Most patients with end-stage renal disease choose maintenance hemodialysis to prolong survival. The clinical application of exercise therapy has a definite effect on maintenance hemodialysis patients, and can effectively improve their quality of life and promote rehabilitation. Individualized exercise therapy under the guidance of medical professionals has positive effects on patients’ physical and mental rehabilitation. This paper mainly summarizes the status of exercise, factors affecting exercise, exercise therapy, exercise and rehabilitation of maintenance hemodialysis patients, and reviews the impact of exercise therapy on the physical and mental health of maintenance hemodialysis patients, in order to provide some references for clinical intervention and prognosis studies.
ObjectiveTo preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).MethodsThirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤−2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.ResultsThe DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤−2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.ConclusionsPostmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.
The coexistence of cognitive impairment and physical frailty in maintenance hemodialysis (MHD) patients is known as cognitive frailty. It has emerged as a novel complication in MHD patients and increases the risk of adverse outcomes such as falls, fractures, functional impairment and death. Timely intervention can delay or even reverse the development of cognitive frailty to dementia, thereby reducing the risk of adverse outcomes and improving the quality of life of patients. Based on this literature review method, this article summarizes the domestic and foreign research progress on the epidemiology, assessment tools, influencing factors and intervention measures of cognitive frailty in MHD patients, aiming to provide reference for clinical staff to carry out early screening and intervention of cognitive frailty in MHD patients.
Objective To investigate the correlation between grip strength and subjective cognitive decline (SCD) in maintenance hemodialysis (MHD) patients of different genders. Methods Patients who underwent outpatient MHD in the Wenjiang Hemodialysis Unit, Department of Nephrology, West China Hospital, Sichuan University between March and June 2024 were selected as the research subjects. Multiple linear regression analysis was used to explore the relationship between grip strength and SCD in MHD patients of different genders. Results A total of 171 patients were investigated, with 76 in the non-SCD group and 95 in the SCD group. The results of multiple linear regression analysis showed that educational level (P=0.039), nutritional status (P=0.026), and grip strength (P=0.042) were the influencing factors of SCD in male MHD patients. Work status (P=0.001) and nutritional status (P=0.011) were the influencing factors of SCD in female MHD patients. Conclusions Educational level, nutritional status, and grip strength are influencing factors of SCD in male MHD patients. Work status and nutritional status are influencing factors of SCD in female MHD patients. Grip strength may serve as an indicator for evaluating SCD in male MHD patients.
Objective To understand the incidence of frailty in maintenance hemodialysis (MHD) patients, and to explore the correlation and influencing factors of frailty in MHD patients, so as to provide some basis for the intervention of frailty in MHD patients. Methods Patients who underwent MHD in the Department of Nephrology of West China Hospital of Sichuan University from January to March 2021 were selected. Frail scale and Pittsburgh Sleep Quality Index (PSQI) were used for evaluation, and the influencing factors of frail in patients with MHD and its correlation with frail were analyzed. Results A total of 141 patients with MHD were included, including 57 cases without frailty (40.43%), 71 cases in early frailty (50.35%), and 13 cases in frailty (9.22%). 54 cases (38.30%) had very good sleep quality, 56 cases (39.72%) had good sleep quality, 24 cases (17.02%) had average sleep quality, and 7 cases (4.96%) had very poor sleep quality. The frailty of MHD patients was positively correlated with age (rs=0.265, P=0.002), PSQI (rs=0.235, P=0.005) and magnesium (rs=0.280, P=0.001). Logistic regression analysis showed that the influencing factors of MHD patients’ frailty were gender [odds ratio (OR) =4.321, 95%confidence interval (CI) (1.525, 12.243), P=0.006], PSQI [OR=1.110, 95%CI (1.009, 1.222), P=0.032], magnesium [OR=122.072, 95%CI (4.752, 3 135.528), P=0.004], hypertension [OR=0.112, 95%CI (0.023, 0.545), P=0.007] and other diseases [OR=0.102, 95%CI (0.019, 0.552), P=0.008]. Conclusions The incidence of frailty in MHD patients is high. Gender, PSQI, magnesium, hypertension and other diseases are the influencing factors of frailty in MHD patients, and there is a correlation between frailty and sleep. It is suggested that renal medical staff should pay more attention to the assessment of MHD frailty and sleep, and carry out multi-disciplinary personalized intervention to improve the quality of life of MHD patients.
ObjectiveTo explore the changes of serum irisin in maintenance hemodialysis (MHD) patients with sarcopenia.MethodsFrom January to June 2019, 56 MHD patients from Shanxi Provincial People’s Hospital were selected. Judging by the results of body composition analyzer, the MHD patients were divided into the sarcopenia group (n=31) and the non-sarcopenia group (n=25). The serum irisin level was detected by enzyme-linked immunosorbent assay. The muscle cross-sectional area at the third lumbar level was measured by CT. SPSS 21.0 software was used for inter-group comparison, correlation analysis, and regression analysis.ResultsThe serum irisin concentration in the sarcopenia group was lower than that in the non-sarcopenia group [medium (lower quartile, upper quartile): 175.46 (126.00, 220.52) vs. 459.10 (233.83, 616.91) pg/mL; Z=−4.195, P<0.001]. The results of Spearman correlation analysis showed that serum irisin level was positively correlated with lean tissue index (rs=0.265, P=0.048), however negatively correlated with serum creatinine level (rs=−0.311, P=0.020). The results of logistic regression analysis showed that serum irisin level [odds ratio (OR)=0.957, 95% confidence interval (CI) (0.925, 0.990), P=0.012], walking speed [OR=0.000, 95%CI (0.000, 0.050), P=0.031], and grip strength [OR=0.658, 95%CI (0.434, 0.997), P=0.048] were protective factors of sarcopenia in MHD patients.ConclusionsThe level of circulating irisin in MHD patients with sarcopenia is lower than that in MHD patients without sarcopenia. Irisin is a protective factor of sarcopenia in MHD patients.
Objective To understand the current situation of eHealth literacy of maintenance hemodialysis (MHD) patients and analyze the influencing factors to improve the eHealth literacy of MHD patients. Methods Using cross-sectional survey method, MHD patients in West China Hospital of Sichuan University were selected as the subjects between February and April 2022. eHealth Literacy Scale (eHEALS) was used to investigate the status of eHealth literacy, and the influencing factors of MHD patients were analyzed. Results A total of 194 MHD patients were investigated. The total eHEALS score of MHD patients was 24.55±9.14. The results of generalized linear regression showed that education level, medical payment method, age, frequency of internet forums, interest in internet health knowledge search, and Baidu search engine (a common channel for searching disease information online) were the influencing factors of MHD patients’ electronic health literacy. Conclusion The electronic health literacy level of MHD patients is low, so renal medical staff should pay attention to the electronic health literacy of MHD patients and develop targeted interventions to help patients better manage their own health problems.
Objective To investigate the awareness and clinical needs of wearable artificial kidney among maintenance hemodialysis (MHD) patients, and to analyze the related influencing factors. Methods MHD patients were recruited from 2 tertiary hospitals in Sichuan province between April and June 2021. The convenient sampling method was used to select patients. The factors influencing the awareness and demand of MHD patients for wearable artificial kidney were analyzed. Results A total of 119 MHD patients were included. The awareness of wearable artificial kidney among the patients was mainly “never heard” (61 cases) and “heard” (58 cases). Most MHD patients (60 cases) were willing to use and participate in clinical trials in the future. The results of logistic regression indicated that the cost on household economy and treatment effect on life quality were the influencing factors for MHD patients’ awareness of wearable artificial kidney (P＜0.05). The average duration of single dialysis and the impact of treatment on working or studying were the influencing factors for MHD patients’ needs of wearable artificial kidney (P＜0.05). Conclusions The awareness of wearable artificial kidney is low among MHD patients. However, most MHD patients showed great interest in the wearable artificial kidney after preliminary understanding, suggesting that the future clinical application of wearable artificial kidney has great demand.
Objective To study the influence of calcium acetate tablets combined with compound alpha-keto acid on calcium and phosphorus metabolism in maintenance hemodialysis (MHD) patients. Methods A total of 112 MHD patients with hyperphosphatemia treated between May 2014 and May 2015 were included in this study. Based on random number table method, they were divided into calcium acetate group (n=37), compound alpha-keto acid group (n=36) and combined drug use group (n=39). All the patients were given a low protein diet. Twelve weeks after treatment, we compared the calcium and phosphorus metabolic indexes, nutrition indicator levels and adverse reactions within and across the three groups. Results Before treatment, there was no significant difference among the three groups in terms of serum calcium, phosphorus, calcium-phosphorus product, and parathyroid hormone (PTH) level (P>0.05). After treatment, the combined drug use group had significantly lower levels of serum phosphorus, calcium-phosphorus product and PTH than the other two groups (P<0.05). Before treatment, the levels of creatinine, serum total protein and albumin were not significantly different among the three groups (P>0.05). After treatment, the serum total protein and albumin level in the combined drug use group were significantly higher than those in the other two groups (P<0.01). Three was no significant difference among the three groups in terms of adverse reactions (P>0.05). Conclusions For MHD patients with hyperphosphatemia, the combined use of calcium acetate tablets and compound alpha-keto acid is better than the use of single drugs, which can effectively improve patients’ symptoms and reduce the level of serum phosphorus with high security. It is worthy of clinical recommendation.