title: Handgrip strength, but not other nutrition parameters, predicts circulatory congestion in peritoneal dialysis patients.
abstract: BACKGROUND
  Handgrip strength (HGS) is a marker of lean muscle mass. This study aims to test the hypothesis that a low HGS reflects a diseased cardiac status and predicts future risk of circulatory congestion in chronic peritoneal dialysis (PD) patients.
  
  
  METHODS
  Two hundred and eighteen chronic PD patients were prospectively recruited from a single regional dialysis unit in Hong Kong. HGS, serum albumin, lean body mass (LBM) by creatinine kinetics (CK) and subjective global assessment (SGA) were assessed at study entry and examined in relation to the risk of developing circulatory congestion over a 4-year follow-up.
  
  
  RESULTS
  Adjusting for age, gender and height, HGS showed significant correlations with LBM by CK, SGA, serum albumin, atherosclerotic vascular disease, left ventricular (LV) mass index and early mitral inflow velocity to peak mitral annulus velocity (E/Em ratio). In the multivariable Cox regression analysis, HGS (P = 0.004) and ejection fraction (P = 0.004) were both second to LV mass index (P < 0.001) as the most significant factors in predicting circulatory congestion at 4 years. Serum albumin, LBM by CK and SGA were not independently predictive of circulatory congestion. Patients with systolic dysfunction and HGS < gender-specific median had an adjusted hazard ratio of 2.77 [95% confidence interval (CI), 1.46-5.28; P = 0.002] in developing circulatory congestion than those with normal systolic function and HGS ≥ gender-specific median.
  
  
  CONCLUSIONS
  A low HGS reflects a diseased cardiac status and predicts future risk of circulatory congestion independent of other nutritional, echocardiographic and clinical parameters in PD patients. The important link between skeletal myopathy and myocardial disease in uraemic patients warrants further investigation.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince ofWales Hospital, Hong Kong. aymwang@hkucc.hku.hk
authors.forename: Angela Yee-Moon
authors.initials: AY
authors.lastname: Wang
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
authors.forename: Mandy Man-Mei
authors.initials: MM
authors.lastname: Sea
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.forename: Christopher Wai-Kei
authors.initials: CW
authors.lastname: Lam
authors.forename: Iris Hiu-Shuen
authors.initials: IH
authors.lastname: Chan
authors.forename: Siu-Fai
authors.initials: SF
authors.lastname: Lui
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003404:Creatinine / Q000378:metabolism; D004452:Echocardiography; D005260:Female; D018737:Hand Strength; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012709:Serum Albumin; D003404:Creatinine