Abstract
Indroduction:Establishing which parameters to use for diagnosing malnutrition in hemodialysis patients is a challenge in clinical practice. The handgrip strength (HGS) has stood out as a method of assessing nutritional status. Thus, the aim of this study was to determine the cut-off point for HGS in the assessment of the risk of malnutrition and inflammation in HD patients, and its association with other parameters.Methods:Study carried out in hemodialysis units in the city of Curitiba, Brazil. We obtained the cut-off point of the HGS through the ROC curve, using the malnutrition and inflammation score (MIS) as a reference. We checked the relationship (Odds ratio) between the variables “MIS” and “HGS” with the other study variables using the multivariate analysis (logistic regression).Results:We assessed 238 patients (132 men), between 18 and 87 years of age (median = 59). The HGS cut-off point for diagnosing malnutrition and inflammation according to the reference used was <14.5 kg for women, and <23.5 kg for men. According to the HGS criteria, malnourished patients were older (OR = 0.958), with lower arm circumference (OR = 1.328) and higher scores in the malnutrition and inflammation score (OR = 0.85).Conclusion:HGS was significantly correlated with other nutritional assessment parameters. These results suggest that HGS is a valid screening tool to identify the risk of malnutrition and inflammation in hemodialysis patients.
Highlights
Protein-energy malnutrition (PEW) is common in patients with chronic kidney disease (CKD), especially in those undergoing chronic hemodialysis (HD), being an important predictor of morbidity and mortality in this population.[1,2,3] inadequate food intake contributes to this condition, there are other characteristics of the syndrome that cannot be explained only by anorexia, such as the inflammation affecting this population.[1,4,5]The malnutrition-inflammation score (MIS) was developed from the Global Subjective Assessment (SGA), using the close relationship between malnutrition and inflammation among dialysis patients
One of the MIS limitations is the low practicality for monitoring dialysis patients, since it uses subjective parameters, which require the evaluator’s experience, and depends on data that may not be available at a certain time.[3]
Since it is a test for measuring voluntary muscle strength, it is strongly correlated to body mass, making it possible to identify patients who had a significant reduction in nutritional status before any change occurred.[3]
Summary
Protein-energy malnutrition (PEW) is common in patients with chronic kidney disease (CKD), especially in those undergoing chronic hemodialysis (HD), being an important predictor of morbidity and mortality in this population.[1,2,3] inadequate food intake contributes to this condition, there are other characteristics of the syndrome that cannot be explained only by anorexia, such as the inflammation affecting this population.[1,4,5]The malnutrition-inflammation score (MIS) was developed from the Global Subjective Assessment (SGA), using the close relationship between malnutrition and inflammation among dialysis patients. Higher MIS scores are associated with a higher risk of death and hospitalizations in HD patients.[6,7,8]. Despite these advantages, one of the MIS limitations is the low practicality for monitoring dialysis patients, since it uses subjective parameters, which require the evaluator’s experience, and depends on data that may not be available at a certain time.[3]. Few studies have evaluated HGS as a parameter for nutritional assessment in hemodialysis patients, and they used different measurement methods.[3,10,11]
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