Força de preensão palmar e área muscular do braço corrigida como fatores de risco para desfechos clínicos e mortalidade em pacientes com doença renal crônica em hemodiálise

Abstract

INTRODUCTION: Chronic kidney disease (CKD) negatively affects muscle health with a consequent reduction in muscle strength especially in patients undergoing hemodialysis (HD), contributing to the worse prognosis of CKD and adverse outcomes. OBJECTIVES: To investigate the association of reduced hand grip strength (HGS) and corrected arm muscle area (cAMA) in patients with CKD on HD and the risk of hospitalizations, cardiovascular events, and all-cause mortality. METHODS: Prospective cohort of 300 CKD HD patients between 18 and 80 years old. HGS was considered reduced when <26kg for men and <16kg for women. Participants with cAMA values ≤15th percentile according to gender and age group were considered as reduced. The participants were followed up for at least 9 months. Clinical outcomes investigated were hospitalizations, cardiovascular events, and death. To investigate the association between reduced HGS and cAMA with clinical outcomes, univariate and multivariable analyses were performed with Cox proportional hazards regression models. RESULTS: Both reduced HGS and cAMA were more prevalent in men than women (50% vs 25.3% p=0.035 and 37.7% vs 8.3% p< 0.001, respectively). Hospitalization occurred in 85 (37.6%) patients with reduced HGS (multivariable HR 7.02; 95% CI 3.0-16.43; p<0.001) and 51 (40.0%) patients with reduced cAMA (HR 1.65; 95% CI 1.02-2.66; p=0.041). Cardiovascular events occurred in 33 (14.6%) patients with reduced HGS (multivariable HR 3.93; 95% CI 1.15-13.38; p=0.029) and 23 (16.7%) patients with reduced cAMA (multivariable HR 2.92; 95% CI 1.31-6.50; p=0.009). Death occurred in 18 (8.0%) patients with reduced HGS (multivariable HR 4.09; CI 95% 0.51-32.77; p=0.185) and 14 (10.1%) patients with reduced cAMA (4.08; 95% CI 1.22-13.67; p=0.022). CONCLUSION: CKD patients on HD with reduced HGS and cAMA were at risk for hospitalizations and cardiovascular events. A higher incidence of hospitalizations, cardiovascular events and death was observed in those with reduced HGS and/or AMBc, compared to participants with normal HGS and AMBc. In addition, death was associated with reduced cAMA, but not for HGS.