Reference Values for Handgrip Strength, Five Times Sit-to-stand, and Gait Speed in Patients on Hemodialysis

Marvery P Duarte; Otávio T Nóbrega; Barbara P Vogt; Marina S Pereira; Maryanne Z C Silva; Dario R Mondini; Henrique S Disessa; Angélica N Adamoli; Daiana C Bündchen; Bruna R M Sant'Helena; Rodrigo R Krug; Maristela Bohlke; Antônio J Inda-Filho; Ricardo M Lima; Carla M Avesani; Luiz R Nakamura; Maycon M Reboredo; Heitor S Ribeiro

doi:10.1093/ndt/gfae232

Reference Values for Handgrip Strength, Five Times Sit-to-stand, and Gait Speed in Patients on Hemodialysis

Nephrol Dial Transplant. 2024 Oct 16:gfae232. doi: 10.1093/ndt/gfae232. Online ahead of print.

Authors

Marvery P Duarte¹, Otávio T Nóbrega¹, Barbara P Vogt², Marina S Pereira³, Maryanne Z C Silva⁴, Dario R Mondini⁵, Henrique S Disessa⁶, Angélica N Adamoli⁷, Daiana C Bündchen⁸, Bruna R M Sant'Helena⁹, Rodrigo R Krug¹⁰, Maristela Bohlke¹¹, Antônio J Inda-Filho¹, Ricardo M Lima¹², Carla M Avesani¹³, Luiz R Nakamura¹⁴, Maycon M Reboredo³, Heitor S Ribeiro¹

Affiliations

¹ University of Brasilia, Faculty of Health Sciences, Brasília ,Brazil.
² Medicine Faculty, Federal University of Uberlandia, Uberlândia, Brazil.
³ School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
⁴ Internal Medicine Department, Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil.
⁵ Applied Kinesiology Laboratory, School of Physical Education, University of Campinas, Campinas, Brazil.
⁶ Department of Physical Education, School of Sciences, Sao Paulo State University, UNESP, Bauru, Brazil.
⁷ Serviço de Educação Física e Terapia Ocupacional, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
⁸ Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil.
⁹ IELUSC Faculty, Joinville, Brazil.
¹⁰ University of Cruz Alta, Cruz Alta, RS, Brazil.
¹¹ Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Brazil.
¹² University of Brasilia, Faculty of Physical Education, Brasília ,Brazil.
¹³ Department of Clinical Science, Technology and Intervention, Division of Renal Medicine and Baxter Novum, Karolinska Institute, Stockholm, Sweden.
¹⁴ Department of Statistics, Federal University of Lavras, Lavras, Brazil.

PMID: 39415426
DOI: 10.1093/ndt/gfae232

Abstract

Background and hypothesis: Low levels of muscle strength and function predict adverse clinical outcomes in patients on hemodialysis; however, reference values remain lacking. We described reference values for handgrip strength, five times sit-to-stand (STS-5), and 4-m gait speed in a large-scale sample in patients on hemodialysis.

Methods: Baseline data from the SARCopenia trajectories and associations with adverse clinical outcomes in patients on HemoDialysis (SARC-HD) study were analyzed. Muscle strength was evaluated using handgrip strength and the STS-5, whereas physical performance was evaluated using usual 4-m gait speed before a midweek dialysis session. Sex- and age-specific smoothed reference curves for each test at the 3rd, 15th, 50th, 85th, and 97th percentiles were constructed using generalized additive models for location shape and scale. Comparisons between sex and age were also performed.

Results: Data from 1004 patients (39% female; 19 to 96 years; 49% ≥ 60 years) were analyzed. Declines in muscle strength and physical performance were observed with advancing age in both sexes. However, among males, muscle strength and performance were similar between 18 and 49 years of age. Males exhibited substantially greater performance in handgrip strength (10.3 kg, 95% confidence interval (CI) 9.1 to 11.4) and 4-m gait speed (-0.10 seconds, 95% CI: -0.14 to -0.05) compared to females. Older patients, independent of sex, exhibited poorer performance on most tests. Lower handgrip strength in the arm with arteriovenous fistula was observed in both sexes (males -2.3 kg, 95% CI: -2.8 to -1.7; and females -2.1 kg, 95% CI: -2.6 to -1.6).

Conclusion: Reference values obtained in this study may be used in clinical and research settings to identify patients on hemodialysis with low physical function according to sex and age. Future studies should test these reference values as potential predictors of adverse clinical outcomes.

Keywords: chronic kidney disease; muscle strength; physical performance; reference values; sarcopenia.