An audit of nutritional status in renal replacement therapy patients — Is there a place for hand dynamometry?

Abstract

• ■ Objective: To audit the nutritional status (including hand dynamometry) of patients receiving renal replacement therapy. • ■ Design: To audit the physical nutritional measurements performed regularly on dialysis patients. Body mass index (BMI), midarm circumference (MAC), triceps skinfold thickness (TSF), midarm muscle circumference (MAMC), and grip strength (GS) were examined. • ■ Setting: Hospital. • ■ Patients: 140 patients (69 on hemodialysis [HD] and 71 on continuous ambulatory peritoneal dialysis [CAPD]). Hand dynamometry quantifying GS was measured in 90 patients. • ■ Results: TSF in male patients on CAPD was significantly higher than in those on HD. For patients younger than 65 years, BMI and MAC values were compared with British norms. In female patients, a distribution similar to that of the normal population was found. In men, a higher proportion (mainly on HD) than expected had low BMI values. For patients older than 65 years, TSF values were distributed in a pattern similar to that of published norms. MAMC values were highly skewed toward the upper range; more than 30% had values above the 90th percentile. Only 12% were classified as mildly/moderately undernourished. None were severely undernourished. Mean GS values achieved were poor (53.8% of expected normative standards) despite favorable nutritional profiles. Multiple regression modeling suggests that the bulk of variability in GS is due to age and gender (51%). Of nutritional parameters examined, only MAMC and albumin contribute together to account for only 6% of the variability. A total of 40% of the variability could not be explained on the basis of the examined variables. • ■ Conclusion: Undernutrition is not as prevalent as cited in other studies. Poor Gs justifies further research, but it does not appear to enhance nutritional assessment.