RELIABILITY, REPRODUCIBILITY AND AGREEMENT BETWEEN PRE DIALYSIS VS MID DIALYSIS HAND GRIP STRENGTH MEASUREMENT
Mrs Anne Snelson1, MRS STEPHANIE GRECO1, MR CHRISTOPHER LETIZI1, DR MATTHEW SNELSON2, DR MELINDA TEE3, DR KELLY LAMBERT4
1Department of Nutrition and Dietetics, Monash Health, , Australia, 2Hypertension Research Laboratory, School of Biological Sciences, Monash University, , Australia, 3Department of Nephrology, Monash Health, , Australia, 4School of Medical, Indigenous and Health Sciences, University of Wollongong, , Australia
Aim: To determine the reliability, reproducibility and agreement of HGS values pre and mid dialysis.
Background: Handgrip strength (HGS) is a marker of protein-energy status in people on haemodialysis (HD). Best practice guidelines recommend measuring HGS prior to dialysis, which is not always possible. No previous research has compared the reliability, reproducibility and agreement of HGS values pre and mid dialysis.
Methods: Participants were recruited from four HD units (n=47). Eligible participants were stable on HD for at least 3 months and not acutely unwell. HGS was measured in triplicate on non-fistula arm before dialysis (pre HGS) and two hours into dialysis (mid HGS) for three consecutive weeks.
Bland Altman plots were used to determine agreement between pre and mid measures. Linear mixed models were used to determine differences between pre and mid values controlling for confounders.
Results: There were no significant differences in pre HGS measures (p=0.34) nor mid HGS measures (p=0.16) over 3 weeks. HGS measures were significantly higher pre compared to mid (p=0.005) but these differences were not clinically significant (mean difference 0.5kg (95%CI: 0.06-0.95). Bland Altman plots indicated agreement between pre and mid HGS measures, suggesting no systematic bias in HGS. The influence of confounders (gender, age, dialysis vintage, frailty status, nutritional status, ultra filtration rate, degree of fluid overload, diabetes and weight) on the differences between pre and mid measures were not statistically significant.
Conclusion: This study found that HGS taken at either pre or mid dialysis were reliable and reproducible. Given the agreement between pre and mid HGS measures, HGS measured mid dialysis may be used for nutritional assessment of HD patients, when baseline measurements are taken mid dialysis.
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Biography:
Anne Snelson is a renal dietitian with 14 years of experience working with people with chronic kidney disease. She has previously worked with remote communities in the Northern Territory and for the past ten years she has been based at Monash Health in Melbourne.