| Part Ⅰ: Influencing factors of sarcopenia with maintenance hemodialysis patients BackgroundSarcopenia is a chronic disease related to aging.Its main feature is the decline of muscle mass,muscle strength and physical function.Studies have found that it has a high incidence in maintenance hemodialysis(MHD),which seriously affects patients’ quality of life and increases risk of death.However,apart from dialysis and aging,the factors of sarcopenia in MHD patients are also closely related to inflammation and nutritional status,which need to be further explored.ObjectiveTo explore the prevalence of sarcopenia in MHD patients and analyze its influencing factors.MethodsThis study is a single-center cross-sectional study.195 MHD patients who were treated regularly in the blood purification center of our hospital from March 2021 to December 2021 were enrolled.Demographic data,biochemical indicators(serum liver and kidney function,blood lipid profile,albumin,prealbumin,etc.)before dialysis and inflammation indicators(Interleukin-6,C-reactive protein,Tumor necrosis factor),measurement of anthropometric indicators [Height,Weight,Triceps Skinfold Thickness(TSF),Mid-arm Circumference(MAC),Mid-arm muscle Circumference(MAMC),Pinch Strength(PS),Handgrip Strength(HGS)were improved.Bioelectrical Impedance Spectroscopy(BIS)was used to analyze body composition,and Nutritional Risk Screening 2002(NRS2002),7 points Subjective Global Assessment(SGA),Geriatric Nutritional Risk Index(GNRI)were used to evaluate the nutritional status of patients.And to evaluate their sleep quality and life quality by Pittsburgh sleep quality index(PSQI)and 36-item Short-Form(SF-36).According to the diagnostic criteria of Asian Working Group for Sarcopenia(AWGS),patients were divided into two groups: sarcopenia group and non-sarcopenia group.For data with normal distribution and homogeneity variance,independent sample T test was used to compare the differences between groups;for data with uneven or non-normal distribution,independent sample non-parametric test was used to compare the differences between groups.Multivariate binary Logistic regression was used to analyze the independent factors associated with the risk of sarcopenia in MHD patients.Results136 MHD patients participated in the study,with 85 males(62.5%)and 51females(37.5%),a median age of 65(58,74)years and a median dialysis age of26(12,54)months,including 50% patients complicated with diabetes.Definition and diagnostic cutoffs for sarcopenia according to AWGS,the prevalence rate of sarcopenia was 36.0%.Compared with patients non-sarcopenia group,patients with sarcopenia had lower predialysis serum phosphorus,PS,MAC,MAMC,TSF,waist circumference,hip circumference,waist-hip ratio,calf circumference,body mass index(BMI)value and body composition analysis indexes,poor social function and higher risk of malnutrition.However,there were no statistically significant differences in inflammation indicators,HGS,6m walking speed and sleep quality between the two groups.Female,younger age,lower BMI,body cell mass(BCM)and skeletal muscle mass(SMM)were independent risk factors for sarcopenia.ConclusionIn my center,the prevalence of sarcopenia in MHD patients is high,and MHD patients with sarcopenia had higher risk of malnutrition and lower quality of life.Female,younger age,lower BMI,BCM and SMM were independent risk factors of sarcopenia with MHD patients.Part Ⅱ: Study on the effect of comprehensive exercise on sarcopenia in MHD patientsBackgroundIn recent years,more and more people pay attention to sarcopenia,especially hemodialysis patients.With the increase of age,exercise endurance decreases in MHD patients,and exercise intervention was considered as an effective measure to reduce sarcopenia.However,many exercise intervention methods were not necessarily suitable and convenient for MHD patients and were not standardized.Therefore,It is necessary to set a convenient,standardized and appropriate comprehensive exercise method for sarcopenia in MHD patients,and observe its effect on MHD patients with sarcopenia.Objective A set of moderate and low intensity resistance-aerobic exercise methods(Red Cross Hospital MHD exercise for short)designed by our center were used to intervene MHD patients with sarcopenia,and observed its effect on sarcopenia.Methods This study is a single-center,randomized,controlled,open-label clinical trial.MHD patients with sarcopenia who were treated regularly in the blood purification center of our hospital from March 2021 to December 2021 were enrolled.According to the random number table method,30 MHD patients who met the inclusion criteria were randomly divided into control group and intervention group,with 15 cases in each group.The intervention group received elastic belt resistance exercise training for 12 weeks,three times a week in interdialysis.Cycling aerobic exercise training was carried out during dialysis,while the control group was only given routine treatment without any exercise intervention.After 12 weeks of intervention,biochemical examination before dialysis,inflammation,anthropometric indexes,human body composition by bioelectrical impedance,NRS2002,7SGA and GNRI were collected,as well as their sleep quality and life quality.Independent sample T test,non-parametric test and Fisher’s exact probability method were used to evaluate the equilibrium of baseline.For intra-group comparison,paired T test was used for normal distribution,and Wilcoxon test was used for non-normal distribution.P<0.05 is the difference with statistical significance.Results A total of 26 MHD patients with sarcopenia completed the trial.In patients in the exercise group,the hemoglobin(Hb)increased,MAC,MAMC,waist circumference,calf circumference and nutritional status were improved,the serum creatinine and total cholesterol decreased in the intervention group(P<0.05).However,there was no statistically significant difference in inflammation,most of body composition analysis index,sleep quality and most of life quality between the two groups(P>0.05).Conclusion Red Cross Hospital MHD exercise was beneficial to increase HB level,improved nutritional status and reduced serum creatinine and blood lipid,but there was no significant improvement in inflammation index,body composition analysis index,life quality and sleep quality. |
PDF Full Text Request