E-Mail karger@karger.com Original Paper Nephron Clin Pract 2014;126:116–123 DOI: 10.1159/000358431 Small Distal Muscles and Balance Predict Survival in End-Stage Renal Disease Matthias Hellberg a Eva Maria Wiberg a Ole Simonsen a Peter Höglund b Naomi Clyne a a Department of Nephrology, Institution of Clinical Sciences, Lund University, and b Department of Clinical Chemistry and Pharmacology, Institution of Laboratory Medicine, Lund University, Lund, Sweden Introduction Background Patients with chronic kidney disease (CKD) suffer from high cardiovascular morbidity and mortality in comparison with the normal population [1, 2]. Inflam- matory activity, susceptibility to infections, protein en- ergy wasting, muscle weakness and reduced exercise ca- pacity are all correlated to the progression of CKD and its complications [3–6]. Frailty as a composite construct consisting of poor physical function, fatigue, low physical activity and malnutrition is associated with a higher risk of death in dialysis patients [7, 8]. Higher levels of self- reported physical activity, exercise capacity and hand grip strength in men only have been shown to be strong pre- dictors of survival in dialysis patients [6, 9]. Hypothesis/Aim The aim of the present study was to analyse whether a standardized set of tests measuring physical function at the start of renal replacement therapy (RRT) predicts survival. Methods Study Design This was a retrospective study using patient records and data from the Swedish Renal Registry, where patients are registered at the start of RRT. All patients were treated at the Department of Key Words Physical function · Functional status · Exercise capacity · Survival · Mortality · Chronic kidney disease · Dialysis · Muscle · Strength · Balance · Uraemia Abstract Background/Aims: Survival for patients on renal replace- ment therapy (RRT) has been shown to correlate to the level of physical activity and exercise capacity. We examined whether composite measures of functional status at the start of RRT predict survival. Methods: In this retrospective study, the same physiotherapist, using a standardized battery of tests for functional status, tested 134 patients at the start of RRT. Results: At the end of the observation period, 112 pa- tients (84%) were still alive. Age (p < 0.0001), co-morbidity (p = 0.028), hand grip strength (right: p = 0.0065; left: p = 0.0039), standing heel rise (right: p = 0.011; left: p = 0.004) and functional reach (p = 0.015) were significant predictors of survival. After adjustment for sex, age and co-morbidity, hand grip strength left (p = 0.023) was a significant predictor of survival. Conclusion: Hand grip strength, standing heel rise and functional reach at the start of RRT seem to affect survival. A 50% reduction in hand grip strength left was as- sociated with an almost 3-fold increase in mortality. Deterio- ration of function in small distal muscles and balance may be early signs of uraemic myopathy. A relatively simple and clin- ically feasible battery of tests can help detect patients at risk. © 2014 S. Karger AG, Basel Received: April 18, 2013 Accepted: January 6, 2014 Published online: April 3, 2014 Matthias Hellberg Department of Nephrology, Institution of Clinical Sciences Lund University, Skåne University Hospital Alwallhuset, Barngatan 2A, SE–22185 Lund (Sweden) E-Mail matthias.hellberg  @  skane.se © 2014 S. Karger AG, Basel 1660–2110/14/1263–0116$39.50/0 www.karger.com/nec