ObjectiveTo understand the maintenance hemodialysis (MHD) patients’ intention to exercise rehabilitation and discuss the influencing factors.MethodsFrom January to March 2019, 141 MHD patients’ intention to exercise rehabilitation was investigated by cross-sectional survey, and the influencing factors of MHD patients’ intention to exercise rehabilitation were analyzed by multiple linear stepwise regression.ResultsA total of 141 questionnaires were issued and 139 valid ones were recovered. The mean score of exercise rehabilitation intention of MHD patients was 39.99±9.29, which was in the middle and high level. Age [unstandardized partial regression coefficient (b)=?5.277, 95% confidence interval (CI) (?8.640, ?1.915), P=0.002], educational level [b=2.412, 95%CI (1.161, 3.663), P<0.001], and 6-minute walking distance [b=3.526, 95%CI (0.032, 7.021), P=0.048] were the influencing factors of exercise rehabilitation intention of MHD patients.ConclusionMHD patients have high intension to exercise rehabilitation, and special attention should be paid to elderly patients and patients with low education level in clinical work to improve their intension to exercise rehabilitation.
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.
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.
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 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.
Along with the illness progresses of maintenance hemodialysis (MHD) patients, their functional limitations such as decreased cardiopulmonary endurance, muscle loss, dysfunction of arteriovenous fistula, fatigue, and sleep disorders are increasingly prominent and urgently need to be resolved. Modern physiotherapy as a non-invasive and non-pharmacological therapy which can reduce the functional limitations of MHD patients, improves the patients’ exercise capacity and quality of life. Physical therapy techniques suitable for MHD patients include active and passive exercise therapy such as aerobic exercise, resistance exercise, breathing training, and muscle stretching, as well as physical agents therapy such as neuromuscular electrical stimulation, infrared, and low-frequency pulsed electromagnetic field. Choosing appropriate physical agents and exercise prescription can reduce the treatment risk and improve the efficacy.
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.
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 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.