Handgrip strength is measured on the non-fistula side before a dialysis session using mechanical dynamometers with a precision of less than 0.5 kg. Subjects are instructed to self-adjust the dynamometer so that it fit comfortably to their hand size to obtain the best performance. Before data collection, a warm up section is conducted so that the subjects could become acquainted with the instrument and procedures and choose the best adjustment. Subjects are instructed to grip the dynamometer with maximum strength in response to a voice command. The subjects stand with both arms extended sideways from the body with the dynamometer facing away from the body. Three trials are performed with a rest period of at least 1 min between trials and the highest HGS value is used in the analyses. Participants with a handgrip strength in the lowest 20% of the sex- and BMI-specific distributions are considered to have low handgrip strength.