Handgrip Strength as a Simple Indicator of Possible Malnutrition and Inflammation in Men and Women on Maintenance Hemodialysis

Abstract

Objective: To assess the validity of handgrip strength (HGS) as a simple screening instrument for malnutrition and inflammation in patients on maintenance hemodialysis (MHD) by correlating it with malnutrition-inflammation score (MIS). Design: Cross-sectional analysis of the Prospective Study of the Prognosis in Chronic Hemodialysis Patients (PROHEMO). Setting: Satellite dialysis units in the city of Salvador, Brazil. Patients: The sample included 274 men and 162 women on MHD. Main Predictor Variable: HGS was chosen as the main predictor variable in this study. Main Outcome Measure: An MIS ≥6. Results: As compared with men, women were found to have lower HGS values (19.38 ± 6.48 kg vs. 29.07 ± 8.67 kg; P < .001) and higher MIS (6.38 ± 3.84 vs. 5.57 ± 3.39; P = .032). HGS was found to be inversely correlated with MIS among women (Spearman’s ρ = −.360; P < .001) as well as men (Spearman’s ρ = −0.384; P < .001); this inverse correlation was observed in patients with and without diabetes, different racial groups, younger and older subjects, incident (<3 months) and prevalent patients, in the case of both genders. Among both men and women, every one standard deviation lower of HGS was associated with more than two-fold higher odds for MIS ≥6, after adjusting for age, race, duration of dialysis, and Kt/V. These associations remained statistically significant after more extensive adjustments. The optimized cutoff point of HGS for MIS ≥6 was 28.3 kg for men (sensitivity = 70.0%; specificity = 66.0%) and 23.4 kg for women (sensitivity = 87.0%; specificity = 43.0%). Conclusions: Lower HGS values were independently associated with higher MIS among patients on MHD across several subgroups. These results suggest that HGS is a valid screening instrument for malnutrition and inflammation in patients on MHD.