Uchiyama Kiyotaka, Washida Naoki, Muraoka Kaori, Morimoto Kohkichi, Kasai Takahiro, Yamaki Kentaro, Miyashita Kazutoshi, Wakino Shu, Itoh Hiroshi
Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Perit Dial Int. 2019 Jan-Feb;39(1):66-73. doi: 10.3747/pdi.2018.00075. Epub 2018 Nov 25.
Muscle wasting, common and progressive in uremic patients, is associated with a high probability for morbidity, lower health-related quality of life (HRQOL), and mortality. However, exercise tolerance in peritoneal dialysis (PD) patients has not been fully elucidated. The aim of this study was to evaluate exercise capacity, its determinants, and its association with HRQOL in PD patients.
Outpatients treated with PD at Keio University Hospital from December 2016 to March 2018 were included in this single-center cross-sectional observational study. Exercise capacity was assessed by incremental shuttle walking test (ISWT) and handgrip and quadriceps strength. In addition to evaluation of PD-related parameters, HRQOL was assessed by the Kidney Disease Quality of Life-Short Form questionnaire.
Among the 50 recruited PD outpatients, age and PD vintage were 63.8 ± 9.6 and 3.8 ± 2.8 years, respectively. Physical examination revealed ISWT of 312.0 ± 138.2 m, handgrip strength of 27.5 ± 6.9 kg, and quadriceps strength of 23.3 ± 10.0 kg. Multivariate analysis showed that younger age and male sex were significantly associated with higher ISWT and handgrip and quadriceps strength. Skeletal mass index (SMI) remained a significant predictor of handgrip and quadriceps strength. Moreover, only ISWT was strongly correlated with higher HRQOL scores, including physical, mental, and kidney-specific domains, even after adjustment for age and sex.
Exercise tolerance in PD patients was partially determined by age, sex, and SMI. Moreover, this is the first study to demonstrate the strong relationship between aerobic capacity and HRQOL in PD patients.
肌肉萎缩在尿毒症患者中常见且呈进行性发展，与高发病概率、较低的健康相关生活质量（HRQOL）及死亡率相关。然而，腹膜透析（PD）患者的运动耐量尚未完全阐明。本研究旨在评估PD患者的运动能力、其决定因素及其与HRQOL的关联。
本单中心横断面观察性研究纳入了2016年12月至2018年3月在庆应义塾大学医院接受PD治疗的门诊患者。通过递增式往返步行试验（ISWT）以及握力和股四头肌力量评估运动能力。除了评估与PD相关的参数外，还通过肾脏病生活质量简表问卷评估HRQOL。
在招募的50例PD门诊患者中，年龄和PD透析龄分别为63.8±9.6岁和3.8±2.8年。体格检查显示，ISWT为312.0±138.2米，握力为27.5±6.9千克，股四头肌力量为23.3±10.0千克。多因素分析显示，年龄较小和男性与较高的ISWT、握力和股四头肌力量显著相关。骨骼肌质量指数（SMI）仍然是握力和股四头肌力量的重要预测指标。此外，即使在调整年龄和性别后，只有ISWT与较高的HRQOL评分密切相关，包括身体、心理和肾脏特定领域。
PD患者的运动耐量部分由年龄、性别和SMI决定。此外，这是第一项证明PD患者有氧能力与HRQOL之间存在密切关系的研究。
