Abstract: TH-PO610
Grip Strength at Dialysis Initiation Predicts Hospitalization over Time
Session Information
- Health Maintenance, Nutrition, Metabolism - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1300 Health Maintenance, Nutrition, and Metabolism
Authors
- Moorthi, Ranjani N., Indiana University, Indianapolis, Indiana, United States
- Cranor, Alissa Ann, Indiana University, Indianapolis, Indiana, United States
- Hindi, Judy, Indiana University, Indianapolis, Indiana, United States
- Lane, Kathleen A., Indiana University, Indianapolis, Indiana, United States
- Avin, Keith G., Indiana University, Indianapolis, Indiana, United States
- Fadel, William F., Indiana University, Indianapolis, Indiana, United States
- Thadhani, Ravi I., Cedars-Sinai, Los Angeles, California, United States
- Moe, Sharon M., Indiana University, Indianapolis, Indiana, United States
Background
Patients new to dialysis are frequently hospitalized. Currently, prediction models for risk of hospitalization use clinical and demographic factors. Grip strength is an objective measure of muscle weakness that is easily measured in dialysis units and is associated with mortality in prior studies. We hypothesize that grip strength is an independent predictor of the total number of hospital days over 2 years of follow-up in incident dialysis patients, after adjusting for demographic and clinical variables.
Methods
This is a prospective cohort study of 195 incident dialysis patients with grip strength testing at enrollment with a median of 647 days of follow-up. Outcome data from all hospitalizations > 48 hours were collected by patient self-report, and verified in the electronic record. We examined the longitudinal relationship between baseline grip strength as a continous variable with total number of days spent in the hospital in the follow-up period using zero-inflated Poisson regression. Univariate relationships were initially studied, followed by grip strength adjusted for clinical/ demographic variables in multivariate models.
Results
The baseline study population was 53% men with mean age of 54.3±13.3 yrs who were enrolled a median of 92 days after dialysis initiation. Mean grip strength was 27.9±12.8 kg. 60.5% of subjects had at least 1 hospitalization in the follow-up period. The median (IQR) number of hospital days was 6(0-17). 74.6% of hospitalizations were < 8 days in duration. Age, black race, dialysis vintage and modality, diabetic nephropathy as primary kidney disease, residual kidney function and comorbidities (diabetes, cardiovascular disease) and grip strength were univariately associated with increased number of hospital days (all p<0.05). In multivariate models, a 5kg higher grip strength at baseline was associated with a rate ratio of 0.96 (95% CI of 0.94-0.99) or a 4% decrease in total days in the hospitalization in the follow-up period (p=0.0009).
Conclusion
In our cohort of 195 incident dialysis patients, we show that grip strength independently predicts total days in the hospital when added to known predictors of hospitalization in patients on dialysis. Routine measurement of grip strength in those newly starting dialysis may help identify those most at risk of hospitalizations over time.
Funding
- NIDDK Support