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eStandardized β\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.994\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.715\u0026thinsp;\u0026minus;\u0026thinsp;1.273\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.978\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.694\u0026thinsp;\u0026minus;\u0026thinsp;1.262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCachexia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.183\u0026minus; \u0026minus;0.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.167\u0026minus; \u0026minus;0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.006\u0026minus; \u0026minus;0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.006\u0026minus; \u0026minus;0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.055\u0026ndash;0.066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.859\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.050\u0026ndash;0.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.735\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.018\u0026ndash;0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.014\u0026ndash;0.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.637\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKt/V\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.079\u0026ndash;0.217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.076\u0026ndash;0.222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.334\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of falls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.099\u0026ndash;0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.112\u0026ndash;0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.141\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of dialysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.006\u0026minus; \u0026minus;0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.006\u0026minus; \u0026minus;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.103\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003eAWGC: Asian Working Group for Cachexia; CI: confidence interval, CCI: Charlson comorbidity index, Kt/V: standardized dialysis dose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAdditional file 1 presents comparisons between patients with cachexia diagnosed using the AWGC criteria alone and those diagnosed using the AWGC and Evans criteria. No significant intergroup differences existed in the EQ-5D-5L indices (0.83 vs. 0.72, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.126) or IADL scores (8.0 vs. 7.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.198).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents the results of multiple regression analysis for identifying factors associated with the HRQoL assessed using EQ-5D-5L. According to the AWGC criteria, cachexia (β = -0.099, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) and age (β = -0.003, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023) were independently associated with HRQoL (R\u0026sup2; = 0.26). Similarly, according to the Evans criteria, cachexia (β = -0.112, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) and age (β = -0.003, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024) were independently associated with HRQoL (R\u0026sup2; = 0.27). These results were consistent between the AWGC and Evans criteria.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple linear regression analysis of factors associated with HRQoL: A comparison between the AWGC and Evans criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eEvans criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e\u003cp\u003eAWGC criteria\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandardized β\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eStandardized β\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.164\u0026ndash;11.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.024\u0026ndash;11.223\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCachexia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;1.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;1.680\u0026minus; \u0026minus;0.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.391\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.894\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;1.636\u0026minus; \u0026minus;0.152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.077\u0026minus; \u0026minus;0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.080\u0026minus; \u0026minus;0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.855\u0026ndash;0.449\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.537\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.814\u0026ndash;0.504\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.641\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.350\u0026ndash;0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.316\u0026ndash;0.090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.272\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKt/V\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.578\u0026ndash;3.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.807\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.586\u0026ndash;3.836\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.817\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of falls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.546\u0026ndash;0.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.667\u0026ndash;0.731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.351\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.928\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of dialysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.036\u0026thinsp;\u0026minus;\u0026thinsp;0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.893\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.037\u0026thinsp;\u0026minus;\u0026thinsp;0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.893\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003eAWGC: Asian Working Group for Cachexia; CI: confidence interval; CCI: Charlson comorbidity index, Kt/V: standardized dialysis dose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e presents the results of multiple regression analysis for identifying factors associated with IADL. According to the AWGC criteria, cachexia (β = -0.894, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019), age (β = -0.047, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), and Kt/V (β\u0026thinsp;=\u0026thinsp;2.211, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) were independently associated with IADL (R\u0026sup2; = 0.30). Similarly, using the Evans criteria, cachexia (β = -1.102, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005), age (β = -0.045, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006), and Kt/V (β\u0026thinsp;=\u0026thinsp;2.182, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) showed similar associations (R\u0026sup2; = 0.31). The consistency of these findings across both criteria reinforces the robustness of the observed relationships.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple linear regression analysis of factors associated with IADL: A comparison between the AWGC and Evans criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eEvans\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c11\" namest=\"c7\"\u003e\u003cp\u003eAWGC\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandardized β\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eStandardized β\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.164\u0026ndash;11.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.024\u0026ndash;11.223\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCachexia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;1.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;1.680\u0026minus; \u0026minus;0.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.391\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.894\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;1.636\u0026minus; \u0026minus;0.152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.077\u0026minus; \u0026minus;0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.080\u0026minus; \u0026minus;0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.855\u0026ndash;0.449\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.537\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.814\u0026ndash;0.504\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.641\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.350\u0026ndash;0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.316\u0026ndash;0.090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.272\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKt/V\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.578\u0026ndash;3.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.807\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.586\u0026ndash;3.836\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.817\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of falls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.546\u0026ndash;0.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.667\u0026ndash;0.731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.351\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.928\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of dialysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.036\u0026thinsp;\u0026minus;\u0026thinsp;0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.893\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;0.037\u0026thinsp;\u0026minus;\u0026thinsp;0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e0.893\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003eAWGC: Asian Working Group for Cachexia; CI: confidence interval; CCI: Charlson comorbidity index, Kt/V: standardized dialysis dose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study evaluated two definitions of cachexia based on the AWGC and Evans criteria, in outpatients with CKD undergoing hemodialysis. We compared their diagnostic accuracy, the detected prevalences of cachexia, and its association with HRQoL and IADL. The AWGC criteria demonstrated higher diagnostic accuracy than the Evans criteria did, and the associations of two definitions of cachexia with HRQoL and IADL were nearly identical. These findings indicate the diagnostic potential of the AWGC criteria and suggest that its ease of clinical application may facilitate early detection and prevention of cachexia progression in outpatients with CKD undergoing hemodialysis.\u003c/p\u003e\u003cp\u003eAmong outpatients with CKD undergoing hemodialysis, those diagnosed with cachexia according to the Evans criteria were invariably identified by the AWGC criteria. The AWGC criteria demonstrated a high level of agreement with the Evans criteria, showing a well-balanced sensitivity and specificity. These findings suggest that the AWGC criteria may serve as a reliable indicator for diagnosing cachexia. These results suggest that the AWGC criteria exhibit high concordance with the Evans criteria, highlighting their use in cachexia diagnosis. Moreover, the AWGC criteria demonstrated high sensitivity in detecting cachexia while maintaining high accuracy in identifying patients without cachexia. The relatively high PPV and extremely high NPV further support the reliability of the AWGC criteria as a diagnostic tool closely aligned with the Evans criteria. As the AWGC criteria comprise anorexia, decreased handgrip strength, and abnormal CRP, they enable a simple and convenient assessment of cachexia. Considering their ease of clinical implementation, the AWGC criteria may facilitate convenient detection and timely intervention for cachexia in outpatients with CKD undergoing hemodialysis.\u003c/p\u003e\u003cp\u003eCachexia prevalence among outpatients with CKD undergoing hemodialysis was 30.1% when using the AWGC criteria and 24.7% when using the Evans criteria. In a previous study on Japanese outpatients with CKD undergoing hemodialysis, the prevalence of cachexia was reported as 21.3% using the Evans criteria and 35.2% using the AWGC criteria [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Our findings are comparable to those of this previous study, suggesting consistency across different definitions. The prevalence of cachexia determined using the AWGC criteria was higher than that determined using the Evans criteria. This discrepancy may be attributed to the BMI threshold difference, where the Evans criteria use a criterion of BMI\u0026thinsp;\u0026lt;\u0026thinsp;20 kg/m\u0026sup2;, whereas the AWGC criteria use BMI\u0026thinsp;\u0026lt;\u0026thinsp;21 kg/m\u0026sup2;. Moreover, the AWGC criteria do not include muscle mass assessment or fatigue evaluation. These factors may have contributed to the higher prevalence of cachexia detected when using the AWGC criteria. The discrepancies between our study and previous studies may be attributed to differences in muscle mass assessment methods. The previous study used the modified Cre index to assess muscle mass, whereas our study employed DEXA to calculate the skeletal muscle mass index. Given that cachexia is characterized by muscle mass loss [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], variations in assessment methods may yield different results despite applying the same cachexia definitions. Consequently, this factor should be carefully considered in future studies.\u003c/p\u003e\u003cp\u003eThe clinical significance of this study is that the AWGC criteria provide a simple and highly sensitive diagnostic tool for cachexia, enabling convenient diagnosis, risk stratification, and timely intervention in patients with CKD undergoing hemodialysis. The AWGC criteria utilize standardized and easily assessable indicators, such as CRP and handgrip strength [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], facilitating practical application in clinical settings. In this study, the AWGC criteria included all patients diagnosed with cachexia using the Evans criteria and additionally identified those with mild cachexia. Cachexia involves multiple factors and significantly worsens patient prognosis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Appropriate assessment of patients with CKD and early intervention are essential in clinical practice for improving patient outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The AWGC criteria allow for the identification of patients with mild cachexia not detected by the Evans criteria, thereby enabling early intervention. Additionally, HRQoL and IADL are critical clinical outcomes of cachexia [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and in this study, cachexia diagnosed by the AWGC criteria was significantly associated with decreased HRQoL and IADL. In a previous study, patients undergoing hemodialysis were found to have lower health-related QoL compared with that before hemodialysis and that in patients receiving kidney transplant [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Moreover, hemodialysis has been reported to affect HRQoL physically, psychologically, and socially [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Furthermore, patients with CKD undergoing hemodialysis demonstrate a decline in IADL and ADL [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It has been reported that up to 50% of older patients with CKD undergoing hemodialysis experience impairments in ADL and IADL [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These findings underscore the prognostic value of the AWGC criteria. Further studies are warranted to examine the long-term impact of cachexia diagnosis using the AWGC criteria on patient outcomes.\u003c/p\u003e\u003cp\u003eThis study has some limitations. First, as this was an observational study conducted at a single center, the generalizability of the results may be limited. Therefore, multicenter collaborative studies should determine whether similar findings can be obtained in different clinical settings. Second, the relatively small sample size resulted in low coefficients of determination, leading to a lower goodness-of-fit in multiple regression analyses. Future studies with larger sample sizes should explore additional confounding factors. Third, this study was cross-sectional, which does not allow for causal inferences. Therefore, more detailed longitudinal studies are warranted.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eOur findings showed that the AWGC criteria demonstrated higher diagnostic accuracy than the Evans criteria did, with both criteria demonstrating nearly identical associations with HRQoL and IADL. These findings suggest the usefulness of the AWGC criteria, and considering their ease of clinical application, they may facilitate the convenient detection of cachexia and help prevent its progression in outpatients with CKD undergoing hemodialysis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAlb\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ealbumin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eappendicular skeletal muscle mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAWGC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAsian Working Group for Cachexia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ebody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCharlson comorbidity index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003econfidence interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003echronic kidney disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCre\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecreatinine\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCRP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eC-reactive protein\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDEXA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003edual-energy X-ray absorptiometry\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEQ-5D-5L\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEuropean Quality of Life 5 dimensions 5-level\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGNRI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003egeriatric nutritional risk index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHb\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehemoglobin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHRQoL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehealth-related quality of life\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIADL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003einstrumental activities of daily living\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNPV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003enegative predictive value\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePPV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epositive predictive value\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eQoL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003equality of life\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSNAQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esimplified nutrition assessment questionnaire\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSPPB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eshort physical performance battery\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee of Hattori Hospital (Hyogo, Japan) (Approval No.: 2022\u0026ndash;02). Written informed consent was obtained from all participants or their legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eT.Y., S.K., T.K., Y.I., Y.H., N.T., R.O., and S.N. conceived the idea of the study. T.Y. and T.I. developed the statistical analysis plan and conducted statistical analyses. T.Y., T.I., M.O., M.O., K.S., N.S., and S.N. contributed to the interpretation of the results. T.Y., T.I., M.O., M.O., and S.I. drafted the original manuscript. T.Y. supervised the conduct of this study. All authors reviewed the manuscript draft and revised it critically on intellectual content. All authors approved the f inal version of the manuscript to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to the members of the Rehabilitation Nutrition Laboratory for their cooperation in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePatel N, Golzy M, Nainani N, Nader ND, Carter RL, Lohr JW, et al. Prevalence of various comorbidities among veterans with chronic kidney disease and its comparison with other datasets. 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Hemodial Int. 2014;18:70\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/hdi.12098\u003c/span\u003e\u003cspan address=\"10.1111/hdi.12098\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"hemodialysis, cachexia, Asian Working Group for Cachexia, diagnostic accuracy, chronic kidney disease","lastPublishedDoi":"10.21203/rs.3.rs-7958646/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7958646/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCachexia worsens the long-term prognosis of patients with chronic kidney disease (CKD) undergoing hemodialysis. The Asian Working Group for Cachexia (AWGC) has proposed diagnostic criteria tailored to Asian populations. In this study, we aimed to validate the AWGC criteria for diagnosing cachexia in patients with CKD undergoing hemodialysis by focusing on the prevalence, diagnostic accuracy, health-related quality of life (HRQoL), and instrumental activities of daily living (IADL).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study included 93 outpatients with CKD undergoing hemodialysis. Cachexia was diagnosed using the AWGC and Evans criteria. HRQoL was assessed using the European Quality of Life 5 Dimensions 5-level (EQ-5D-5L), and IADL was evaluated using the Lawton IADL scale. Statistical analyses included evaluation of sensitivity and specificity and multiple regression to examine the associations of cachexia definitions with HRQoL, and IADL.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCachexia prevalence was 30.1% and 24.7% according to the AWGC and Evans criteria, respectively. All patients diagnosed with cachexia based on the Evans criteria were also identified as having the condition based on the AWGC criteria. The AWGC criteria demonstrated superior diagnostic accuracy (κ\u0026thinsp;=\u0026thinsp;0.865), with a sensitivity of 1.000 and specificity of 0.929. Associations of cachexia (as defined by each criterion) with HRQoL and IADL were similar.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eIn contrast to the Evans criteria, the AWGC criteria demonstrated high validity and superior applicability for diagnosing cachexia in outpatients with CKD undergoing hemodialysis. These findings highlight the practicality of the AWGC criteria. Their use may facilitate early detection and help prevent cachexia progression, thereby improving patient outcomes.\u003c/p\u003e","manuscriptTitle":"Validity of cachexia diagnosed using AWGC criteria in outpatients with chronic kidney disease undergoing hemodialysis: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 16:07:56","doi":"10.21203/rs.3.rs-7958646/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ecbe778-52db-48b1-897f-3e47c3290d86","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T02:34:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 16:07:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7958646","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7958646","identity":"rs-7958646","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}