Measurement of Muscle Strength in Haemodialysis Patients by Pinch and Hand Grip Strength and Comparison to Lean Body Mass Measured by Multifrequency Bio-Electrical Impedance

Abstract

Background: Muscle weakness is a risk factor for mortality in haemodialysis (HD) patients; we wished to determine whether measuring the composition of the arm with bioimpedance was associated with arm muscle strength. Methods: We measured pinch strength (PS) and hand grip strength (HGS) in 250 adult HD patients with corresponding post-dialysis multifrequency bioelectrical assessments with segmental body analysis. Results: Mean age 64.0 ± 15.6, 66% male and 45.6% diabetic. The maximum HGS in the dominant or non-fistula arm was 18.9 ± 9.2 kg and PS 4.09 ± 1.96 kg respectively, with a correlation of r = 0.80, p < 0.001. HGS was associated with body cell mass (β 0.37, p < 0.001) and PS with appendicular muscle mass (β 0.06, p < 0.001). Both HGS and PS were independently associated with the ratio of extracellular water (ECW) to total body water (TBW); β -139.5, p = 0.024, β -44.8, p < 0.001 in the arm. The presence of an arterio-venous fistula increased the ECW/TBW ratio in the arm from 0.383 ± 0.009 to 0.390 ± 0.012, p < 0.05. Conclusion: Muscle strength measured by HGS and PS was associated with both markers of whole body and segmental body composition within the arm, particularly ECW/TBW. Bioimpedance measurements and assessment of muscle strength should be measured in the non-fistula arm.

C reactive protein and depressive symptoms in hemodialysis patients: A questionable association

“…7,16 Many kidney dialysis patients complain of physical tiredness, mental fatigue, and have reduced physical activity, 18 which often do not improve following the initiation of dialysis therapy, and may even be made worse by haemodialysis treatments. 19,20 Patients with chronic kidney disease treated by haemodialysis are more likely to suffer protein energy wasting leading to muscle loss, 21 and reduced muscle mass is associated with reduced physical activity and energy expenditure, 22 so increasing weakness and fatigue. The BDI-II score was associated with younger age, higher serum albumin, and anuria.…”

Differences in Prevalence of Muscle Weakness (Sarcopenia) in Haemodialysis Patients Determined by Hand Grip Strength Due to Variation in Guideline Definitions of Sarcopenia

“…Patients with chronic kidney disease treated by hemodialysis (HD) are at increased risk of losing muscle mass as a result of multiple factors, including dietary restrictions, metabolic acidosis, insulin resistance, urinary and dialysate protein losses, and reduced physical activity along with fatigue and self‐reported depression . Reports of studies using HGS measurements in HD patients have shown that HGS measurements are reliable and reproducible and not affected by the presence of an arterio‐venous fistula or the dialysis session . In addition, HGS weakness in HD patients is associated with increased mortality risk …”

“…8,9 Reports of studies using HGS measurements in HD patients have shown that HGS measurements are reliable and reproducible and not affected by the presence of an arterio-venous fistula or the dialysis session. [10][11][12] In addition, HGS weakness in HD patients is associated with increased mortality risk. 13 As there has been recent concordance in defining sarcopenia first by a loss of muscle strength measured by HGS by both the European Working Group on Sarcopenia in Older People (EWGSOP) 3 and the North American Foundation for the National Institutes of Health Sarcopenia Project (FNIH), 4 we determined the prevalence of muscle weakness using these definitions as well as comparing muscle weakness with age-matched and gender-matched controls.…”

Extracellular Water Excess and Increased Self‐Reported Fatigue in Chronic Hemodialysis Patients

“…We also noted an association between muscle wasting, using the FNIH Sarcopenia Project cut‐offs, and lower self‐reported fatigue scores. Although this may appear paradoxical, previous reports in dialysis patients have not shown a relationship between muscle mass and muscle strength, or physical activity in hemodialysis patients , and one study reported an inverse association between muscle mass measured by magnetic resonance imaging and physical activity . However, these studies typically measured muscle mass pre‐dialysis, and measurement of muscle mass is affected by dialysis, with more reliable measurements obtained post‐dialysis using magnetic resonance imaging and bioimpedance , after allowing time for re‐equilibration.…”