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维持性透析中影响低体力活动的表型。

Phenotypes influencing low physical activity in maintenance dialysis.

作者信息

Panaye Marine, Kolko-Labadens Anne, Lasseur Catherine, Paillasseur Jean-Louis, Guillodo Marie Paule, Levannier Martial, Teta Daniel, Fouque Denis

机构信息

Néphrologie, Hôpital E. Herriot, Lyon, France.

Hémodialyse, AURA Nord, Saint Ouen, France.

出版信息

J Ren Nutr. 2015 Jan;25(1):31-9. doi: 10.1053/j.jrn.2014.07.010. Epub 2014 Oct 8.

Abstract

OBJECTIVE

The "Pas à Pas" initiative aimed at evaluating the weekly physical activity (PA) and its determinants in a large cohort of dialysis patients.

SETTING

Physical inactivity is a risk factor for mortality in maintenance dialysis patients and is still poorly documented in this population.

DESIGN

A prospective national epidemiological study was performed.

SUBJECTS

A total of 1,163 patients on maintenance dialysis (hemodialysis and peritoneal dialysis) were included.

INTERVENTION AND MAIN OUTCOME MEASURE

PA was recorded during seven consecutive days using a pedometer to measure daily step numbers.

RESULTS

Median age was 63 years (Q1 51-Q3 75). Sixty-three percent were sedentary (<5000 steps/day) with a median of 3,688 steps/day (1,866-6,271)]. PA level was similar between hemodialysis patients and those on peritoneal dialysis (3,693 steps [1,896-6,307] vs. 3,320 [1,478-5,926], P = .33). In hemodialysis patients, PA was lower on dialysis days compared with nondialysis days (2,912 [1,439-5,232] vs. 4,054 [2,136-7,108], respectively, P < .01). PA gradually decreased with age, 57% being sedentary between 50 and 65 years and 83% of patients after 80 years. Beyond this age effect, we identified, for the first time, specific phenotypes of patients with lower PA, such as inflammation, cardiovascular disease, protein energy wasting, obesity, and diabetes. By contrast, previous kidney transplantation and a higher muscle mass were associated with higher PA.

CONCLUSIONS

Dialysis patients present a very low level of PA with high sedentary. Acting on patient's modifiable phenotypes may help to increase PA to improve morbidity, mortality, and quality of life.

摘要

目的

“循序渐进”倡议旨在评估一大群透析患者的每周身体活动(PA)及其决定因素。

背景

身体活动不足是维持性透析患者死亡的一个危险因素,而该人群对此的记录仍然很少。

设计

进行了一项前瞻性全国性流行病学研究。

研究对象

共纳入1163例维持性透析患者(血液透析和腹膜透析)。

干预措施和主要观察指标

连续七天使用计步器记录PA,以测量每日步数。

结果

中位年龄为63岁(第一四分位数51 - 第三四分位数75)。63%的患者久坐不动(每天步数<5000步),每天步数中位数为3688步(1866 - 6271步)。血液透析患者和腹膜透析患者的PA水平相似(3693步[1896 - 6307步]对3320步[1478 - 5926步],P = 0.33)。在血液透析患者中,透析日的PA低于非透析日(分别为2912步[1439 - 5232步]对4054步[2136 - 7108步],P < 0.01)。PA随年龄逐渐下降,50至65岁之间57%的患者久坐不动,80岁以后83%的患者久坐不动。除了这种年龄效应外,我们首次确定了PA较低患者的特定表型,如炎症、心血管疾病、蛋白质能量消耗、肥胖和糖尿病。相比之下,既往肾移植和较高的肌肉量与较高的PA相关。

结论

透析患者的PA水平非常低,久坐情况严重。针对患者可改变的表型采取措施可能有助于增加PA,以改善发病率、死亡率和生活质量。

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