2319
A Study to Derive Normative Handgrip Strength Values for Patients on Haemodialysis
Dilloway, T,Ahmad C, Dassanayake, T, El-Sherbini, N, Hickson, M, Kander, R. Kourtellidou, S, Temple, A, Johansson, L
Imperial College Healthcare NHS Trust, Imperial College Renal & Transplant Centre
Introduction: Handgrip strength (HGS) has been used to measure a patient’s muscle strength to detect protein-energy wasting or malnutrition. HGS is abnormally low in patients on haemodialysis (HD) compared to other patient groups.A previous pilot study in patients on HDfound the independent variables affecting HGS to be age, gender and ethnic background.
Aim: This study’s aimswere tobuild on the pilot data to confirm the independent influencers of HGS in patients on HD as well as developing a set of normative data for HGS in patients on HD.
Methods:Well-nourished patients on HD (BMI >18.5kg/m2 and/or Subjective Global Assessment score of 6-7) were invited to participate in the study. Each participant performed one HGS measurement according to a set protocol on their dominant hand, excluding fistula arm, prior to commencing a haemodialysis session using a Jamar® Hand Dynamometer. Pain was measured before and after using a visual analogue scale and measurements with a pain score of more than 20mm were excluded. Data collection also included demographics (age, gender, ethnic background), clinical data (co-morbidities, dialysis adequacy, serum albumin, potassium and phosphate), nutritional data (Subjective Global Assessment, dry weight, body mass index (BMI) and diet (vegetarian, non-vegetarian). A linear regression was used to determine which variables significantly influenced HGS. By May 2015, mean HGS datawill be compiled (ie norms) using categories of ethnicity (Black, White Europeans and Asian), gender and age (over and under-65 years). The target is to obtain 30 patients per category stratified by these variables, as variability becomes stable with this sample size.
Results:To date, 459 participants (55% men) have been recruited from 10 HD satellite units throughout North West London. In the current sample, mean ± SD age for men is 62.9±14 years and for women 60.9±15.6 years. 36% are White Europeans, 32% Asian and 25% Black.Linear regression analysis found that age (p=<0.001), gender (p=<0.001) and ethnic background(p=0.018) significantly influenced HGS along with height (p=<0.001) andBMI (p<0.001). A further 110 participants are required to complete the compilation of a set of normative HGS measurements in HD patients that is sensitive to differences in muscle strength dependent on age, ethnic background and gender.
Conclusion: This study confirms that HGS is influenced by age, gender and ethnic background and therefore normative values for use in the HD population should reflect these categories when using this objective measure to assess nutritional status and changes over time.