Evaluation of nutritional status of hemodialysis patients by hand grip strength

authors:

avatar Atefeh As’habi ORCID , avatar Samin Hejazi , avatar Maryam Mofidinejad , avatar Atena Ramezani , avatar Maryam Nazari , *

Koomesh: Vol.24, issue 4; 496-503
published online: August 01, 2022
article type: issue_documents_importer
received: August 02, 2021
accepted: January 01, 2022

how to cite: As’habi A, Hejazi S, Mofidinejad M, Ramezani A, Nazari M. Evaluation of nutritional status of hemodialysis patients by hand grip strength. koomesh. 2022;24(4):e152758. 

Abstract

Introduction: Malnutrition (MN) is a typical complication among hemodialysis patients which is associated with morbidity and mortality rates. This cross-sectional study investigated different indices in detecting MN in hemodialysis patients. Materials and Methods: MN assessment was performed using subjective [Subjective Global Assessment (SGA) and Dialysis Malnutrition Score (DMS)] and objective techniques [Hand Grip Strength (HGS)] on patients undergoing hemodialysis 3 times a week in Semnan Province (Iran). SGA and DMS were evaluated by their specific check-lists and HGS analysis was performed using a handgrip dynamometer. The dietary intake of hemodialysis patients was determined using a 4-day dietary recall. Moreover, 4 ml blood sample was obtained from each patient to measure serum biochemical parameters. Results: Amongst 116 enrolled patients, 61 were male and 55 were female. The total prevalence of MN in terms of SGA, DMS, and HGS was 74.2, 58.6, and 63% respectively. Moreover, the association of SGA with age and of DMS with age, gender, and time of hemodialysis were shown. For HGS, not only these factors but also biochemical parameters showed a relationship. This index was associated with serum Albumin and inflammatory marker, hsCRP. Conclusion: Simple and easily accessible tools like handheld dynamometers can verify to be a good nutrition assessment technique for hemodialysis patients in combination with SGA or DMS.

References

  • 1.

    Kalantar-Zadeh K, Kopple JD. Trace elements and vitamins in maintenance dialysis patients. Adv Ren Replace Ther 2003; 10: 170-182.https://doi.org/10.1053/j.arrt.2003.09.002PMid:14708071.

  • 2.

    Ashabi A, Tabibi H, Houshiar Rad A, Nozary Heshmati B, Mahdavi-Mazdeh M, Hedayati M.. Dietary assessment of hemodialysis patients in T ehran, I ran. Hemodial Int 2011; 15: 530-537.https://doi.org/10.1111/j.1542-4758.2011.00582.xPMid:22111822.

  • 3.

    Jasani R, Kumar R, Dedhia P. Why do we need to add objectivity to subjective nutrition assessment tools in hemodialysis patients. J Indian Dietet Assoc 2021; 43: 21-27.

  • 4.

    Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National kidney foundation-kidney disease outcome quality initiative (nkf-k/doqi), k/doqi clinical practice guideliner for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med 2003; 139: 137-147.https://doi.org/10.7326/0003-4819-139-2-200307150-00013PMid:12859163.

  • 5.

    Randhawa G, Singla MK. Evaluation of nutritional status among patients undergoing hemodialysis: A single-center study. J Ren Nutr Metab 2019; 5: 23.https://doi.org/10.4103/jrnm.jrnm_19_19.

  • 6.

    Tian M, Zha Y, Li Q, Yuan J. Handgrip Strength and Mortality in Maintenance Hemodialysis Patients. Iran Red Crescent Med J 2019; 21.https://doi.org/10.5812/ircmj.97860.

  • 7.

    Sostisso CF, Olikszechen M, Sato MN, Oliveira MD, Karam S. Handgrip strength as an instrument for assessing the risk of malnutrition and inflammation in hemodialysis patients. J Bras Nefrol 2020; 42: 429-436.https://doi.org/10.1590/2175-8239-jbn-2019-0177PMid:32672327 PMCid:PMC7860643.

  • 8.

    Birajdar N, Anandh U, Premlatha S, Rajeshwari G. Hand grip strength in patients on maintenance hemodialysis: An observational cohort study from India. Indian J Nephrol 2019; 29: 393.https://doi.org/10.4103/ijn.IJN_251_18PMid:31798220 PMCid:PMC6883853.

  • 9.

    Burleigh KS. Associations among plasma homocysteine, amino acids and nutritional status in hemodialysis patients. 2001.

  • 10.

    Stephen W, Janssen I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. J Nutr Health Aging 2009; 13: 460-466.https://doi.org/10.1007/s12603-009-0084-zPMid:19390754.

  • 11.

    Omichi Y, Srivareerat M, Panorchan K, Greenhall GH, Gupta S, Davenport A. 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. Ann Nutr Metab 2016; 68: 268-275.https://doi.org/10.1159/000447023PMid:27288418.

  • 12.

    Jiang K, Slee A, Davenport A. Body composition and weakness of hand grip strength and pinch strength in patients with chronic kidney disease from different ethnic backgrounds. J Hum Nutr Diet 2021; 34: 450-455.https://doi.org/10.1111/jhn.12825PMid:33085839.

  • 13.

    Leal VO, Stockler-Pinto MB, Farage NE, Aranha LN, Fouque D, Anjos LA, Mafra D. Handgrip strength and its dialysis determinants in hemodialysis patients. Nutrition 2011; 27: 1125-1129.https://doi.org/10.1016/j.nut.2010.12.012PMid:21454052.

  • 14.

    Steiber AL, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L. Subjective Global Assessment in chronic kidney disease: a review. J Ren Nutr 2004; 14: 191-200.https://doi.org/10.1053/j.jrn.2004.08.004https://doi.org/10.1016/S1051-2276(04)00139-6.

  • 15.

    Pupim LB, Ikizler TA. Assessment and monitoring of uremic malnutrition. J Ren Nutr 2004; 14: 6-19.https://doi.org/10.1053/j.jrn.2003.10.001PMid:14740325.

  • 16.

    Sacks GS, Dearman K, Replogle WH, Cora VL, Meeks M, Canada T. Use of subjective global assessment to identify nutrition-associated complications and death in geriatric long-term care facility residents. J Am Coll Nutr 2000; 19: 570-577.https://doi.org/10.1080/07315724.2000.10718954PMid:11022870.

  • 17.

    McCann L. Pocket guide to nutrition assessment of the patient with chronic kidney disease. N Y Nat Kidney Found Counc Ren Nutr 2009.

  • 18.

    As'habi A, Tabibi H, Nozary-Heshmati B, Mahdavi-Mazdeh M, Hedayati M. Comparison of various scoring methods for the diagnosis of protein-energy wasting in hemodialysis patients. Int Urol Nephrol 2014; 46: 999-1004.https://doi.org/10.1007/s11255-013-0638-1PMid:24381133.

  • 19.

    Hashemi R, Heshmat R, Motlagh AD, Payab M, Esmaillzadeh A, Baigy F, et al. Sarcopenia and its determinants among Iranian elderly (SARIR): study protocol. J Diabetes Metab Disord 2012; 11: 1-6.https://doi.org/10.1186/2251-6581-11-23PMid:23497567 PMCid:PMC3598166.

  • 20.

    Isoyama N, Qureshi AR, Avesani CM, Lindholm B, Brny P, Heimbrger O, et al. Comparative associations of muscle mass and muscle strength with mortality in dialysis patients. Clin J Am Soc Nephrol 2014; 9: 1720-1728.https://doi.org/10.2215/CJN.10261013PMid:25074839 PMCid:PMC4186520.

  • 21.

    Bahat G, Tufan A, Tufan F, Kilic C, Akpinar TS, Kose M, et al. Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition. Clin Nutr 2016; 35: 1557-1563.https://doi.org/10.1016/j.clnu.2016.02.002PMid:26922142.

  • 22.

    Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014; 15: 95-101.https://doi.org/10.1016/j.jamda.2013.11.025PMid:24461239.

  • 23.

    As' habi A, Najafi I, Tabibi H, Hedayati M. Prevalence of sarcopenia and dynapenia and their determinants in Iranian peritoneal dialysis patients. Iran J Kidney Dis 2018; 12: 53.

  • 24.

    O'keefe A, Daigle NW. A new approach to classifying malnutrition in the hemodialysis patient. J Ren Nutr 2002; 12: 248-255.https://doi.org/10.1053/jren.2002.35322PMid:12382218.

  • 25.

    Kalantar-Zadeh K, Kopple JD. Malnutrition as a risk factor of morbidity and mortality in patients undergoing maintenance dialysis. Kopple and Massry's nutritional management of renal disease. 2nd ed. Philadelphia: Lippincott Williams & Wilkins 2004; p: 183-198.

  • 26.

    Vasheghani-Farahani A, Tahmasbi M, Asheri H, Ashraf H, Nedjat S, Kordi R. The Persian, last 7-day, long form of the International Physical Activity Questionnaire: translation and validation study. Asian J Sports Med 2011; 2: 106.https://doi.org/10.5812/asjsm.34781PMid:22375226 PMCid:PMC3289200.

  • 27.

    Kalantar-Zadeh K, Kopple JD, Deepak S, Block D, Block G. Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire. J Ren Nutr 2002; 12: 17-31.https://doi.org/10.1053/jren.2002.29598PMid:11823990.

  • 28.

    Mardani M, Rezapour P, Baba H, Balavar S, Naghdi N. The nutritional status of hemodialysis patients admitted to Khoramabad's Shohadie Ashaier hospital, Korramabad, Iran. J Prev Epidemiol 2015; 1: e09-e09. (Persian).

  • 29.

    Hasheminejad N, Namdari M, Mahmoodi MR, Bahrampour A, Azmandian J. Association of handgrip strength with malnutrition-inflammation score as an assessment of nutritional status in hemodialysis patients. Iran J Kidney Dis 2016; 10: 30.

  • 30.

    Agboton BL, Agueh VD, Vigan J, Sourou BA, Ahoui S, Agboton CG, Djrolo F. Assessing the nutritional status of hemodialysis patients in a sub-saharan country. J Kidney 2017; 3: 1-5.

  • 31.

    Susetyowati S, Djarwoto B, Faza F. Nutrition screening tools as predictor of malnutrition for hemodialysis patients in Dr. Sardjito Hospital in Yogyakarta, Indonesia. Saudi J Kidney Dis Transpl 2017; 28: 1307.https://doi.org/10.4103/1319-2442.220871PMid:29265041.

  • 32.

    da Cunha Bandeira SB, Cansano K, de Paula TP, Peres WA. Evaluation of the prognostic significance of the malnutrition inflammation score in hemodialysis patients. Clin Nutr ESPEN 2020; 35: 109-115.https://doi.org/10.1016/j.clnesp.2019.10.019PMid:31987102.

  • 33.

    Tayyem RF, Mrayyan MT, Heath DD, Bawadi HA. Assessment of nutritional status among ESRD patients in Jordanian hospitals. J Ren Nutr 2008; 18: 281-287.https://doi.org/10.1053/j.jrn.2007.12.001PMid:18410884.

  • 34.

    Akhlaghi Z, Sharifipour F, Nematy M, Safarian M, Malekahmadi M, Barkhidarian B, Norouzy A. Assessment of nutritional status in maintenance hemodialysis patients: A multicenter crosssectional study in Iran. Semin Dial 2021; 34: 77-82.https://doi.org/10.1111/sdi.12917PMid:33058310.

  • 35.

    Lin YL, Hsu BG. Assessment of uremic sarcopenia in dialysis patients: An update. Tzu Chi Med J 2021; 34: 182-191.https://doi.org/10.4103/tcmj.tcmj_254_20PMid:35465288 PMCid:PMC9020246.

  • 36.

    Amparo FC, Cordeiro AC, Carrero JJ, Cuppari L, Lindholm B, Amodeo C, Kamimura MA. Malnutrition-inflammation score is associated with handgrip strength in nondialysis-dependent chronic kidney disease patients. J Ren Nutr 2013; 23: 283-287.https://doi.org/10.1053/j.jrn.2012.08.004PMid:23046737.

  • 37.

    Slee A, McKeaveney C, Adamson G, Davenport A, Farrington K, Fouque D. et al. Estimating the prevalence of muscle wasting, weakness, and sarcopenia in hemodialysis patients. J Ren Nutr 2020; 30: 313-321.https://doi.org/10.1053/j.jrn.2019.09.004PMid:31734056.

  • 38.

    Foley RN, Wang C, Ishani A, Collins AJ, Murray AM. Kidney function and sarcopenia in the United States general population: NHANES III. Am J Nephrol 2007; 27: 279-286.https://doi.org/10.1159/000101827PMid:17440263.

  • 39.

    Bataille S, Serveaux M, Carreno E, Pedinielli N, Darmon P, Robert A. The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients. Clin Nutr 2017; 36: 1654-1660.https://doi.org/10.1016/j.clnu.2016.10.016PMid:27816311.

  • 40.

    Bataille S, Serveaux M, Carreno E, Pedinielli N, Darmon P, Robert A. Impact of hemodialysis session on handgrip strength. J Bras Nefrol 2015; 37: 451-457.

  • 41.

    Lamarca F, Carrero JJ, Rodrigues JC, Bigogno FG, Fetter RL, Avesani CM. Prevalence of sarcopenia in elderly maintenance hemodialysis patients: the impact of different diagnostic criteria. J Nutr Health Aging 2014; 18: 710-717.https://doi.org/10.1007/s12603-014-0505-5PMid:25226111.

  • 42.

    Bakkal H, Dizdar OS, Erdem S, Kulakolu S, Akcakaya B, Katrclar Y, Uludag K. The relationship between hand grip strength and nutritional status determined by malnutrition inflammation score and biochemical parameters in hemodialysis patients. J Ren Nutr 2020; 30: 548-555.https://doi.org/10.1053/j.jrn.2020.01.026PMid:32197719.

  • 43.

    Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B, Bergstrm J. Factors predicting malnutrition in hemodialysis patients: a cross-sectional study. Kidney Int 1998; 53: 773-782.https://doi.org/10.1046/j.1523-1755.1998.00812.xPMid:9507226.

  • 44.

    Fahal IH. Uraemic sarcopenia: aetiology and implications. Nephrol Dial Transplant 2014; 29: 1655-1665.https://doi.org/10.1093/ndt/gft070PMid:23625972.

  • 45.

    Granic A, Davies K, Martin-Ruiz C, Jagger C, Kirkwood TB, von Zglinicki T, Aihie Sayer A. Grip strength and inflammatory biomarker profiles in very old adults. Age Ageing 2017; 46: 976-982.https://doi.org/10.1093/ageing/afx088https://doi.org/10.1093/ageing/afx110.37PMid:28541423 PMCid:PMC5860623.

  • 46.

    Staib JL, Swoap SJ, Powers SK. Diaphragm contractile dysfunction in MyoD gene-inactivated mice. Am J Physiol Regul Integr Comp Physiol 2002; 283: R583-R590.https://doi.org/10.1152/ajpregu.00080.2002PMid:12184991.

  • 47.

    Wheeler MT, Snyder EC, Patterson MN, Swoap SJ. An E-box within the MHC IIB gene is bound by MyoD and is required for gene expression in fast muscle. Am J Physiol 1999; 276: C1069-C1078.https://doi.org/10.1152/ajpcell.1999.276.5.C1069PMid:10329954.

  • 48.

    Stenvinkel P, Yeun JY. Role of inflammation in malnutrition and atherosclerosis in chronic renal failure. Kopple & Massry's nutritional management of renal disease. 2nd ed. Philadelphia: Lippincott Williams & Wilkins 2004; p: 199-212.

  • 49.

    Kwon YN, Yoon SS. Sarcopenia: neurological point of view. J Bone Metab 2017; 24: 83-89.https://doi.org/10.11005/jbm.2017.24.2.83PMid:28642851 PMCid:PMC5472802.

  • 50.

    Wheeler MT, Snyder EC, Patterson MN, Swoap SJ. Associations of 25-hydroxyvitamin D with markers of inflammation, insulin resistance and obesity in black and white community-dwelling adults. J Clin Transl Endocrinol 2016; 5: 21-25.https://doi.org/10.1016/j.jcte.2016.06.002PMid:27833859 PMCid:PMC5098550.