Combined use of handgrip strength and hemoglobin as markers of undernutrition in patients with stage 3-5 chronic kidney disease

Maria Serena Lonardo; Nunzia Cacciapuoti; Martina Chiurazzi; Mariastella Di Lauro; Bruna Guida; Simona Damiano; Mauro Cataldi

doi:10.1016/j.numecd.2023.06.015

Combined use of handgrip strength and hemoglobin as markers of undernutrition in patients with stage 3-5 chronic kidney disease

Nutr Metab Cardiovasc Dis. 2023 Nov;33(11):2169-2178. doi: 10.1016/j.numecd.2023.06.015. Epub 2023 Jun 22.

Authors

Maria Serena Lonardo¹, Nunzia Cacciapuoti², Martina Chiurazzi², Mariastella Di Lauro², Bruna Guida², Simona Damiano², Mauro Cataldi³

Affiliations

¹ Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy. Electronic address: mariaserena.lonardo@unina.it.
² Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy.
³ Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology, Federico II University of Naples, Italy.

PMID: 37544868
DOI: 10.1016/j.numecd.2023.06.015

Abstract

Background and aims: The early identification of undernourished patients with CKD could help instating appropriate nutritional intervention before the full development of the threatening condition known as Protein Energy Wasting (PEW). Handgrip strength (HGS) and blood hemoglobin (Hb) concentration are two parameters considered representative of nutritional status but not included among the criteria for PEW diagnosis. In the present work we investigated whether they could help identifying CKD patients at risk of undernutrition.

Methods and results: We performed a two-step cluster analysis to classify a cohort of 71 stage 3-5 CKD patients, none of which with PEW, according to their Hb concentration and dominant-hand HGS. Two clusters were finely separated using this method. When we compared the two groups for main body composition and nutritional variables by using t-test statistics or Mann-Whitney test, as appropriate, we found significant differences in PhA, ECW/TBW, ASMI, serum iron. Then we stratified our population by gender and performed cluster analysis as well. PhA, ECW/TBW were still significantly different in the two clusters both in M and in F, while serum iron concentration only in males and ASMI only in females.

Conclusion: These results suggest that either in male than in female Hb concentration and HGS may distinguish two subgroups of CKD patients with different nutritional status and disease severity. Patient belonging to either of these cluster can be easily identified by using the HGS/Hb ratio which represents the HGS normalized per gr Hb.

Keywords: Chronic renal failure; Handgrip strength; Malnutrition; Skeletal muscle mass loss.

Copyright © 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.