Handgrip strength as an instrument for assessing the risk of malnutrition and inflammation in hemodialysis patients

Abstract

Indroduction: Establishing which parameters to use for diagnosing malnutrition in hemodialysis patients is a challenge in clinical practice. The handgrip strength (HGS) has stood out as a method of assessing nutritional status. Thus, the aim of this study was to determine the cut-off point for HGS in the assessment of the risk of malnutrition and inflammation in HD patients, and its association with other parameters. Methods: Study carried out in hemodialysis units in the city of Curitiba, Brazil. We obtained the cut-off point of the HGS through the ROC curve, using the malnutrition and inflammation score (MIS) as a reference. We checked the relationship (Odds ratio) between the variables “MIS” and “HGS” with the other study variables using the multivariate analysis (logistic regression). Results: We assessed 238 patients (132 men), between 18 and 87 years of age (median = 59). The HGS cut-off point for diagnosing malnutrition and inflammation according to the reference used was <14.5 kg for women, and <23.5 kg for men. According to the HGS criteria, malnourished patients were older (OR = 0.958), with lower arm circumference (OR = 1.328) and higher scores in the malnutrition and inflammation score (OR = 0.85). Conclusion: HGS was significantly correlated with other nutritional assessment parameters. These results suggest that HGS is a valid screening tool to identify the risk of malnutrition and inflammation in hemodialysis patients.

Indicadores de desnutrição em diálise peritoneal e hemodiálise / Malnutrition indicators in peritoneal dialysis and hemodialysis

“…Diversos estudos nacionais foram publicados nos últimos cinco anos avaliando o estado nutricional dos pacientes renais, apresentando uma ampla variação na prevalência de desnutrição associada à diálise (11% a 86%), possivelmente em função das diferentes metodologias utilizadas na avaliação nutricional constituída por métodos objetivos e subjetivos 6,9,[12][13][14][15][16][17][18][19][20][21] .…”

“…Determinar quais parâmetros para a avaliação da desnutrição nessa população é um desafio na prática clínica 18 . A utilização da antropometria, bioimpedância, avaliações subjetivas e parâmetros bioquímicos para identificação do estado nutricional são alguns métodos práticos e disponíveis 13 .…”

“…A utilização da antropometria, bioimpedância, avaliações subjetivas e parâmetros bioquímicos para identificação do estado nutricional são alguns métodos práticos e disponíveis 13 . Na literatura científica é unânime constatar que não há apenas um marcador isolado capaz de avaliar o perfil nutricional dos pacientes renais, não existindo um "padrãoouro" para diagnóstico, no entanto, encontra-se concordância entre os diferentes indicadores nutricionais 17,18 .…”

Handgrip strength evaluation in CKD: do we have enough evidence?

“…More recently, Sostisso and colleagues 6 have indicated the HGS cutoff point of <14.5kg for women and <23.5kg for men to diagnose malnutrition in Brazilian patients on hemodialysis, having the MIS as a reference.…”

“…More recently, Sostisso and colleagues 6 have indicated the HGS cutoff point of <14.5kg for women and <23.5kg for men to diagnose malnutrition in Brazilian patients on hemodialysis, having the MIS as a reference. However, the main limitation of this study was the wide age range (18 to 87 years) because it is well known that elderly patients present not only a reduced muscle strength but also an altered motor coordination compared to younger people, which can result in an inaccurate measurement.…”