Handgrip Strength for Mortality Prediction in Hemodialysis Patients Using the Chronological-To-Metabolic Age Ratio: A Multicenter Prospective Cohort Study Publisher Pubmed

Summary: Can grip strength predict dialysis survival? A hemodialysis study linked weaker grip to mortality; metabolic age added little beyond clinical measures. #KidneyHealth #Sarcopenia

Navab F ; Heidari Z ; Hassanizadeh S ; Moeinzadeh F ; Rouhani M H
Source: Kidney360 Published:2026

Abstract

Background: – Hemodialysis patients face disproportionately high mortality, with sarcopenia and reduced muscle strength as major contributors. In this study, we aimed to investigate whether the prognostic value of handgrip strength for all-cause mortality is modified by the chronological-to-metabolic age ratio, a marker of biological aging and cumulative physiological stress. Methods: – This multicenter prospective cohort study enrolled 307 adult hemodialysis patients. handgrip strength was measured with a standardized dynamometer prior to dialysis, and metabolic age was estimated via multifrequency bioelectrical impedance analysis to calculate the chronological-to-metabolic age ratio. Demographic, clinical, anthropometric, and dialysis-related parameters were also collected. Participants were followed every three months through three years for all-cause mortality, and the prognostic value of handgrip strength was assessed using Cox proportional hazards models, and discriminative performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: – Higher handgrip strength was associated with reduced all-cause mortality in hemodialysis patients, particularly among those whose metabolic age exceeded chronological age (HR = 0.879; 95% CI: 0.812–0.953; P = 0.002). While handgrip strength showed poor discrimination across chronological (AUC = 0.550–0.578) and metabolic age categories (AUC = 0.571–0.648), it demonstrated relatively higher discriminative performance in patients with accelerated metabolic aging (AUC = 0.810; cut-off = 22.16; sensitivity 65%; specificity 94%). Conclusions: – Handgrip strength was associated with all-cause mortality in hemodialysis patients, and this association may be modified by the chronological-to-metabolic age ratio. However, the chronological-to-metabolic age ratio did not provide incremental prognostic value beyond conventional clinical variables and handgrip strength. The observed subgroup-specific discriminative performance and HGS cut-off values are exploratory and require external validation before clinical application. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, LLC. on behalf of the American Society of Nephrology