Muscle strength and function
AIDS
Physical assessments took place immediately before connection to dialysis on the participants routine dialysis session. Grip strength was assessed using hand grip Dynamometer (Grip-D, Takei Scientific Instruments, Japan), with arm resting at the side of the patient with elbow in extension and wrist in the neutral resting position. A practice grip was taken with results discarded, then one summative grip on each hand, for which the participant was encouraged to give maximum effort. Both scores were noted, but the greater of the two scores taken for subsequent analysis. Adjusted hand-grip strength was calculated as fold change from the lowest 20% by gender and BMI in the original Fried frailty phenotype cohort [Walking speed was measured over 4 m from a standing start; usual walking aids were permitted. If the participant was not able to complete the 4 m distance, no walking speed was calculated, and a deficit registered for this component of the relevant frailty scores.