Clinical Nutrition Open Science (Jun 2024)
Diagnostic value of the handgrip strength in detecting protein-energy wasting among patients on maintenance hemodialysis at National Kidney and Transplant Institute, Philippines
Abstract
Summary: Background and aims: Protein energy wasting (PEW) is a syndrome of adverse nutritional changes common to chronic kidney disease patients. Handgrip strength (HGS) is a method to screen PEW as mentioned in the Kidney Disease Outcomes Quality Initiative Guidelines. However, determining the validity of such method requires further and more thorough studies. This study, therefore, aims to determine the diagnostic validity of HGS in detecting PEW among patients on MHD. Methods: A cross-sectional study of 143 randomly-selected patients on MHD in a Philippine tertiary government specialty hospital from September to October, 2022 was conducted. Diagnosis of PEW was based on the Malnutrition Inflammation Score ≥5. HGS was measured using a dynamometer pre- and post-hemodialysis sessions. Results: The prevalence of PEW among the included patients was 53.15% (95% CI: 44.89–61.24%). The majority were <60 years old and were males, with a median dialysis vintage of 24 months. The most common comorbidity was hypertension, and hypertensive nephrosclerosis was the most common kidney disease etiology. HGS measured pre-hemodialysis (AUC: 0.77) and post-hemodialysis (AUC: 0.76) showed acceptable discriminative ability detecting PEW regardless of patient sex. Among males, both pre-hemodialysis (cutoff: <16.3, sensitivity: 64%, specificity: 86%) and post-hemodialysis (cutoff: <17.9, sensitivity: 71%, specificity: 74%) HGS measures showed acceptable diagnostic value parameters. However, in females, only the pre-hemodialysis HGS measure was acceptable (cutoff: <18.6, sensitivity: 83%, specificity: 65%). Although post-hemodialysis specificity was 88%, sensitivity was only 50%. Conclusion: The diagnostic performance of HGS in detecting PEW was found to be acceptable. While both pre- and post-hemodialysis measures can be used in males, only the pre-hemodialysis measures are recommended for females. HGS can be used as an objective, accurate and inexpensive screening assessment tool in detecting PEW for patients on MHD.
