Predictive values of handgrip strength for protein-energy wasting among patients undergoing maintenance hemodialysis: a systematic review and meta-analysis
File(s)
Published version
Author(s)
Ghifari, Muhammad Haneef
Al-Gunaid, Seba Talat
Rampengan, Derren David Christian Homenta
Wira, Juan Fransiscus
Syukri, Maimun
Type
Journal Article
Abstract
Protein-energy wasting (PEW) increases the morbidity and mortality in maintenance hemodialysis (MHD) patients. The existing screening tools (e.g., Malnutrition-Inflammation Score (MIS)) are time-consuming and require expertise. Consequently, assessing a more practical and reliable tool such as handgrip strength (HGS) is important, as it strongly correlates with the PEW status in patients undergoing MHD, in whom increased protein and fat breakdown leads to muscle strength and function loss. A systematic search of five databases identified studies assessing HGS’s predictive value for PEW in patients undergoing MHD, using MIS as the reference. The quality of the studies was evaluated with the updated QUADAS tool. A diagnostic meta-analysis was carried out to estimate the pooled sensitivity, specificity, sROC, and sAUC using a two-level mixed-effects model. From 350 records, five studies were obtained which were included for analysis. The pooled sensitivity and specificity of the HGS among male patients were 68% (95%CI: 63–73%) and 66% (95%CI: 53–77%), respectively. Among female patients, the pooled sensitivity and specificity were 73% (95%CI: 62–82%) and 65% (95%CI: 48–79%), respectively. The positive likelihood ratio and negative likelihood ratio for male patients were 2.0 (95%CI: 1.4 to 2.9) and 0.48 (95%CI: 0.38 to 0.60), respectively. Meanwhile, among female patients, the positive likelihood ratio and negative likelihood ratio were 2.1 (95%CI: 1.4–3.1) and 0.41 (95%CI: 0.29–0.59), respectively. The sAUC for males and females was estimated to be 0.69 (95%CI: 0.65 to 0.73) and 0.75 (95%CI: 0.71–0.79). In summary, the sensitivity and specificity of the HGS were modest for all sexes, with females being more sensitive. HGS may be useful for triaging during daily screening and guiding further examination, but it requires supporting measurements to be employed as a diagnostic tool. PROSPERO: CRD42024595677 as of 1 October 2024.
Date Issued
2025-06-01
Date Acceptance
2025-04-18
Citation
Kidney and Dialysis, 2025, 5 (2)
ISSN
2673-8236
Publisher
MDPI
Journal / Book Title
Kidney and Dialysis
Volume
5
Issue
2
Copyright Statement
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/).
License URL
Identifier
10.3390/kidneydial5020016
Subjects
Ghifari, M.H.
Al-Gunaid, S.T.
Rampengan, D.D.C.H.
Wira, J.F.
Syukri, M.
Yufika, A.
Habiburrahman, M.
Iqhrammullah, M. Predictive Values of Handgrip Strength for Protein-Energy Wasting Among Patients Undergoing Maintenance Hemodialysis: A Systematic Review and Meta-Analysis
Publication Status
Published
Article Number
16
Date Publish Online
2025-04-21