Validity of cachexia diagnosis using AWGC criteria in outpatients with chronic kidney disease undergoing hemodialysis

Purpose: Cachexia worsens the long-term prognosis of patients with chronic kidney disease (CKD) receiving 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 receiving hemodialysis by focusing on 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 sensitivity, specificity, and multiple regression to examine the associations between cachexia definitions, HRQoL, and IADL. Results: Cachexia prevalence was 30.1% according to the AWGC criteria and 24.7% by Evans criteria. All patients identified by the Evans criteria were also identified by 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. Conclusion: In contrast to the Evans criteria, the AWGC criteria demonstrated high validity and superior applicability for diagnosing cachexia in outpatients with CKD receiving 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.