Validation of Handgrip Strength as a Nutritional Assessment Tool for Hemodialysis Patients in Dr. Sardjito Hospital, Indonesia
DOI:
https://doi.org/10.3923/pjn.2017.763.769Keywords:
Chronic kidney disease (CKD), handgrip strength, hemodialysis, malnutrition, nutritional assessmentAbstract
Background and Objective: Handgrip strength (HGS) is used for continuous and systematic assessment of muscle mass related to nutritional status in hemodialysis (HD) patients. This study aimed to evaluate the ability of the HGS test to assess the nutritional status of hemodialysis patients. Materials and Methods: Data were collected from 104 patients with chronic kidney disease (CKD) undergoing routine HD in Dr. Sardjito Hospital, Yogyakarta, Indonesia. Patients were selected for the study using purposive sampling. All subjects were assessed using the HGS test and then compared using the subjective global assessment (SGA), dialysis malnutrition score (DMS), nutritional risk screening 2002 (NRS 2002) and simple nutrition screening tool (SNST). Correlation tests were conducted to determine associations between HGS and SGA, DMS, NRS 2002, SNST, body mass index and mid-upper arm circumference (MUAC). Results: The sensitivity of HGS for the study of male participants was the highest when compared to SGA (76.9%), but it had low specificity, accuracy, positive predictive value and area under the curve. HGS performed poorly when compared to other tools. For women in the study, HGS had highest specificity when compared to SGA (79.2%), but it had low sensitivity, positive and negative predictive values and area under the curve. When compared to other tools, HGS gave an even lower result. HGS had a negative correlation with the other four nutritional assessment tools, but it had a positive correlation with MUAC. Conclusion: The HGS test appeared to be an inaccurate assessment of nutritional status in male and female CKD patients undergoing hemodialysis.
References
Qureshi, A.R., A. Alvestrand, J.C. Divino-Filho, A. Gutierrez, O. Heimburger, B. Lindholm and J. Bergstrom, 2002. Inflammation, malnutrition and cardiac disease as predictors of mortality in hemodialysis patients. J. Am. Soc. Nephrol., 13: S28-S36.
Wang, A.Y.M., M.M.M. Sea, Z.S.Y. Ho, S.F. Lui, P.K.T. Li and J. Woo, 2005. Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients. Am. J. Clin. Nutr., 81: 79-86.
Leal, V.O., D. Mafra, D. Fouque and L.A. Anjos, 2010. Use of handgrip strength in the assessment of the muscle function of chronic kidney disease patients on dialysis: A systematic review. Nephrol. Dialysis Transp., 26: 1354-1360.
National Kidney Foundation, 2000. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI. Am. J. Kidney Dis., 35: S1-S140.
Detsky, A.S., J.R. McLaughlin, J.P. Baker, N. Johnston, S. Whittaker, R.A. Mendelson and K.N. Jeejeebhoy, 1987. What is subjective Global assessment of nutritional status? J. Parenteral Enteral Enteral Nutr., 11: 8-13.
Kalantar-Zadeh, K., M. Kleiner, E. Dunne, G.H. Lee and F.C. Luft, 1999. A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol. Dialysis Transp., 14: 1732-1738.
As'habi, A., H. Tabibi, B. Nozary-Heshmati, M. Mahdavi-Mazdeh and M. Hedayati, 2014. Comparison of various scoring methods for the diagnosis of protein-energy wasting in hemodialysis patients. Int. Urol. Nephrol., 46: 999-1004.
Kondrup, J., H.H. Rasmussen, O.L.E. Hamberg and Z. Stanga, 2003. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin. Nutr., 22: 321-336.
Susetyowati, S., H. Hadi, M. Hakimi and H.A.H. Asdie, 2014. Development, validation and reliability of the Simple Nutrition Screening Tool (SNST) for adult hospital patient in Indonesia. Pak. J. Nutr., 13: 157-163.
Sanchez-Garcia, S., C. Garcia-Pena, M.X. Duque-Lopez, T. Juarez-Cedillo, A.R. Cortes-Nunez and S. Reyes-Beaman, 2007. Anthropometric measures and nutritional status in a healthy elderly population. BMC Public Health, Vol. 7.
Parikh, R., A. Mathai, S. Parikh, G.C. Sekhar and R. Thomas, 2008. Understanding and using sensitivity, specificity and predictive values. Indian J. Ophthalmol., 56: 45-50.
Fischer, J.E., L.M. Bachmann and R. Jaeschke, 2003. A readers' guide to the interpretation of diagnostic test properties: Clinical example of sepsis. Intensive Care Med., 29: 1043-1051.
Van Hoek, F., M.R. Scheltinga, I. Kouwenberg, K.E.M. Moret, C.H. Beerenhout and J.H.M. Tordoir, 2006. Steal in hemodialysis patients depends on type of vascular access. Eur. J. Vascular Endovascular Surg., 32: 710-717.
Qureshi, A.R., A. Alvestrand, A. Danielsson, J.C. Divino-Filho, A. Gutierrez, B. Lindholm and J. Bergstrom, 1998. Factors predicting malnutrition in hemodialysis patients: A cross-sectional study. Kidney Int., 53: 773-782.
Schlussel, M.M., L.A. dos Anjos, M.T.L. de Vasconcellos and G. Kac, 2008. Reference values of handgrip dynamometry of healthy adults: A population-based study. Clin. Nutr., 27: 601-607.
Norman, K., N. Stobaus, M.C. Gonzalez, J.D. Schulzke and M. Pirlich, 2011. Hand grip strength: Outcome predictor and marker of nutritional status. Clin. Nutr., 30: 135-142.
Gowhar, S., S.H. Gayathri and A.J. Hemamalini, 2012. Handgrip strength as a simple indicator of malnutrition in hemodialysis patients. Kidney Res. Clin. Pract., Vol. 31.
Zhu, W., N. Zeng and N. Wang, 2010. Sensitivity, specificity, accuracy, associated confidence interval and ROS analysis with practical SAS® implementation. NESUG Health Care Life Sciences. http://www.cpdm.ufpr.br/documentos/ROC.pdf.
Garcia, M.F., E. Wazlawik, Y.M.F. Moreno, L.M. Fuhr and D.A. Gonzalez-Chica, 2013. Diagnostic accuracy of handgrip strength in the assessment of malnutrition in hemodialyzed patients. Clin. Nutr. E-SPEN J., 8: e181-e186.
Alfitri, K.N., 2015. Handgrip strength sebagai alat asesmen gizi pada pasien penyakit ginjal kronik yang menjalani hemodialisis di RSUP Dr. Sardjito Yogyakarta. Ph.D. Thesis, Department of Nutrition and Health, Faculty of Medicine, Universitas Gadjah Mada, Indonesia.
Jones, C.H., R.C. Wolfenden and L.M. Wells, 2004. Is subjective global assessment a reliable measure of nutritional status in hemodialysis? J. Renal Nutr., 14: 26-30.
Fiedler, R., P.M. Jehle, B. Osten, O. Dorligschaw and M. Girndt, 2009. Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance. Nephrol. Dialysis Transp., 24: 3812-3817.
Stenvinkel, P., P. Barany, S.H. Chung, B. Lindholm and O. Heimburger, 2002. A comparative analysis of nutritional parameters as predictors of outcome in male and female ESRD patients. Nephrol. Dial. Transp., 17: 1266-1274.
Jones, C.H., C.G. Newstead, E.J. Will, S.W. Smye and A.M. Davison, 1997. Assessment of nutritional status in CAPD patients: Serum albumin is not a useful measure. Nephrol. Dialysis Transp., 12: 1406-1413.
Hasheminejad, N., M. Namdari, M.R. Mahmoodi, A. Bahrampour and J. Azmandian, 2016. Association of handgrip strength with malnutrition-inflammation score as an assessment of nutritional status in hemodialysis patients. Iran J. Kidney Dis., 10: 30-35.
Carrero, J.J., A.R. Qureshi, J. Axelsson, C.M. Avesani and M.E. Suliman et al., 2007. Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetite. Am. J. Clin. Nutr., 85: 695-701.
Cheng, L.T., W. Tang and T. Wang, 2005. Strong association between volume status and nutritional status in peritoneal dialysis patients. Am. J. Kidney Dis., 45: 891-902.
Nascimento, M.M., A.R. Qureshi, P. Stenvinkel, R. Pecoits-Filho and O. Heimburger et al., 2004. Malnutrition and inflammation are associated with impaired pulmonary function in patients with chronic kidney disease. Nephrol. Dial. Transp., 19: 1823-1828.
Constantinâ€Teodosiu, D., S. Young, F. Wellock, A.H. Short, R.P. Burden, A.G. Morgan and P.L. Greenhaff, 2002. Gender and age differences in plasma carnitine, muscle strength and exercise tolerance in haemodialysis patients. Nephrol. Dial. Transp., 17: 1808-1813.
Sofyan, S., 2011. Perbedaan pengaruh pemberian latihan de lorme terhadap otot bicep brachii dan kolaborasi bicep brachii dan brachioradialis dalam peningkatan kekuatan menggenggam [essay]. Esa Unggul University.
Chakraborty, R., K. Bose and S. Bisai, 2009. Use of Mid-Upper Arm Circumference as a Measure of Nutritional Status and its Relationship with Self Reported Morbidity Among Adult Bengalee Male Slum Dwellers of Kolkata, India. In: Appetite and Nutritional Assessment, Ellsworth, S.J. and R.C. Schuster (Eds.). Nova Science, New York, pp: 377-385.
Chilima, D.M. and S.J. Ismail, 2001. Nutrition and handgrip strength of older adults in rural Malawi. Public Health Nutr., 4: 11-17.
Downloads
Published
Issue
Section
License
Copyright (c) 2017 The Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
