Hand Grip Strength Index, a Novel Tool in Risk-Assessing Multi-Ethnic End-Stage Kidney Disease Patients Treated by Haemodialysis

Abstract

Introduction: Increasing numbers of elderly co-morbid patients with end-stage kidney disease (ESKD) are now offered haemodialysis. Simple, rapid screening tools are required to risk-assess patients, highlighting those requiring nutritional or other support and advising on prognosis. As such, we assessed a newly introduced tool, the hand grip strength index (HGS index), a comparison of measured to predicted HGS. Methods: We reviewed ESKD dialysis patients dialysing under the care of an inner-city tertiary dialysis centre who had contemporaneous HGS measurements, and body composition measured by multifrequency bioelectrical impedance analysis, followed for ≤ 9 years, censoring for transplantation. Results: Results from 1023 patients, 63.2% male, 48.2% White and 46.5% diabetic, with a dialysis vintage of 21.2 (7.2–61.0) months, were analysed. Mortality was significantly greater for those in the lowest HGS index quartile using Kaplan–Meier analysis (p < 0.001). On multivariable step-backward Cox regression analysis, mortality was independently significantly associated (p < 0.001) with increasing age (hazard ratio [HR] 1.04 95% confidence interval (CI) [1.029–1.045]), higher co-morbidity score (HR 1.24 [1.142–1.347]) and post-dialysis extracellular water/total body water ratio (HR 1.15 [1.089–1.219]) and lower HGS index (HR −0.76 [0.991–0.998]), whereas sarcopenia and frailty were not retained in the model. Conclusion: Increasing numbers of elderly co-morbid patients are being treated with dialysis, so simple screening tools are required to advise on prognosis and highlight patients who may need additional support, including nutrition. We found the HGS index to have prognostic value, along with the traditional risk factors of patient age and co-morbidity.