Grip strength in children with chronic kidney disease



The relationship between muscle strength and chronic kidney disease (CKD) in children is unknown. This study aims to quantify the association between grip strength (GS) and kidney function and to explore factors associated with grip strength in children and adolescents with CKD.


We included 411 children (699 GS assessments) of the Chronic Kidney Disease in Children (CKiD) study. They were matched by age, sex, and height to a healthy control from the National Health and Nutrition Examination Survey to quantify the relationship between GS and CKD. Linear mixed models were used to identify factors associated with GS among CKD patients.


Median GS z-score was − 0.72 (IQR − 1.39, 0.11) among CKD patients with CKD stages 2 through 5 having significantly lower GS than CKD stage 1. Compared with healthy controls, CKiD participants had a decreased GS z-score (− 0.53 SD lower, 95% CI − 0.67 to − 0.39) independent of race/ethnicity and body mass index. Factors associated with reduced GS included longer duration of CKD, pre-pubertal status, delayed puberty, neuropsychiatric comorbidities, need of feeding support, need for alkali therapy, and hemoglobin level. Decreased GS was also associated with both a lower frequency and intensity of physical activity.


CKD is associated with impaired muscle strength in children independent of growth retardation and BMI. Exposure to CKD for a prolonged time is associated with impaired muscle strength. Potential mediators of the impact of CKD on muscle strength include growth retardation, acidosis, poor nutritional status, and low physical activity. Additional studies are needed to assess the efficacy of interventions targeted at these risk factors.

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Data in this manuscript were collected by the Chronic Kidney Disease in Children (CKiD) prospective cohort study with clinical coordinating centers (principal investigators) at Children’s Mercy Hospital and the University of Missouri - Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD and Derek Ng, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U24-DK-082194, U24-DK-66116). The CKiD website is located at

Funding information

This study was supported by a grant from the French Society of Pediatrics-Evian Société Danone Eaux France and the Barry Warshaw Fund for Pediatric Nephrology Fellows at Emory University and the Children’s Healthcare of Atlanta and Emory University’s Pediatric Biomarkers Core.

Author information

Correspondence to Julien Hogan.

Ethics declarations

The CKiD study (NCT00327860) was approved by an external study monitoring board appointed by the National Institute of Diabetes and Digestive and Kidney Diseases and by the institutional review board of each participating center, including Children’s National Health System. Informed consent of all individual participants included in the study was obtained by each center, and the study was conducted in accordance with the Declaration of Helsinki.

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The authors declare that they have no conflict of interest.

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Hogan, J., Schneider, M.F., Pai, R. et al. Grip strength in children with chronic kidney disease. Pediatr Nephrol (2020).

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  • Children
  • Chronic kidney disease
  • Muscle strength
  • Outcomes
  • Quality of life