Hand grip strength: A tool of nutritional assessment in prevalent hemodialysis patients

Abstract

Carnitine deficiency is known to develop in patients receiving hemodialysis, and may contribute to a number of clinical conditions, including cachexia, erythropoiesis stimulating agent-resistant anemia, myasthenia, insulin resistance, and myopathy, as well as intradialytic symptoms, including muscle cramps, hypotension, and arrhythmias. Protein-energy wasting (PEW) is common in patients with end-stage renal disease on maintenance dialysis and is associated with increased morbidity and mortality. Protein-energy malnutrition (PEW) is common in patients with chronic kidney disease (CKD), especially in those undergoing chronic hemodialysis (HD), being an important predictor of morbidity and mortality in this population. Although inadequate food intake contributes to this condition, there are other characteristics of the syndrome that cannot be explained only by anorexia, such as the inflammation affecting this population. The malnutrition-inflammation score (MIS) was developed from the Global Subjective Assessment (SGA), using the close relationship between malnutrition and inflammation among dialysis patients. In addition, higher MIS scores are associated with a higher risk of death and hospitalizations in HD patients. Despite these advantages, one of the MIS limitations is the low practicality for monitoring dialysis patients, since it uses subjective parameters, which require the evaluator’s experience, and depends on data that may not be available at a certain time.