#2616 DIAGNOSTIC VALUE OF THE HANDGRIP STRENGTH IN DETECTING PROTEIN-ENERGY WASTING AMONG HEMODIALYSIS PATIENTS AT NATIONAL KIDNEY AND TRANSPLANT INSTITUTE

Abstract

Abstract Background and Aims Protein energy wasting (PEW) is a syndrome of adverse nutritional and catabolic changes common among chronic kidney disease (CKD) patients. Handgrip strength (HGS) was one of the methods of screening PEW mentioned in Kidney Disease Outcomes Quality Initiative guidelines. However, only few studies determined the validity of HGS in detecting PEW among maintenance hemodialysis (MHD) patients. The study aimed to determine the diagnostic validity of HGS in detecting PEW among MHD patients in a tertiary government hospital, with the following specific objectives: to determine the prevalence of PEW among MHD patients, to compare the demographic and clinical profile by PEW status, to identify the optimal cut-off point of HGS pre- and post-HD sessions in detecting PEW by sex, and to determine the following diagnostic value parameters of HGS pre- and post-HD sessions in detecting PEW by sex in terms of discriminative ability, accuracy, sensitivity, specificity, positive predictive value and negative predictive value. Method Participants included in this cross-sectional study are randomly selected patients undergoing MHD in National Kidney and Transplant Institute (NKTI) from September to October, 2022. Diagnosis of PEW was based on the Malnutrition Inflammation Score (MIS) ≥5. HGS was measured using a dynamometer pre- and post-dialysis sessions. Results A total of 143 patients were included in the study, and 53% were diagnosed with PEW. Pre-HD and post-HD HGS have acceptable discriminative ability based on Area Under the Curve >0.70 in detecting PEW regardless of patient sex. In males, a post-hemodialysis cut-off of <17.9 showed 72% sensitivity and 71% specificity in detecting PEW. Meanwhile, a pre-hemodialysis cut-off of <18.6 in females showed 83% sensitivity and 65% specificity in detecting PEW. Conclusion PEW is common among MHD patients in NKTI. The diagnostic performance of HGS in detecting PEW was found to be acceptable in both males and females. While both pre- and post-HD measures can be used in males, only the pre-HD measures are recommended for females. HGS can, therefore, be used as a non-expensive, accurate and objective screening assessment tool in detecting PEW for MHD patients. External validation of the proposed HGS cut-off values is still recommended.