1851

Examining Changes in Hand Grip Strength, Body Mass Index and Subjective Global Assessmentin Peritoneal Dialysis.

H Clackson, D Kariyawasam, R Blacklock, and HL MacLaughlin

King’s College Hospital NHS Foundation Trust

Background

Hand grip strength (HGS) measurement in dialysis patients is a valid measure ofmuscle function. HGS results are considered alongside Subjective Global Assessment (SGA) scores in the nutritional assessment of peritoneal dialysis (PD) patients in our Renal Unit. Few studies have reported on change in HGS in PD patients with changes in nutritional status. This study aimed to examinechanges in HGS score, nutritional status (SGA), Body Mass Index (BMI) and albuminpre and post nutrition intervention in PD patients.

Method

Data was prospectively collected for all PD patients at 6-monthly nutritional assessments between January 2012and November 2013. HGS scores were measured using the non-dominant arm, twice, in a standing position with the non-dominant arm held straight beside the body, and the highest score recorded. SGA was performed by an experienced dietitian and BMI and albumin recorded. All patients received nutritional intervention, with more intensive treatment for malnourished patients. Changes in HGS, BMI and albumin over a 6 to 12 month period were compared to baseline values with paired t-tests.

Results

68 PD patients (49M and 19F) of mean age 60.9 (± 17.2)years were included.At baseline 57 patients were well-nourished (SGA A) and 11 malnourished (SGA B) (Table 1). Malnourished patients of equal gender distributionwere significantly older and had significantly lower HGS than well-nourished patients at baseline.At follow-up 9/57patients declined from SGA A to B and HGS decreased significantly. Decliners were older and had a lower BMI compared to those who maintained an SGA A.10/11 malnourished patients improvedfrom SGA B to A, and BMI increased significantly with the improvement in nutritional status but HGS did not.There was no statistically significant change in albumin levels in any of the groups.

Table 1: Nutritional parameters at baseline and after 6-12 months in peritoneal dialysis patients

Nutritional Status / Baseline / 6-12 months
SGA A
n =57 / SGA B
n =11 / Declined
n= 9 / Improved
n= 10 / Maintained n=49
Age (years) / 59.1(±16.7) / 70.5(±17.4)* / 65 (±20.5) / 69.8(±18.1) / 58(±15.9)
BMI (kg/m2) / 27.6 (±4.4) / 24.1 (±4.1)* / -1.6 (±1.2)** / +0.52 (±0.6)^ / +0.13 (±1.6)
HGS (kg) / 29.5 (±12.7) / 20.8 (±7.1)* / -5.4 (±7.2)+ / +0.3 (±3.1) / +0.4 (±2.8)
Albumin (g/L) / 37.1 (±4.2) / 35 (±2.4) / -0.1(±4.3) / -0.7(±5.2) / -0.3(±2.7)

*p= <0.05 unpaired t-test, **p= <0.01 paired t-test,^ p<0.05 paired t-test

Conclusion

In this PD population, older age and a lower BMI, even in well-nourished patients may be a risk factor for a decline in nutritional status. As malnutrition occurs there isa significantdecline in HGS and BMI. Whilst BMI improves with reversal of malnutrition, HGS does not, suggesting that muscle function and recovery may not improve with nutritional intervention alone. These observations demonstrate the importance of maintaining optimal nutritional status in order to preserve muscle function.