Handgrip Strength and Weight Predict Long-Term Mortality in Acute Kidney Injury Patients

Introduction: Surviving acute kidney (AKI) patients have a higher late mortality. The negative impact of malnutrition on the early outcome of AKI patients has recently been confirmed by various studies. However, its impact after hospital discharge has not been studied. The objective of the study was to determine the role of anthropometric measurements and handgrip strength as predictors of mortality 180 days after discharge. Methodology: Ninety-five consecutive AKI patients who were older than 18 y old and followed by AKI team were prospectively evaluated. Patient's characteristics were recorded, anthropometric measurements were taken, handgrip strength was measured,subjective global assessment and bio impedance were applied and blood samples were collected in two moments at hospitalization (at the beginning and end of nephrologist evaluation) and in three moments after hospital discharge (at 1 month, 3 and 6 months). Multivariable logistic regression was used to adjust confounding and selection bias. Results: Age was 62.3 ± 14.7 years, prevalence of hospitalization in medical wards of 71.6%, index of severity of AKI (ATN-ISS) was 28%, early and late mortality rates were 13.6 and 25.6%, respectively. Risk factors associated with late mortality were the number of comorbidities(HR=1.79, 95% CI=1.45-2.46, p=0.04), cancer (HR=1.89, 95% CI=1.48-3.16, p=0.01), sepsis (HR=1.47, 95% CI=1.18-2.38, p=0.03), no recovery of renal function at hospital discharge (HR=1.46, 95% CI=1.02-2.16, p=0.03), malnutrition at first evaluation (HR=1.58, 95% CI=1.14-2.94, p=001) p=0.01), the hand grip value at the moment of last evaluation by nephrologist (HR=1.81, 95% CI=1.17-2.31, p=0.04) and gain weigh < 1 kg between the moment at first evaluation by nephrologist and one month after hospital discharge (HR=1.95, 95% CI=1.29-3.3, p=0.02). Conclusion: Handgrip strength and gain weight were identified as predictors of late mortality. Simple and ease methods can be applied in AKI patients during and after hospitalization to diagnose nutritionally patients who are at higher risk for poor prognosis and, consequently intervention measures can be performed to improve survival in longterm.