Stronger: Before or After...?!

Written by Meguid El Nahas on Thursday, 21 December 2017. Posted in OLA Blog

Stronger: Before or After...?!

Hand grip strength (HGS) is a key measurement in the assessment of frailty phenotype in haemodialysis patients. However, the measurement is not very standardized, and notably, current data on the potential impact of a haemodialysis session on the results are both limited and controversial. In the present analysis, we compared HGS results before and after a haemodialysis session in 101 patients.
In the current observational study, HGS has been measured in adult haemodialysis patients on the same day, first before connection to the dialysis machine and then just after disconnection. At each timing, measurements were repeated three times with an interval of 5 s between measurements and the higher value was used for analysis.
One hundred and one patients (64% men) with a median (interquartile range, 25th percentile; 75th percentile) age of 66 (46; 76) years were included. In the whole population, a significant decline in HGS was observed after dialysis, with an absolute median decline of − 4 (0; −6) kg and a relative median difference of −11 (0; −20)%. These differences were observed in both genders and were independent of the baseline HGS value.
Our results suggest that the timing (before or after the dialysis session) of hand grip assessment is clinically relevant and should be taken into account in clinical practice and also in epidemiological and clinical studies.
Author's comments:
A very simple and pragmatic study. Hand grip strength (HGS) is a very simple tool to assess muscle strength. It is a functional test and this test is more predicitive of mortality than muscle mass measurement by DEXA. HGS is used in the evaluation of sarcopenia (or dynapenia) and frailty. We simple measured HGS with a classical dynamometer before and after the dialysis session. The data were discrepant in the literature. Some authors says that HGS is stable after dialysis session and other says it was decreasing. We clearly showed that HGS was decreasing after one single session. The decline was both statistically and clinically significant. The decline was significant both in men and women and both in patients with normal HGS at baseline and in patients with low HGS at baseline. As every measurement in medicine, HGS measurement must be standardized and obviously, the timing of the measurement is important. Even if we have no definitive proofs, we would recommend to measure before dialysis. Further reseach is now needed to better identify parameters that are associated with decline of HGS during the session.





Meguid El Nahas

Professor Meguid El Nahas PhD, FRCP

Chief Editor, OLA Director

Professor El Nahas was born in Cairo, Egypt and undertook his undergraduate medical education in...
Posted: 2 months 3 weeks ago by elnahas #21645
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Is the fall in HSG a function of changes in BP?
Posted: 2 months 3 weeks ago by delanaye #21646
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difficult to say...the sample was too limited...but one way to investgate...
Posted: 3 weeks 1 day ago by Arache #21690
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A study which opens the way to a new criterion of evaluation of the effects of hemodialysis but which remains to be confirmed by wider studies seen the number of intradialytic incidents which can also explain the decline of the muscular strength at the end of the session.
To be continued...

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