Journal Article

Handgrip strength, but not other nutrition parameters, predicts circulatory congestion in peritoneal dialysis patients

Angela Yee-Moon Wang, John E. Sanderson, Mandy Man-Mei Sea, Mei Wang, Christopher Wai-Kei Lam, Iris Hiu-Shuen Chan, Siu-Fai Lui and Jean Woo

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 25, issue 10, pages 3372-3379
Published in print October 2010 | ISSN: 0931-0509
Published online April 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq216
Handgrip strength, but not other nutrition parameters, predicts circulatory congestion in peritoneal dialysis patients

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Background. Handgrip strength (HGS) is a marker of lean muscle mass. This study aims to test the hypothesis that a low HGS reflects a diseased cardiac status and predicts future risk of circulatory congestion in chronic peritoneal dialysis (PD) patients.

Methods. Two hundred and eighteen chronic PD patients were prospectively recruited from a single regional dialysis unit in Hong Kong. HGS, serum albumin, lean body mass (LBM) by creatinine kinetics (CK) and subjective global assessment (SGA) were assessed at study entry and examined in relation to the risk of developing circulatory congestion over a 4-year follow-up.

Results. Adjusting for age, gender and height, HGS showed significant correlations with LBM by CK, SGA, serum albumin, atherosclerotic vascular disease, left ventricular (LV) mass index and early mitral inflow velocity to peak mitral annulus velocity (E/Em ratio). In the multivariable Cox regression analysis, HGS (P = 0.004) and ejection fraction (P = 0.004) were both second to LV mass index (P < 0.001) as the most significant factors in predicting circulatory congestion at 4 years. Serum albumin, LBM by CK and SGA were not independently predictive of circulatory congestion. Patients with systolic dysfunction and HGS < gender-specific median had an adjusted hazard ratio of 2.77 [95% confidence interval (CI), 1.46–5.28; P = 0.002] in developing circulatory congestion than those with normal systolic function and HGS ≥ gender-specific median.

Conclusions. A low HGS reflects a diseased cardiac status and predicts future risk of circulatory congestion independent of other nutritional, echocardiographic and clinical parameters in PD patients. The important link between skeletal myopathy and myocardial disease in uraemic patients warrants further investigation.

Keywords: circulatory congestion; echocardiography; handgrip strength; nutrition; peritoneal dialysis

Journal Article.  5239 words.  Illustrated.

Subjects: Nephrology

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