Hand grip strength in patients on maintenance hemodialysis: An observational cohort study from India

Abstract

Introduction:Malnutrition is a common manifestation in patients with dialysis and is a major cause of mortality in these patients. Various biochemical parameters are used to detect and monitor malnutrition in these patients. Confounding variables present in hemodialysis have an effect on the sensitivity and specificity of these tests.Methods:We studied hand grip strength (HGS) as a monitoring tool for protein malnutrition in these patients.Results:In a prospective observational study over 18 months, 83 patients (60 males) consented to be part of the study. The biochemical parameters showed the mean (±sd) of haemoglobin and albumin as 10.(±1.9) gm/dl and 3.5 (±0.5) gm/dl respectively. Majority of the patients (54/83) were well nourished according to subjective global assessment (SGA). The hand grip score in the cohort was weak in the majority of patients. It is interesting to note that majority of the males have weak HGS as compared with the general population of the same age group. The female patients had HGS which were in the normal range of values that of the population. A multiple regression analysis showed that there was a significant association with serum creatinine and HGS.Conclusions:No correlation between albumin and HGS was noted. Of the anthropometric variables a significant correlation was noted between mid arm muscle circumference and HGS.

Assessment of the Nutritional Status of the Hemodialysis Patients by Anthropometric Measurements

“…In our study, 21 patients (10.8%) had pedal edema despite thrice per week MHD. In contrast to our study, an Indian study showed pedal edema in 50% of the study population [ 14 ]. Ideally, the anthropometric measurements should be done at the correct dry weight of the patient when he/she is free of excess fluid to give an accurate picture of the nutritional status.…”

“…The functional status of general muscle strength is correlated consistently with the extent of HGS. In an Indian study, HGS in most males was weak compared to the general population of the same age group [ 14 ]. In our study, males have weaker HGS as compared to females.…”

Factors associated with the prevalence of malnutrition among adult hemodialytic patients: A two-center study in the Jeddah region, Saudi Arabia

“…Additionally, the handgrip results indicate early nutrition status deterioration, which facilitates prompt and early intervention. [19] Our findings showed that the malnourished HD patients recorded lower handgrip values ( P = .011) compared to the well-nourished HD patients (18.3 ± 12 and 21.5 ± 11.9, respectively). This observation could be attributed to potential muscle weakness in response to malnutrition.…”

“…This observation could be attributed to potential muscle weakness in response to malnutrition. [19] It is well known that muscle mass, as measured by fat-free mass, is higher in well-nourished HD patients than in malnourished patients. [20] This is in agreement with our findings, where the impact of malnutrition yielded comparable results by reducing both muscle mass and handgrip values.…”

“…This is consistent with a previous study which showed an inverse relationship between handgrip and malnutrition. [19] The handgrip is an inexpensive, simple, fast, and reliable method for evaluating muscle strength and malnutrition, and this measurement was incorporated with anthropometric and laboratory measurements. Additionally, the handgrip results indicate early nutrition status deterioration, which facilitates prompt and early intervention.…”