Hand-grip muscle strength, lean body mass, and plasma proteins as markers of nutritional status in patients with chronic renal failure close to startof dialysis therapy

We studied 115 patients (69 men, 46 women) with chronic renal failure (CRF) aged younger than 70 years close to the start of dialysis therapy to asses s the prevalence of malnutrition and study the relationship between various nutritional parameters in these patients. Nutritional status was classifie d by means of subjective global assessment. Anthropometric measurements (AM s) were performed, and hand-grip strength (HGS) was measured using the Harp enden dynamometer. Body composition, including lean body mass (LBM), was ev aluated by dual-energy x-ray absorptiometry (DXA), and LBM was also estimat ed by means of AMs and creatinine kinetics (CK). The mean age of the patien ts was 52 +/- 12 years, and creatinine clearance was 9 +/- 3 mL/min. Malnut rition was seen in 53 patients (48%). As expected, malnourished patients di ffered in several aspects from well-nourished patients. LBM (estimated by a ll methods), fat mass (FM), HGS, creatinine clearance, and transthyretin an d vitamin A levels were less in malnourished patients, whereas serum albumi n levels did not differ. Estimates of LBM by means of DXA, AMs, and CK corr elated well with each other. Although DXA and AMs gave similar mean values, LBM was an average of 8 kg less estimated by means of CK, and Bland-Altman plots showed the best agreement between AMs and DXA. HGS showed a strong c orrelation to LBM (regardless of method) in both men and women. Serum album in level was not related to HGS or LBM, whereas significant correlations we re found between serum albumin level and albumin losses in urine, C-reactiv e protein (CRP) level, and creatinine clearance. Multiple logistic regressi on showed that low HGS, low percentage of FM, female sex, and high serum CR P levels were independent factors associated with malnutrition, whereas ser um albumin level and percentage of LBM did not reach statistical significan ce. In conclusion, the present study shows a high prevalence of malnutritio n in predialysis patients with CRF and suggests that HGS is a reliable, ine xpensive, and easy-to-perform nutritional parameter in patients with CRF. C onversely, serum albumin level seems to be a poor nutritional marker in pat ients with advanced CRF. (C) 2000 by the National Kidney Foundation, Inc.