The association between hand grip strength and chronic kidney disease progression: insights from SMP-CKD studies

This study aims to investigate the relationship between handgrip strength (HGS) and the progression of chronic kidney disease (CKD) in non-dialysis patients in China, as part of the Self-Management Program for Patients with CKD Cohort (SMP-CKD).

In the SMP-CKD cohort, we utilized Cox regression and Kaplan-Meier survival analysis to explore the association between HGS and CKD progression. Data were stratified by sex-specific HGS quartiles, sarcopenia status, and HGS thresholds. The HGS thresholds were determined through curve analysis of HGS against composite renal outcomes. Group differences were compared to assess the impact of HGS on CKD outcomes.

A total of 441 participants (mean age 57.0 ± 17 years, 56.0% male) with CKD stages 3-5 from the SMP-CKD cohort who underwent grip strength evaluation between April 2019 and June 2024 were included in the analysis. The findings revealed that participants in the highest bilateral HGS quartile had a significantly lower risk of renal endpoints, with a hazard ratio (HR) of 0.102 (95% CI 0.041-0.255) compared to those in the lowest quartile. Patients without sarcopenia had a significantly lower risk of CKD composite outcomes, including increased serum creatinine or acute CKD exacerbations (HR 0.422, 95% CI 0.211-0.844, p < 0.012), as well as severe renal endpoints (HR 0.265, 95% CI 0.101-0.694, p < 0.003). Gender-specific cutoffs identified through log-rank test were 63.7 kg for men and 34.6 kg for women. Participants with bilateral HGS above these thresholds demonstrated better renal outcomes, underscoring the protective effect of higher HGS against CKD progression.

The study provides strong evidence that HGS is a crucial factor in reducing the risk of CKD progression. Higher levels of HGS are significantly associated with a lower occurrence of renal endpoint events.