Handgrip strength and all-cause mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis of cohort studies

Objectives In observational studies, handgrip strength (HGS), a prognostic marker for healthy aging, has been associated with several chronic disease outcomes. The present systematic review and meta-analysis aimed to determine the quantitative relationship between HGS and the risk of all-cause mortality in patients with chronic kidney disease (CKD). Methods Search PubMed, Embase, and Web of Science databases. The search was performed from inception to July 20, 2022, and the search was updated in February 2023. Cohort studies were included exploring the relationship between handgrip strength and the risk of all-cause mortality in patients with chronic kidney disease. Effect estimates and 95% confidence intervals (95% CI) were extracted from the studies to perform pooling. The quality of included studies was assessed using the Newcastle–Ottawa scale. We evaluated the overall certainty of evidence using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Results This systematic review included 28 articles. A random-effects meta-analysis that included 16,106 patients with CKD showed that participants with lower HGS had an increased mortality risk of 96.1% compared to higher HGS (HR: 1.961; 95% CI 1.591–2.415) (GRADE: very low). Moreover, this association was independent of baseline mean age and follow-up time. In 2,967 patients with CKD, a random-effects model-based meta-analysis showed that for each 1-unit increase in HGS, the risk of death in patients with CKD was reduced by 3.9% (HR: 0.961; 95% CI 0.949–0.974) (GRADE: moderate). Conclusions In patients with CKD, better HGS is associated with a lower risk of all-cause mortality. This study supports using HGS as a strong predictor of mortality in this population.