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Recommendations Summary

CKD: Nutrition Assessment: Handgrip Strength (2020)

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    CKD: Handgrip Strength

    In adults with CKD 1-5D, we suggest that handgrip strength may be used as an indicator of protein-energy status and functional status when baseline data (prior measures) are available for comparison (2B).

    Rating: Fair
    Conditional

    • Risks/Harms of Implementing This Recommendation

      The potential risk or harm associated with the application of the guideline for handgrip strenght (HGS) in maintenance hemodialysis (MHD) patients involves the side of the body assessed. The measurement should be obtained on the opposite side of the vascular access. In all other patients (i.e. peritoneal dialysis and pre-dialysis), there are no potential risks or harms. Staff need to be properly trained on performing the measurement and interpreting the results.

    • Conditions of Application

      Implementation Considerations

      • The guideline for handgrip strength (HGS) applies to all adult MHD, PD and non-dialyzed patients.
      • The potential risk or harm associated with the application of the guideline for HGS in MHD patients involves the side of the body assessed.  The measurement should be obtained on the opposite side of the vascular access.  In all other patients (i.e. PD and pre-dialysis), there are no potential risks or harms.  Staff need to be properly trained on performing the measurement and interpreting the results.
      • Many individuals with CKD also have type 2 diabetes, a consequence of which may include peripheral neuropathy.  Practitioners should account for potential loss in HGS due to peripheral neuropathy in patients with type 2 diabetes when comparing measurements over time (Gundmi et al 2018). 

      Measuring HGS is simple; however, it is not routinely used in clinical practice. 

    • Potential Costs Associated with Application

      There is a cost associated with purchasing the equipment to measure Handgrip Strength.

    • Recommendation Narrative

      Handgrip strength (HGS) is a simple and reliable method to evaluate muscle function in patients with CKD.  In addition, it can be used as an indirect measure of nutritional status in maintenance dialysis and non-dialyzed patients.

      Detailed Justification
      Five studies examined relationships between HGS and comparative measures in patients with CKD, including one study with non-dialyzed patients (Amparo et al 2013),  one study with incident dialysis patients (Isoyama et al 2014),  two studies with MHD patients (Hasheminejad et al 2016, Silva et al 2011),  and one study with PD patients (Konings et al 2003).  Overall, HGS was a valid measure of nutritional status compared to malnutrition inflammation score (MIS) in MHD patients (sensitivity=70-87%, specificity=43-66%) (Silva et al 2011) and was negatively associated with MIS in non-dialyzed patients (r=0.42; p<0.001) (Amparo et al 2013),  but results may vary according to confounding variables.  HGS was correlated with lean body mass (LBM) assessed by other methods, but there was no correlation with other markers of body composition or nutritional status in PD patients (Konings et al 2003). In incident dialysis patients, HGS had higher correlations with nutritional status and inflammatory markers, and was more predictive of mortality than muscle mass measured by dual energy X-ray absorptiometry (DEXA) (Isoyama et al 2014).

    • Recommendation Strength Rationale

      Evidence supporting thi recommendation is based on Grade II/Grade B evidence.

    • Minority Opinions

      Consensus reached.