Hand Grip Strength: A Tool of Nutritional Assessment in Prevalent Hemodialysis Patients
Authors: Elsharkawy Magdy Mohamed Saeed , Tawfik Ahmed Mohamed , Elsharabasy Reem Mohsen , Saeid Doaa Bakry Abdul Fattah 
Published: August 2023

Abstract

Background
Malnutrition is a common problem in patients with end stage renal disease (ESRD) undergoing hemodialysis that is associated with increased morbidity and mortality. There are several clinical, nutritional, and biochemical parameters that may be indicative of PEW in patients using hemodialysis (HD). Handgrip strength is a simple, quick, non-invasive, inexpensive, rapid, and objective procedure. In addition, it has other advantages as a diagnostic/screening tool for nutritional assessment. However, HGS relies on the motivation of the subjects, and therefore it is imperative that researchers and clinicians are sufficiently trained in HGS assessment. L-Carnitine supplementation, levocarnitine is an amino acid derivative which is an essential cofactor of fatty acid metabolism, may improve several situations.

Aim of the Work
The aim of our study, a longitudinal observational study, is to assess HGS as an independent tool for assessment of the nutritional status in hemodialysis patients. This study can also show the significance of the commitment to high protein diet (1.2-1.4 g/ kg/ d) and receiving L-carnitine (10-20 mg/kg intravenously after each dialysis session) and its effect on the handgrip strength and other studied nutritional tools.

Patients and Methods
In our study, a longitudinal observational study, study duration was 3 months after washout period; our population is all End Stage Renal Disease patients in Kasr AlAiny Hemodialysis Unit, Cairo University. The unit provides hemodialysis and medical service for 104 patients from whom 50 were excluded and 54 patients were enrolled.

Results
the study showed comparison between both studied groups regarding the studied laboratory parameters and different nutrition assessment tools showed no statistically significant differences. The study showed Comparison between the effect of high protein diet and L Carnitine (pre and post) in patients of group B on the studied nutritional tools and laboratory parameters. Again HGS was the only tool that showed statistical significance. %BF(body fat) assessed by anthropometry was negativelycorrelated with HGS. Also they found lower HGSvalues in patients on HD with higher estimates of abdominal fatdeposition. Thus, it seems that low muscle mass can occurdespite fat accumulation, and one possible explication for thiswould be the proinflammatory phenotype presented by individualswith abdominal fat deposition. This confirms that subjects can have normal or higher BMI and have a depletionprocess, thus increasing the need for screening proceduresrelated to functional status.

Conclusion
In this study, we concluded that HGS was the only significant (p value: &lt;.001), while all other nutrition assessment tools didn’t show any significant difference.The correlation between nPCR and HGS was statistically significant (p value:.001, r:.616). L-carnitine supplementation has no role over commitment to high protein diet only regarding improving the nutritional status and hemoglobin level in hemodialysis patients.