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Objective:To investigate the incidence of sarcopenia in maintenance hemodialysis (MHD) patients and analyze its influencing factors.Methods:Totally 441 non-hospitalized MHD patients in stable condition were selected,by bioelectrical impedance analysis (BIA) to test appendicular skeletal muscle mass(ASM), by testing grip strength of MHD patients, to assess Muscle strength, by gait speed test to measure the 4-m usual walking speed, to assess physical performance of MHD patients.Risk factors of sarcopenia were identified by Logistic regression analysis.Results:The total incidence of sarcopenia in 441 MHD patients was 16.55% (73/441) and the incidence of sarcopenia in patients over 60 years old was 28.91% (61/211).The results showed older age ( OR=0.213, 95% CI 0.099-0.458, P<0.01), Karnofsky ( OR=9.661, 95% CI 3.850-24.244, P<0.01), subjective global assessment ( OR=0.491, 95% CI 0.250-0.965, P=0.039), serum phosphorus ( OR=0.422, 95% CI 0.204-0.875, P=0.020) and body mass index ( OR=0.754, 95% CI 0.609-0.935, P=0.010) were risk factors of sacopenia. Conclusions:The incidence of sarcopenia in elder, performed less physical activity, malnutrition predisposed MHD patients was high, so to those patients we should be paid more attention and gave active interventions to reduce sarcopenia.
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Objective:To investigate the status of frailty and activities of daily living (ADL) in maintenance hemodialysis (MHD) patients, and to explore the effect of frailty phenotype on ADL.Methods:The patients who underwent MHD in Kidney Disease Center of the First Affiliated Hospital from March 2019 to March 2020 were enrolled in this study. The demographic and laboratorial data were collected by cross-sectional survey method. Fried frailty phenotype scale and ADL scale were used to evaluate the frailty and ADL, respectively. The differences of basic data and different frailty phenotypes between the normal function group and the function decline group were compared in terms of ADL, physical self-maintenance ability and instrumental ADL ability. Pearson correlation analysis was used to analyze the correlation between frailty and ADL, and binary logistic regression analysis was used to analyze the influencing factors of ADL.Results:A total of 676 MHD patients were included in this study, including 434 males (64.2%) and 242 females (35.8%). The age was (59.2±19.4) years old, and the median dialysis age was 59.0 (25.3, 110.0) months. There were 159 frailty patients (23.5%), 230 pre-frailty patients (34.0%), and 287 non-frailty patients (42.5%). The ADL was decreased in 163 patients (24.1%), including 131 patients (19.4%) with decreased physical self-maintenance ability and 161 patients (23.8%) with decreased instrumental ADL ability. Pearson correlation analysis showed that the frailty score was positively correlated with total ADL score ( r=0.728, P<0.001), physical self-maintenance ability score ( r=0.669, P<0.001) and instrumental ADL ability score ( r=0.729, P<0.001). Binary logistic regression analysis results showed that older age and lower physical activity, fatigue, slowed steps and lower grip strength in the frailty phenotypes were the independent influencing factors of ADL, physical self-maintenance ability and instrumental ADL ability (all P<0.05). Conclusions:The prevalence of frailty is 23.5% in MHD patients, and 24.1% of MHD patients have decreased ADL. Elder age and lower physical activity, fatigue, reduced step counts, and lower grip strength in frailty phenotypes are the independent influencing factors for poor ADL, poor physical self-maintenance ability and poor instrumental ADL ability.
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Objective To investigate the relationship between ultrafiltration rate (UFR) and cardiovascular death in maintenance hemodialysis patients.Methods This retrospective study observed adult hemodialysis patients treated in Kidney Disease Center,the First Affiliated Hospital,College of Medicine,Zhejiang University during January 2010 to December 2015 and the follow-up were finished at April 2017.Patients were averagely divided into 3 groups according to their UFR.Their clinic characteristics were collected,the survival rate and death related factors were analyzed by Kaplan-Meier (Log-rank test) method and Logistic regression.Results Totally 2184 patients (male 1370,62.7％) were enrolled,the age was 53.39±16.47.The UFR was (8.88±3.05) ml·h-1· kg-1.During the 7 years’ follow-up,168 patients died,of whom 58 cases (34.5％) died due to the cardiovascular events.Chi-square test showed that there were significant differences in death causes among the high,middle and low UFR group (x2=12.584,P ＜ 0.01),and the mortality rate of cardiovascular events in high UFR group was significantly higher than that in low (x2=10.861,P=0.010) and middle UFR group (x2=4.671,P=0.031).Kaplan-Meier survival curve showed that the difference of the survival rates in the 3 groups was statistically significant (Log-rank test x2=23.394,P ＜ 0.001).Cox regression analysis showed that high UFR (UFR≥10.95 ml· h-1· kg-1),old age (＞ 60 years old),and low left ventricular ejection fraction (LVEF,≤50％ were independent risk factors of cardiovascular death.Conclusions High UFR level,old age and low LVEF are independent risk factors of cardiovascular death in hemodialysis patients.Maintaining low UFR level is beneficial to reduce cardiovascular mortality in hemodialysis patients.