【Objective】 Malnutrition is becoming a bigger problem as the number of elderly and long-term dialysis patients increases. Malnutrition is a factor that causes sarcopenia and is also a factor in lowering both activities of daily living and quality of life, and in worsening prognosis. At our dialysis clinic, we use the geriatric nutritional risk index （GNRI） and practice nutritional support based on the calculated results. In this study, we used handgrip
strength （HGS） as a sarcopenia evaluation method and further examined the relationship between GNRI and HGS.
【Method】 HGS measurement was performed before dialysis for 108 maintenance hemodialysis （MHD) patients（79 men and 29 women） who were visiting our clinic. The possible sarcopenia group was identified and the presence or absence of a correlation between GNRI and HGS was also investigated.
【Results】 The average HGS was 30.1±7.9 kg for men and 18.3±5.8 kg for women. Patients meeting the reasonable sarcopenia criteria （men< 28 kg, women<18 kg) of the Asian Working Group for Sarcopenia 2019 were 32.9 % and 44.8 % in men and women, respectively. The HGS among MHD patients was lower than that of the healthy population, and the group of patients with older age or lower GNRI tended to suffer more frequently from possible sarcopenia. There was a significant positive correlation between GNRI and HGS for both men and women （men; rs= 0.3093 p< 0.01, women; rs= 0.4686 p < 0.05）．Thus, GNRI appropriately correlated with the severity of HGS impairment and vice versa. The cutoff value of GNRI for possible sarcopenia was 93.8 as estimated by receiver operating characteristic (ROC） analysis.
【Conclusions】 It was clearly shown that a decrease in GNRI predicts a decrease in HGS, i.e., a degree of muscle weakness, and conversely, a decrease in HGS suggests a decrease in GNRI, i.e., a degree of malnutrition. In the dialysis population, it seems that GNRI should be maintained at 93.8 or higher in both men and women for the prevention of sarcopenia. Simultaneous observation of HGS in addition to GNRI may provide more meaningful nutritional support to MHD patients while ensuring objectivity, with the advantage that both indicators are readily available in any dialysis facility.
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