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.
Patients undergoing maintenance hemodialysis are characterized with lower cardiorespiratory capacity and muscle atrophy, thus easily leading to a sedentary lifestyle. These patients are usually associated with lower quality of life and worse prognosis. Evidence indicates appropriate exercise rehabilitation plan could help maintenance hemodialysis patients achieve better health outcomes. However, there is still a lack of evidence data to precisely recommend exercise type, intensity, frequency and timing specially designed for maintenance hemodialysis patients. This article aims to summarize the existing expert consensus on exercise rehabilitation for maintenance hemodialysis patients, important considerations in the implementation process, factors that affect exercise rehabilitation, with a view to encouraging maintenance hemodialysis patients to participate in the development of appropriate exercise rehabilitation plan and maximize health benefits.
Objective To explore the current status of electronic health (eHealth) literacy and online health information seeking behavior of maintenance hemodialysis (MHD) patients, and to explore the relationship between them. Methods MHD patients in the Hemodialysis Center of West China Hospital of Sichuan University between January and April 2022 were selected by convenient sampling method. The patients were investigated with general condition questionnaire, eHealth Literacy Scale and internet health information retrieval behavior questionnaire. According to the score of eHealth literacy, patients were divided into high eHealth literacy group and low eHealth literacy group, to compare the differences between the two groups, and analyze the factors that affected the internet health information retrieval behavior. Results A total of 194 MHD patients were included. Among them, 112 were male and 82 were female. The average score of eHealth literacy was 24.84±9.24. There were 136 cases in low eHealth literacy group, and the average score of eHealth literacy was 20.76±7.91. There were 58 cases in high eHealth literacy group, and the average score of eHealth literacy was 34.36±3.01. Multivariate analysis showed that eHealth literacy and education level were the influencing factors of health information search behavior (P<0.05). Conclusions The overall eHealth literacy of MHD patients is low, and the online health information search means is single and behaviorally inconsistent. It is necessary to improve the eHealth literacy of hemodialysis patients, and at the same time, provide various health information publicity and education for patients with different levels of eHealth literacy, which will help them better carry out disease management.
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 explore the characteristics of blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients with and without diabetes mellitus and the effects of BPV on cardiac function based on the research of clinical data. MethodsOne hundred MHD patients treated in the Hemodialysis Center of the People’s Hospital of Taixing City between January 2013 and January 2015 were recruited and divided into diabetes group (n=46) and non-diabetes group (n=54). Interdialytic and intradialytic BPV and cardiac function were monitored and compared between the two groups. Standard deviation (SD) and coefficient of variation (CV) were used for the evaluation of BPV. ResultsTriacylglycerol, cholesterol and plasma albumin were significantly different between the diabetes group and non-diabetes group (P<0.05), while hemoglobin, serum calcium, phosphorus and parathyroid hormone were not significantly different between the two groups (P>0.05). Forty-two patients in the diabetes group and 53 in the non-diabetes group took antihypertensive drugs. The varieties of antihypertensive drugs and the proportion of patients who used antihypertensive drugs were not significantly different between the two groups. The ambulatory blood pressure monitoring displayed 40 patients (86.9%) with reverse dipper or non-dipper blood pressure in the diabetes group and 35 (64.8%) in the non-diabetes group, and the difference was significant (P<0.05). The interdialytic mean systolic blood pressure (SBP), SBP-SD and SBP-CV in the diabetes group were all significantly higher than those in the non-diabetes group (P<0.05), and the mean diastolic blood pressure (DBP), DBP-SD and DBP-CV were also significantly different between the two groups (P<0.05). The intradialytic mean SBP, SBP-SD and SBP-CV in the diabetes group were significantly higher than those in the non-diabetes group (P<0.05), but there were no significant differences in intradialytic mean DBP, DBP-SD and DBP-CV between the two groups. In patients with reverse dipper or non-dipper blood pressure, the interventricular septal thickness, left ventricular end-diastolic diameter and ejection fraction were significantly different between the diabetes group and the non-diabetes group. However, in patients with dipper blood pressure, the cardiac function parameters were not significantly different between the two groups. Conclusion MHD patients with diabetes have higher ratio of reverse dipper or non-dipper blood pressure, more significant blood pressure variability and more severe cardiac function damage.
Blood pressure variability (BPV) refers to the fluctuations of blood pressure in a certain period of time. In recent years, BPV is becoming a predictive marker for cardiovascular events. Given the hemodynamic and internal environmental change brought by hemodialysis as well as the complex complications, hemodialysis patients always have complex BPV. Nowadays there is no consensus on an optimal standard to evaluate BPV in hemodialysis population. Metrics usually used are as follows: blood pressure change during a certain period of time, standard deviation, coefficient of variation, variation independent of mean, average real variability, weighted mean of daytime and night-time standard deviation, residual derived from generalized linear models, and residual standard deviation. Impact factors of BPV in hemodialysis patients include age, ultrafitration volume, hemodialysis frequency and time length, peripheral vascular disease, serum calcium, antihypertensive drugs and so on. Recent studies showed significant associations between both long-term and short-term BPV with prognosis of hemodialysis patients. This review focuses on the evaluation methods, the influencing factors and the impact on prognosis of BPV.
Objective To explore the current situation and influencing factors of self-regulatory fatigue in maintenance hemodialysis (MHD) patients, so as to provide good dialysis treatment for MHD patients, reduce their level of self-regulated fatigue and improve their quality of life. Methods The convenient sampling method was used to select the MHD patients in the Wenjiang Hemodialysis Center of West China Hospital of Sichuan University between April 12 and April 30, 2022. The patients were investigated by self-made basic information scale and self-regulatory fatigue scale. Results A total of 131 patients were included. The average score of self-regulatory fatigue was 53.47±6.45, cognitive dimension was 20.21±2.39, emotional dimension was 20.85±2.85, behavioral dimension was 12.40±3.63. The results of multiple linear stepwise regression analysis showed that age, duration of dialysis and educational background could inversely predict the score of self-regulatory fatigue (P<0.05). Conclusions MHD patients have a high level of self-regulatory fatigue. Clinical nurses can make individual dialysis programs according to the actual situation of MHD patients, improve their self-regulated level and physical and mental health, and 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.
ObjectiveTo investigate the level and influencing factors of self-management behaviors among maintenance hemodialysis patients.MethodsPatients undergoing maintenance hemodialysis were recruited from 4 tertiary hospitals in Chengdu from October 2016 to October 2017. Convenient sampling method was used to select patients. The instruments used in the study included General Information Questionnaire, Hemodialysis Self-management Instrument, Hemodialysis-related Knowledge Questionnaire, Herth Hope Index, Multidimensional Health Locus of Control Scale, and Chronic Illness Resources Survey.ResultsA total of 360 patients were investigated, and 343 patients were finally included. The mean score of self-management behavior was 54.87±9.65. The results of multiple linear stepwise regression showed that gender, age, ethnic, monthly family income, chronic illness resources, knowledge and internal health locus of control were the significant influencing factors of self-management behaviors (P<0.05).ConclusionThe self-management behavior among patients undergoing maintenance hemodialysis can be promoted by improving the level of knowledge and internal health locus of control, and making effective use of chronic illness resources.
Objective To investigate the mediating effect of phase angle between muscle strength and muscle function in maintenance hemodialysis (MHD) patients, aiming to provide a reference basis for clinical improvement of muscle strength and muscle function in MHD patients. Methods Random sampling was used to collect patients undergoing outpatient MHD in the Wenjiang Hemodialysis Room of the Department of Nephrology, West China Hospital, Sichuan University between September and December 2023 as the subjects of this study. Muscle strength was assessed by handgrip strength, muscle function was assessed by Short Physical Performance Battery (SPPB), and phase angle was measured by bioelectrical impedance analysis. The mediating effect of phase angle between muscle strength and muscle function was analyzed. Results A total of 239 MHD patients were included, including 125 males (52.3%) and 114 females (47.7%). The mean phase angle of MHD patients was (5.77±1.17)°, 89 patients (37.2%) showed decreased muscle strength, and 109 patients (45.6%) showed muscle hypoplasia. Spearman’s correlation analyses showed that phase angle was significantly and positively correlated with both handgrip strength and SPPB in MHD patients (P<0.001). The results of mediation effect analysis showed that handgrip strength was able to positively predict phase angle (β=0.535, P<0.001); handgrip strength was able to positively predict SPPB (β=0.481, P<0.001); phase angle was able to positively predict SPPB (β=0.296, P<0.001); and when both handgrip strength and phase angle entered in the regression equation, both handgrip strength (β=0.392, P<0.001) and phase angle (β=0.165, P<0.05) could positively predict SPPB. Phase angle in MHD patients partially mediated the association between muscle strength and muscle function, with the mediating effect accounting for 32.5% of the total effect. Conclusions There is a close relationship between phase angle, muscle strength and muscle function in MHD patients, and muscle strength can affect muscle function directly or indirectly through phase angle. Medical professionals should pay attention to the muscle function of MHD patients and further improve their muscle function by improving their phase angle and muscle strength.