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 investigate the efficacy of Quality Control Circles (QCC) in reducing the emergency application times of maintenance hemodialysis. MethodsIn December, 2012, the quality circle was formed by eight nurses and a physician, through brainstorming. The group finally selected "Reducing emergency maintenance dialysis times" as the theme. With the help of questionnaire, interview, and comparative study, we analyzed the emergency situation of maintenance hemodialysis patients, and regulate and implement related policies. ResultsBy QCC practices, the times of hemodialysis declined from 11.7 to 5.3 cases per month, which exceeded our expectations largely. As to the circle members, their problem-solving skills, responsibility, communication skills, self-confidence, motivation and QCC techniques were also improved. ConclusionQCC can not only reduce the times of maintenance dialysis, but also improve the team cohesion, harmony and quality management capabilities.
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.
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.
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 explore the potential categories and influencing factors of chronic comorbidity treatment burden in maintenance hemodialysis (MHD) patients. Methods Convenience sampling method was used to select MHD patients between April and May 2023 at Northern Jiangsu People’s Hospital and Jiangdu People’s Hospital as the research subjects. The general information questionnaire, Chronic Disease Comorbidity Treatment Burden Scale, and Health Literacy Scale for Chronic Disease Patients were used for the questionnaire survey. The latent class analysis was used to explore the classification of chronic comorbidity treatment burden in MHD patients, and the multi-class logistic regression analysis was used to explore the influencing factors of comorbidity treatment burden. Results A total of 450 survey questionnaires were distributed, and 406 valid questionnaires were collected, with an effective response rate of 90.22%. According to the latent class analysis results, the comorbidity treatment burden of MHD patients was divided into three potential categories. Among them, there were 26 cases in the low-burden group, 194 cases in the medium-burden group, and 186 cases in the high-burden group. The results of the ordered multi-class logistic regression analysis showed that patient age, educational level, dialysis age, number of comorbidities, and level of economic support were potential factors affecting the comorbidity treatment burden in MHD patients (P<0.05). Conclusions The comorbidity treatment burden of MHD patients can be divided into three potential categories. The age, educational level, dialysis age, number of comorbidities, and level of economic support of patients are potential factors affecting the comorbidity treatment burden in MHD patients.
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 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 investigate the effect of 24-week intradialytic progressive resistance exercise on hemoglobin and iron metabolism in maintenance hemodialysis (MHD) patients.MethodsFrom April to May 2019, 62 MHD patients were enrolled and randomly assigned into exercise group (n=31) and control group (n=31). Both groups of patients received regular routine hemodialysis, on that basis, patients in the exercise group completed intradialytic resistance exercise three times per week for 24 weeks. Each exercise included 8-10 muscle groups (grasping the grip ring with both hands, flexion and extension of the elbows and shoulders on the non-vascular side and lower limbs with sandbag), 3 sets of 15 repetitions with a rest of 1-2 min between 2 sets. Exercise began with a low load, the sandbag weight was gradually increased, and the Borg score was aimed to be 11-13 points after exercise. Hemoglobin, serum ferritin, transferrin saturation, serum creatinine, high-sensitivity C-reactive protein, urea clearance index, recombinant human erythropoietin (rHuEPO) dosage at baseline and after 24 weeks, as well as the cumulative iron supplement dose and hemoglobin variation of the two groups during the study period were evaluated.ResultsThere were 20 patients in the exercise group and 30 ones in the control group who completed the study. After 24 weeks of progressive resistance exercise, the medium (lower quartile, upper quartile) of the amount of rHuEPO in the exercise group decreased from 6 000 (6 000, 9 000) U/week to 6 000 (4 500, 7 125) U/week (Z=−2.599, P=0.009), while that in the control group had no statistically significant difference (Z=−1.340, P=0.180); there was no statistically difference in hemoglobin, hemoglobin coefficient of variation, serum ferritin, transferrin saturation, or 24-week cumulative iron supplementation between the two groups.ConclusionIntradialytic progressive resistance exercise can reduce the amount of rHuEPO in MHD patients, which is benefitial to optimizing the management of hemoglobin.
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.