Annalisa Noce ^1,2* Maria J. Ceravolo ³ Paola Gualtieri ^4* Giulia Marrone ⁵ Lorenzo Romano ⁴ Amir Shoshi ² Manuela Di Lauro ⁵ Antonino De Lorenzo ⁴

• ¹ University of Rome Tor Vergata, Roma, Italy
• ² Catholic University Our Lady of Good Counsel, Tirana, Tirana, Albania
• ³ Policlinico Tor Vergata, Rome, Lazio, Italy
• ⁴ Division of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Lazio, Italy
• ⁵ Department of Systems Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Lazio, Italy

Introduction: The sarcopenia is a chronic pathological condition, firstly defined in 2010 and revised in 2018. The sarcopenia most recent definition pays mainly the attention to the "low muscle strength". A secondary form of sarcopenia is represented by the uremic sarcopenia (US), a condition that characterizes the end-stage kidney disease (ESKD) patients. The intramuscular adipose tissue (IMAT) seems to impact negatively on the muscle strength, as it would seem to replace muscle fibers with a non-contractile component. The aim of the study is to compare body composition parameters either those standardized and innovative related to the diagnosis of US in HD patients, stratified according to the diagnosis of sarcopenia. Furthermore, the different indices of sarcopenia are compared in order to evaluate their predictive capacity. Methods: We analyzed 48 ESKD patients according to the sarcopenia diagnosis, obtained with dual-energy X-ray absorptiometry (DXA). Moreover, we assessed the presence of IMAT and we calculated the sarcopenia index (SI). Results: for the study, the enrolled population was divided according to the sarcopenia diagnosis: no sarcopenic patients had higher transferrin (p=0.03), total proteins (p=0.04) and azotemia pre-dialysis (p=0.05) values. On the contrary, atherogenic indices were lower in no sarcopenic patients. Moreover, we observed an indirect correlation between SI and PTH (p=0.00138, R 2 =0.54). Finally, we calculated the prevalence of sarcopenia and of sarcopenia adjusted for IMAT. We showed a different prevalence between the sarcopenia diagnosed with standard index and with index adjusted for IMAT (p=0.043). In conclusion, we believe that the most important result obtained is the indirect correlation between SI and PTH. This data corroborates the theories, in which PTH seems to play a central role in the cachexia genesis. Moreover, SI adjusted for IMAT seems to be a more reliable parameter, useful to early identify subjects at risk to develop US, as it could permit to establish promptly a targeted therapeutic strategy.