Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
J Ren Nutr. 2013 Sep;23(5):380-6. doi: 10.1053/j.jrn.2013.04.006. Epub 2013 Jun 22.
Pediatric patients on chronic hemodialysis (HD) are at high risk of inactivity and poor physical fitness. The aim of this study was to assess the main correlates of exercise capacity in a cohort of children and young adults on chronic HD.
Twelve patients on chronic HD (median age 15.6 years; range 9.1-24.2) underwent a 6-minute walking test (WT), spirometry, a 1-minute chair stand test, and the measurement of lower extremity strength. Demographic data, anthropometry (dry weight, height, body mass index, and skinfold thickness, all expressed as standard deviation scores [SDS]), biochemistry (serum albumin, hemoglobin, creatinine, C-reactive protein, bicarbonate), bioimpedance analysis, HD adequacy indices (spKt/V and eKt/V), left ventricular mass index, and medications were also recorded.
There was a significant correlation among the distance covered during the WT (median 552 m, range 186-670), forced vital capacity (87.8% of predicted, range 49.7-136), forced expiratory volume in 1 second (86.7%, range 54.7-126.7), and peak expiratory flow (75.5%, 49.7-105.1). All of these indices positively correlated with the weight SDS (r 0.69-0.85), pre-HD serum creatinine (0.57-0.77), and serum albumin (0.60-0.77) and negatively correlated with weekly erythropoietin dose per kilogram of body weight (from -0.64 to -0.83), with P values ranging from <.05 to <.0005. Lower extremity strength (median 11.5 kg, range 3-15) positively correlated with the number of stands at the chair stand test (median 33, range 18-47; r 0.73, P < .05) and serum albumin (r 0.83, P < .01). Distance at the WT, forced vital capacity, lower extremity strength, and the number of stands at the chair stand test all negatively correlated with C-reactive protein levels (r from -0.81 to -0.67, P < .05).
Our findings show that protein-energy wasting and chronic inflammation are strongly correlated with the exercise capacity of children and young adults on chronic HD.
接受慢性血液透析（HD）治疗的儿科患者存在活动不足和身体机能较差的高风险。本研究旨在评估一组慢性 HD 患儿和青少年的运动能力的主要相关因素。
12 名接受慢性 HD 治疗的患者（中位年龄 15.6 岁；范围 9.1-24.2）进行了 6 分钟步行测试（WT）、肺活量测定、1 分钟椅立测试和下肢力量测量。记录人口统计学数据、人体测量学（干重、身高、体重指数和皮褶厚度，均表示为标准偏差分数 [SDS]）、生物化学（血清白蛋白、血红蛋白、肌酐、C 反应蛋白、碳酸氢盐）、生物电阻抗分析、HD 充分性指数（spKt/V 和 eKt/V）、左心室质量指数和药物。
WT 期间覆盖的距离（中位数 552m，范围 186-670）、用力肺活量（预测值的 87.8%，范围 49.7-136）、1 秒用力呼气量（预测值的 86.7%，范围 54.7-126.7）和呼气峰流速（预测值的 75.5%，范围 49.7-105.1）之间存在显著相关性。所有这些指标均与体重 SDS（r 0.69-0.85）、HD 前血清肌酐（0.57-0.77）和血清白蛋白（0.60-0.77）呈正相关，与每周每公斤体重的红细胞生成素剂量（-0.64 至-0.83）呈负相关，P 值范围从<.05 至<.0005。下肢力量（中位数 11.5kg，范围 3-15）与椅立测试中的站立次数（中位数 33，范围 18-47；r 0.73，P<.05）和血清白蛋白（r 0.83，P<.01）呈正相关。WT 距离、用力肺活量、下肢力量和椅立测试中的站立次数均与 C 反应蛋白水平呈负相关（r 从-0.81 至-0.67，P<.05）。
我们的研究结果表明，蛋白质-能量消耗和慢性炎症与慢性 HD 患儿和青少年的运动能力密切相关。
