Handgrip strength at baseline and mortality risk in a cohort of women and men on hemodialysis: a 4-year study.

Objective: The objective of this study was to investigate the association between handgrip strength (HGS) and the risk of all-cause mortality in maintenance hemodialysis (MHD) patients and its relationship with nutritional status. This study also investigated whether the association between HGS and mortality is similar in female and male patients.

Design And Methods: This was a cohort study using data from the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) with a median follow-up of 33.81 months. The study setting was satellite dialysis units in the city of Salvador, Brazil.The sample included 443 adult patients in MHD. The main predictor variable was baseline HGS categorized into low and high groups on the basis of sex-specific optimized cutoffs, and the main outcome measure was all-cause mortality.

Results: In Cox regression models adjusted for age and other demographic variables, the hazard of death was significantly higher for patients with lower HGS for males (hazard ratio [HR] = 3.10, 95% confidence interval [CI] = 1.68-5.74) and for females (HR = 2.72, 95% CI = 1.03-7.19). The hazard of death for male and female patients with lower HGS was more than 2 times higher in models that included numerous covariates, with the exception of nutritional status indicators. After nutritional indicators were included, the hazard of death associated with lower HGS decreased by 6% in males and 55% in females.

Conclusions: This study demonstrates that HGS predicts all-cause mortality in men and women on MHD. Differences seem to exist between women and men on MHD in the role played by nutritional status in explaining the increased risk of death associated with low HGS.