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Hopelessness and Depression Predict Sarcopenia in Advanced CKD and Dialysis: A Multicenter Cohort Study



Depression and hopelessness are frequently experienced in chronic kidney disease (CKD) and are generally associated with lessened physical activity. The aim of this study was to quantify the associations between sarcopenia as determined by SARC-F with both depression and hopelessness.

Design and Setting

This multicenter cohort study involving cross-sectional and longitudinal analyses was conducted in a university hospital and four general hospitals, each with a nephrology center, in Japan.


Participants consisted of 314 CKD patients (mean age 67.6), some of whom were receiving dialysis (228, 73%).


The main exposures were depression, measured using the Center for Epidemiologic Studies Depression (CES-D) questionnaire, and hopelessness, measured using a recently developed 18-item health-related hope scale (HR-Hope). The outcomes were sarcopenia at baseline and one year after, measured using the SARC-F questionnaire. Logistic regression models were applied.


The cross-sectional and longitudinal analyses included 314 and 180 patients, respectively. Eighty-nine (28.3%) patients experienced sarcopenia at baseline, and 44 (24.4%) had sarcopenia at the one-year follow-up. More hopelessness (per 10-point lower, adjusted odds ratio [AOR]: 1.33, 95% confidence interval [95% CI] 1.12–1.58), depression (AOR: 1.87, 95% CI 1.003–3.49), age (per 10-year higher, AOR: 1.70, 95% CI 1.29–2.25), being female (AOR: 2.67, 95% CI 1.43–4.98), and undergoing hemodialysis (AOR, 2.92; 95% CI, 1.41–6.05) were associated with a higher likelihood of having baseline sarcopenia. More hopelessness (per 10-point lower, AOR: 1.69, 95% CI 1.14–2.51) and depression (AOR: 4.64, 95% CI: 1.33–16.2) were associated with a higher likelihood of having sarcopenia after one year.


Among patients with different stages of CKD, both hopelessness and depression predicted sarcopenia. Provision of antidepressant therapies or goal-oriented educational programs to alleviate depression or hopelessness can be useful options to prevent sarcopenia.

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The authors greatly thank the following researchers, research assistants, and medical staff members for their assistance in collecting the questionnaire-based and clinical information used in this study: Ms. Asako Tamura, Ms. Yuka Masuda, and Ms. Takae Shimizu (St. Marriana University, Kawasaki-City, Kanagawa); Takayuki Nakamura, MD and Eiko Hashimoto, RN (JCHO Nihonmatsu Hospital, Nihonmatsu-City, Fukushima); Atsushi Kyan, MD and Masashi Saito, CE (Shirakawa Kosei General Hospital, Shirakawa-City, Fukushima); Ms. Lisa Shimokawa and Ms. Miyuki Sato (Fukushima Medical University Hospital, Fukushima-City, Fukushima).

Author information




Authors’ contributions: Research idea and study design: NK, TW, YS, YI; data acquisition: NK, YI, SF, M Yazawa, TS, KK, M Yanagi, HK; data analysis and interpretation: NK, TW, YS, YI; statistical analysis: NK; supervision or mentorship: YS, YI. Each author contributed important intellectual content during article drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Noriaki Kurita.

Ethics declarations

Conflict of interests: The authors have no conflicts to disclose.

Ethical Standards: The study was conducted in accordance with the Declaration of Helsinki and the ethical guidelines for Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan.

Additional information

Financial Disclosure: This study was supported by JSPS KAKENHI (Grant Number: JP16H05216 and JP18K17970).

Sponsor’s role: The funder had no role in the study design, analysis, or interpretation of data; writing of the manuscript; or the decision to submit the manuscript for publication.

Impact Statement: We certify that this work is a novel clinical research contribution. We believe that its novelty and impact lie in the fact that existing literature has not investigated the predictive aspect of hopelessness for sarcopenia, differentiating it from depression amongst CKD and dialysis patients. The findings will allow clinicians and caregivers to create interventions that alleviate depression and hopelessness among CKD and dialysis patients, thus preventing sarcopenia.

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Kurita, N., Wakita, T., Fujimoto, S. et al. Hopelessness and Depression Predict Sarcopenia in Advanced CKD and Dialysis: A Multicenter Cohort Study. J Nutr Health Aging 25, 593–599 (2021).

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Key words

  • Depression
  • chronic kidney disease
  • health-related hope
  • hopelessness
  • sarcopenia