NUTRITIONAL STATUS AND HANDGRIP STRENGTH IN PRE‐DIALYSIS PATIENTS

Abstract

Protein-energy malnutrition (PEM) is a well-known problem in the care of persons with chronic kidney disease (CKD). Continuous assessment of nutritional status (NS) is therefore recommended in dialysis care as well as in the care of pre dialysis patients. Subjective Global Assessment (SGA) is a multifactor, subjective method for assessment of a patients' NS. Reduced handgrip strength (HGS) is associated with PEM and considered to be a reliable nutritional parameter that reflects loss of muscle mass. The aim of this retrospective study was to analyse NS in pre dialysis patients with a focus on the significance of HGS. In this retrospective study HGS and NS assessed by SGA in 112 pre dialytic individuals were analysed. The patients' mean Glomerular Filtration Rate (GFR) was 14 (+/- 4) ml/min and their mean age was 63 (+/- 15) years. The patients were assessed consecutively from November 2001 to November 2003. Sixty-three percent of these patients were assigned a protein-restricted diet (PRD) 0.6-0.8g/kg/day. Relatively few patients (13%) were classified as malnourished according to SGA but many reported fatigue, loss of appetite and reduced levels of physical activity. Few patients (6%) were underweight (BMI < 20), whereas 58% were overweight (BMI > 25). Patients on a PRD did not have impaired NS, compared to patients not on a PRD. Patients who had some degree of malnutrition tended to have reduced HGS. Among male patients, those with a lower level of physical activity tended to have lower HGS. Among the female patients, those who experienced loss of appetite and/or feeling of fatigue tended to have lower HGS. The pre dialysis patients had lower HGS compared to predicted norm for healthy subjects.