Predictors of handgrip strength in hemodialysis patients at a single center in Argentina
Abstract
Introduction: There is a great incidence of fractures in patients suffering from end-stage chronic disease. This is partly caused by chronic kidney disease-mineral bone disorder and partly by the high prevalence of muscle weakness in these patients. Objective: Our objective was to identify the determining factors of muscle strength measured by means of handgrip strength (HGS) in chronic hemodialysis patients. Methods: A cross-sectional study was conducted on adult patients in a hemodialysis center. Handgrip strength (HGS) and lean mass index (LMI) were measured, as well as albumin and magnesium values and other serological parameters. Multiple linear regression was used to assess HGS predictors. Results: We analyzed 139 patients (88 men and 51 women; age: 60.7 ± 16); 18 subjects were excluded. Mean albumin values: 3.8 +/- 0.47 mg/dL; median hemodialysis time: 37 months (15-83). From the total number of patients, 25% (n=35) were found to be sarcopenic and 21.5% (n=30) had a history of diabetes. The univariate analysis showed a positive correlation between magnesium and HGS (ß 0.19 p 0.02). According to the multivariate analysis, all the following showed a correlation with HGS and were statistically significant: (R2 0.61 p <0.001): albumin (ß:.4.36 p 0.02); LMI (ß: 1.44 p <0.001); age (ß -0.10 p 0.04); sex (ß 6.21 p 0.007); diabetes (ß -5,08 p 0.005). Conclusion: Age, diabetes, albumin values, sex and LMI are independently associated with HGS in hemodialysis patients. Serum magnesium levels showed an association in the univariate analysis.References
Coco M, Rush H. Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis. 2000;36(6):1115-21.
Stehman-Breen CO, Sherrard DJ, Alem AM, Gillen DL, Heckbert SR, Wong CS, et al. Risk factors for hip fracture among patients with end-stage renal disease. Kidney Int. 2000;58(5):2200-5.
Mathew AT, Hazzan A, Jhaveri KD, Block GA, Chidella S, Rosen L, et al. Increasing hip fractures in patients receiving hemodialysis and peritoneal dialysis. Am J Nephrol. 2014;40(5):451-7.
Delgado C, Shieh S, Grimes B, Chertow GM, Dalrymple LS, Kaysen GA, et al. Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis. Am J Nephrol. 2015;42(2):134-40.
Yamamoto S, Kido R, Onishi Y, Fukuma S, Akizawa T, Fukagawa M, et al. Use of renin-angiotensin system inhibitors is associated with reduction of fracture risk in hemodialysis patients. PLoS One. 2015;10(4):e0122691.
Tentori F, McCullough K, Kilpatrick RD, Bradbury BD, Robinson BM, Kerr PG, et al. High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int. 2014;85(1):166-73.
Maravic M, Ostertag A, Urena P, Cohen-Solal M. Dementia is a major risk factor for hip fractures in patients with chronic kidney disease. Osteoporos Int. 2016;27(4):1665-9.
Stenvinkel P, Carrero JJ, von Walden F, Ikizler TA, Nader GA. Muscle wasting in end-stage renal disease promulgates premature death: established, emerging and potential novel treatment strategies. Nephrol Dial Transplant. 2016;31(7):1070-7.
Isoyama N, Qureshi AR, Avesani CM, Lindholm B, Bàràny P, Heimbürger O, et al. Comparative associations of muscle mass and muscle strength with mortality in dialysis patients. Clin J Am Soc Nephrol. 2014;9(10):1720-8.
Lee DY, Wetzsteon RJ, Zemel BS, Shults J, Organ JM, Foster BJ, et al. Muscle torque relative to cross-sectional area and the functional muscle-bone unit in children and adolescents with chronic disease. J Bone Miner Res. 2015;30(3):575-83.
Schlussel MM, Anjos LA, Kac G. A dinamometria manual e seu uso na avaliação nutricional. Rev. Nutr. 2008;21(2):233-5.
Leal VO, Stockler-Pinto MB, Farage NE, Aranha LN, Fouque D, Anjos LA, et al. Handgrip strength and its dialysis determinants in hemodialysis patients. Nutrition. 2011;27(11-12):1125-9.
Qureshi AR, Alvestrand A, Danielsson A, Divino-Filho JC, Gutierrez A, Lindholm B, et al. Factors predicting malnutrition in hemodialysis patients: a cross-sectional study. Kidney Int. 1998;53(3):773-82.
Carrero JJ, Chmielewski M, Axelsson J, Snaedal S, Heimbürger O, Bárány P, et al. Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients. Clin Nutr. 2008;27(4):557-64.
Stenvinkel P, Barany P, Chung SH, Lindholm B, Heimbürger O. A comparative analysis of nutritional parameters as predictors of outcome in male and female ESRD patients. Nephrol Dial Transplant. 2002;17(7):1266-74.
Okazaki H, Ishimura E, Okuno S, Norimine K, Yamakawa K, Yamakawa T, et al. Significant positive relationship between serum magnesium and muscle quality in maintenance hemodialysis patients. Magnes Res. 2013;26(4):182-7.
Delanaye P, Quinonez J, Buckinx F, Krzesinski J-M, Bruyère O. Hand grip strength measurement in haemodialysis patients: before or after the session? Clin Kidney J. 2018;11(4)555-8.
Bohannon RW. Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther. 2008;31(1):3-10.
Bohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care. 2015;18(5):465-70.
Wang AY, Sea MM, Ho ZS, Lui SF, Li PK, Woo J. Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients. Am J Clin Nutr. 2005;81(1):79-86.
Hardy R, Cooper R, Aihie Sayer A, Ben-Shlomo Y, Cooper C, Deary IJ, et al. Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme. PLoS One. 2013;8(2):e56483.
Leal VO, Mafra D, Fouque D, Anjos LA. Use of handgrip strength in the assessment of the muscle function of chronic kidney disease patients on dialysis: a systematic review. Nephrol Dial Transplant. 2011;26(4):1354-60.
Matos CM, Silva LF, Santana LD, Santos LS, Protásio BM, Rocha MT, et al. Handgrip strength at baseline and mortality risk in a cohort of women and men on hemodialysis: a 4-year study. J Ren Nutr. 2014;24(3):157-62.
Rock E, Astier C, Lab C, Vignon X, Gueux E, Motta C, et al. Dietary magnesium deficiency in rats enhances free radical production in skeletal muscle. J Nutr. 1995;125(5):1205-10.
Pelit A, Emre M, Dağli K, Tuli A. The impact of magnesium on isometric twitch parameters and resting membrane potential of the skeletal muscle in diabetic rats. Cell Biochem Biophys. 2013;65(3):315-9.
Dominguez LJ, Barbagallo M, Lauretani F, Bandinelli S, Bos A, Corsi AM, et al. Magnesium and muscle performance in older persons: the InCHIANTI study. Am J Clin Nutr. 2006;84(2):419-26.
Saha H, Harmoinen A, Pietilä K, Mörsky P, Pasternack A. Measurement of serum ionized versus total levels of magnesium and calcium in hemodialysis patients. Clin Nephrol. 1996;46(5):326-31.
Navarro JF, Mora C, Jiménez A, Torres A, Macía M, García J. Relationship between serum magnesium and parathyroid hormone levels in hemodialysis patients. Am J Kidney Dis. 1999;34(1):43-8.
Alhosaini M, Walter JS, Singh S, Dieter RS, Hsieh A, Leehey DJ. Hypomagnesemia in hemodialysis patients: role of proton pump inhibitors. Am J Nephrol. 2014;39(3):204-9.
Pinto AP, Ramos CI, Meireles MS, Kamimura MA, Cuppari L. Impact of hemodialysis session on handgrip strength. J Bras Nefrol. 2015;37(4):451-7.
Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249-56.
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(1):30-5.
Azar AT, Wahba K, Mohamed AS, Massoud WA. Association between dialysis dose improvement and nutritional status among hemodialysis patients. Am J Nephrol. 2007;27(2):113-9.
Rhee CM, You AS, Koontz Parsons T, Tortorici AR, Bross R, St-Jules DE, et al. Effect of high-protein meals during hemodialysis combined with lanthanum carbonate in hypoalbuminemic dialysis patients: findings from the FrEDI randomized controlled trial. Nephrol Dial Transplant. 2017;32(7):1233-43.
Smart N, McFarlane J, Cornelissen V. The Effect of Exercise Therapy on Physical Function, Biochemistry and Dialysis Adequacy in Haemodialysis Patients: A Systematic Review and Meta-Analysis. Open J Nephrol. 2013;3(1):25-36.
Vogt BP, Borges MCC, Goés CR, Caramori JCT. Handgrip strength is an independent predictor of all-cause mortality in maintenance dialysis patients. Clin Nutr. 2016;35(6):1429-33.
