The effect of timing on handgrip strength test in the determination of malnutrition status in patients undergoing haemodialysis therapy

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Abstract
Background The incidence of end-stage renal disease (ESRD) in Ireland has increased by 2.3% annually over the last decade. Patients undergoing haemodialysis are particularly susceptible to protein-energy malnutrition (PEM), a critical predictor of morbidity and mortality. The subjective global assessment (SGA) tool is commonly used to assess nutritional status, but its effectiveness in detecting malnutrition within this cohort remains uncertain. Similarly, handgrip strength (HGS) has been proposed as an indicator of PEM due to its association with poorer renal outcomes. However, there is no standardized protocol for HGS measurement, and data on the optimal timing of assessment are limited. Aim This study aims to determine the optimal timing for HGS measurement to assess malnutrition status in patients receiving haemodialysis treatment. Methods A total of 101 participants were recruited from dialysis units in Galway, Ireland. The SGA tool and three repeated HGS measures were administered to each patient before, during, and after dialysis. Malnutrition status was assessed using the SGA tool and the Irish Nutrition and Dietetic Institute (INDI) HGS reference values. Results The sample comprised 101 participants (64.4% males, 35.6% females) with a median age of 69 years (range: 30–95). Pre-dialysis HGS measurements were higher than those recorded during dialysis (median: 23.5kg [IQR: 16.3] vs. 22.7kg [IQR: 14.7], p < 0.0001). No significant difference was found between pre- and post-dialysis measurements (23.5kg [IQR: 16.3] vs. 23.0kg [IQR: 14.8], p = 0.052). HGS values during dialysis were lower than post-dialysis (22.7kg [IQR: 14.7] vs. 23.0kg [IQR: 14.8], p = 0.047). The SGA identified 18.8% (n = 19) of participants as malnourished, with 16.8% (n = 17) being mildly/moderately malnourished and 2% (n = 2) severely malnourished. In contrast, 64.4% (n = 65) were considered at risk of PEM according to the INDI reference values for HGS. Conclusions Pre-dialysis HGS measurements were the highest among the three time points, indicating that HGS should be measured before haemodialysis to assess nutritional status accurately. The SGA tool showed limited sensitivity in detecting malnutrition compared to the INDI reference values for HGS.

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