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.
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.
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.
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.
目的 研究自体动静脉内瘘全程规范化护理的可实施性及优势。 方法 制定自体动静脉内瘘全程规范化护理工作流程及标准，将2011年6月－8月经自体动静脉内瘘行维持性血液透析患者随机分为观察组（125例）和对照组（115例），分别予以全程规范化护理和普通护理，对比分析两组之间内瘘不良事件发生率、患者满意度、护士认同度等指标的差异。 结果 两组内瘘不良事件发生率分别为8.0%和21.0%，患者满意度分别为98.4%和84.3%，差异均有统计学意义（P＜0.05）；两组护士对本组护理模式认同度均为90.0%，差异无统计学意义（P＞0.05）。 结论 自体动静脉内瘘全程规范化护理模式能有效降低内瘘不良事件发生率并显著提高患者满意度，值得临床推广。
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 investigate the relationship among bone density, osteoprotegerin (OPG) and vascular calcification (VC) in maintenance hemodialysis (MHD) patients. MethodsOne hundred MHD patients were collected from our department between May 2010 and December 2012. The VC was detected by plain radiographs. Bone mineral density was measured with dual-energy X-ray absorptionmeter. The level of serum OPG was measured by enzymelinked immunosorbent assay. Other clinically related indicators were also detected. The related parameters were examined statistically. ResultsThe incidence of VC in MHD patients was 74% (74/100), and the OPG level significantly increased with the degree of vascular calcification (P<0.05). The proportion of patients with normal bone volume was 40%, and with abnormal bone volume was 60%. Compared with patients with normal bone volume, the patients with abnormal bone volume had higher serum OPG level (P<0.05). The patients with no VC had a lower incidence of abnormal bone volume than patients with VC (P<0.05). Multiple linear regression analysis revealed that vascular calcification score, OPG level and age were independent factors for bone mineral density. Dialysis time, OPG level, serum albumin level and bone mineral density were independent factors for vascular calcification score. ConclusionThe MHD patients with vascular calcification are often associated with osteoporosis at the same time. OPG plays an important role in the relationship between vascular calcification and osteoporosis.