Tsai Yi-Chun, Chen Hui-Mei, Hsiao Shih-Ming, Chen Cheng-Sheng, Lin Ming-Yen, Chiu Yi-Wen, Hwang Shang-Jyh, Kuo Mei-Chuan
Division of General Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
PLoS One. 2017 Aug 23;12(8):e0183642. doi: 10.1371/journal.pone.0183642. eCollection 2017.
Patients with chronic kidney disease (CKD) are more readily prone to have impaired physical activity than the general population. The aim of this study is to examine the relationship between physical activity and adverse clinical outcomes and quality of life (QOL) in CKD. One hundred and sixty-one patients with CKD stages 1-5 was enrolled from February 2013 to September 2013 and followed up until June 2016. Physical activity was measured using high handgrip strength, 30-second chair stand, and 2-minute step. The QOL was assessed using the Taiwan version of the World Health Organization Quality of Life-BREF. Clinical outcomes included commencing dialysis, major adverse cardiovascular events (MACEs), and first hospitalization. Of all participants, 1 kgf increase in handgrip strength was significantly associated with 0.13 score increase in total scores of QOL and 0.05 score increase in physical domain of QOL in adjusted analysis. One time increase in 30-second chair stand was significantly correlated with 0.14 score increase in psychological domain of QOL. Over a mean follow-up period of 29.1±11.2 months, 37 (23.0%) reached commencing dialysis, 11(6.8%) had MACEs, and 50(31.1%) had first hospitalization. High handgrip strength (hazard ratio (HR): 0.89, 95% CI: 0.84-0.96) and high 2-minute step (HR: 0.04, 95% CI: 0.01-0.95) were significantly associated with decreased risk for commencing dialysis in multivariate analysis. Thirty-second chair-stand was negatively associated with MACEs (HR: 0.65, 95%CI: 0.47-0.89) and first hospitalization (HR: 0.84, 95%CI: 0.74-0.95). In conclusion, physical activity is a potential predictor of QOL and adverse clinical outcomes in patients with CKD.
与普通人群相比，慢性肾脏病（CKD）患者更容易出现身体活动受损的情况。本研究旨在探讨CKD患者身体活动与不良临床结局及生活质量（QOL）之间的关系。2013年2月至2013年9月招募了161例1 - 5期CKD患者，并随访至2016年6月。使用高握力、30秒椅子站立试验和2分钟步行试验来测量身体活动。使用台湾版世界卫生组织生活质量简表（WHOQOL - BREF）评估生活质量。临床结局包括开始透析、主要不良心血管事件（MACE）和首次住院。在所有参与者中，校正分析显示握力每增加1千克力，生活质量总分增加0.13分，生活质量身体领域得分增加0.05分。30秒椅子站立试验次数每增加一次，生活质量心理领域得分显著增加0.14分。在平均29.1±11.2个月的随访期内，37例（23.0%）开始透析，11例（6.8%）发生MACE，50例（31.1%）首次住院。多因素分析显示，高握力（风险比（HR）：0.89，95%置信区间（CI）：0.84 - 0.96）和高2分钟步行试验结果（HR：0.04，95%CI：0.01 - 0.95）与开始透析风险降低显著相关。30秒椅子站立试验与MACE（HR：0.65，95%CI：0.47 - 0.89）和首次住院（HR：0.84，95%CI：0.74 - 0.95）呈负相关。总之，身体活动是CKD患者生活质量和不良临床结局的潜在预测指标。
