title: Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients.
abstract: BACKGROUND
  Serum albumin has limitations as a nutritional marker in patients undergoing peritoneal dialysis (PD) in that it is affected by inflammation, systemic disease, overhydration, and urinary and dialysate protein loss. Handgrip strength is a simple, easily performed bedside test that has been shown to correlate with lean body mass in patients close to inception of dialysis.
  
  
  OBJECTIVE
  We evaluated the associations of handgrip strength with other clinical factors and examined its relations with mortality and cardiovascular death in PD patients.
  
  
  METHODS
  We prospectively enrolled 233 chronic PD patients and assessed handgrip strength and other variables at baseline and then followed the patients for a mean (+/-SD) of 30 +/- 14 mo.
  
  
  RESULTS
  Baseline handgrip strength was significantly associated with age, sex, height, diabetes, residual glomerular filtration rate (GFR), and hemoglobin but not with C-reactive protein (CRP). After adjustment for age, sex, and height, handgrip strength was most strongly correlated with lean body mass on the basis of creatinine kinetics (r = 0.334, P < 0.001), followed by serum albumin and subjective global assessment. Both men and women who died had lower handgrip strengths than did those who remained alive (P < 0.001). After control for age, sex, diabetes, atherosclerotic vascular disease, GFR, hemoglobin, CRP, and serum albumin, greater handgrip strength was predictive of lower all-cause [hazards ratio (HR): 0.95 (95% CI: 0.92, 0.99); P = 0.005] and cardiovascular [HR: 0.94 (0.90, 0.98); P = 0.004] mortality.
  
  
  CONCLUSIONS
  Handgrip strength not only is a marker of body lean muscle mass but also provides important prognostic information independent of other covariates, including CRP and serum albumin. Our data suggest that handgrip strength may be used in conjunction with serum albumin as a nutrition-monitoring tool in patients undergoing PD.
authors.affiliation: Department of Medicine and Therapeutics, Center for Nutritional Studies, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong. awang@cuhk.edu.hk
authors.forename: Angela Yee-Moon
authors.initials: AY
authors.lastname: Wang
authors.forename: Mandy Man-Mei
authors.initials: MM
authors.lastname: Sea
authors.forename: Zoe So-Ying
authors.initials: ZS
authors.lastname: Ho
authors.forename: Siu-Fai
authors.initials: SF
authors.lastname: Lui
authors.forename: Philip Kam-Tao
authors.initials: PK
authors.lastname: Li
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D005260:Female; D005919:Glomerular Filtration Rate; D018737:Hand Strength; D006304:Health Status; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies