title: Handgrip strength at baseline and mortality risk in a cohort of women and men on hemodialysis: a 4-year study.
abstract: OBJECTIVE
  The objective of this study was to investigate the association between handgrip strength (HGS) and the risk of all-cause mortality in maintenance hemodialysis (MHD) patients and its relationship with nutritional status. This study also investigated whether the association between HGS and mortality is similar in female and male patients.
  
  
  METHODS
  This was a cohort study using data from the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) with a median follow-up of 33.81 months. The study setting was satellite dialysis units in the city of Salvador, Brazil.The sample included 443 adult patients in MHD. The main predictor variable was baseline HGS categorized into low and high groups on the basis of sex-specific optimized cutoffs, and the main outcome measure was all-cause mortality.
  
  
  RESULTS
  In Cox regression models adjusted for age and other demographic variables, the hazard of death was significantly higher for patients with lower HGS for males (hazard ratio [HR] = 3.10, 95% confidence interval [CI] = 1.68-5.74) and for females (HR = 2.72, 95% CI = 1.03-7.19). The hazard of death for male and female patients with lower HGS was more than 2 times higher in models that included numerous covariates, with the exception of nutritional status indicators. After nutritional indicators were included, the hazard of death associated with lower HGS decreased by 6% in males and 55% in females.
  
  
  CONCLUSIONS
  This study demonstrates that HGS predicts all-cause mortality in men and women on MHD. Differences seem to exist between women and men on MHD in the role played by nutritional status in explaining the increased risk of death associated with low HGS.
authors.affiliation: Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brazil; Instituto de Nefrologia e Diálise, Salvador, BA, Brazil.
authors.forename: Cácia Mendes
authors.initials: CM
authors.lastname: Matos
authors.affiliation: Instituto de Nefrologia e Diálise, Salvador, BA, Brazil; Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, BA, Brazil.
authors.forename: Luciana Ferreira
authors.initials: LF
authors.lastname: Silva
authors.affiliation: Instituto de Nefrologia e Diálise, Salvador, BA, Brazil.
authors.forename: Ludmilla Dias
authors.initials: LD
authors.lastname: Santana
authors.affiliation: Instituto de Nefrologia e Diálise, Salvador, BA, Brazil.
authors.forename: Larissa S
authors.initials: LS
authors.lastname: Santos
authors.affiliation: Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Protásio
authors.affiliation: Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Mateus Teixeira
authors.initials: MT
authors.lastname: Rocha
authors.affiliation: Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Vanessa Lima
authors.initials: VL
authors.lastname: Ferreira
authors.affiliation: Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Matheus Freitas
authors.initials: MF
authors.lastname: Azevedo
authors.affiliation: Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Márcia Tereza Silva
authors.initials: MT
authors.lastname: Martins
authors.affiliation: Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Gildete Barreto
authors.initials: GB
authors.lastname: Lopes
authors.affiliation: Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Universidade Federal da Bahia, Salvador, BA, Brazil; Departamento de Medicina e Apoio Diagnóstico da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil. Electronic address: aaslopes@ufba.br.
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Lopes
mesh_terms: D000328:Adult; D001938:Brazil; D015331:Cohort Studies; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D012737:Sex Factors