Vanden Wyngaert Karsten, Van Craenenbroeck Amaryllis H, Holvoet Els, Calders Patrick, Van Biesen Wim, Eloot Sunny
Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, B-9000 Ghent, Belgium.
Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, B-2650 Antwerp, Belgium.
Toxins (Basel). 2020 Feb 22;12(2):135. doi: 10.3390/toxins12020135.
Impaired physical performance is common in patients on hemodialysis (HD) and is associated with poor prognosis. A patient relevant marker of adequacy of dialysis is lacking. Previous studies evaluated uremic toxicity by assessing the impact of different uremic toxins separately. However, such an approach is most likely not reflective of true uremic toxicity. Therefore, this cross-sectional study aimed to examine if the uremic syndrome, estimated as one composite of different uremic toxins (facilitated by ridge regression method) to reflect the kinetic behavior during dialysis, is associated with physical performance in patients on HD. Levels of p-cresyl glucuronide and sulfate, indole-acetic acid, indoxyl sulfate, uric acid, hippuric acid, and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid were assessed and associated by ridge regression to muscle strength, functional exercise capacity, and measures of balance and coordination. 75 HD patients were included (mean age 68 years, 57% male). The composite of different uremic toxins (i.e., uremic load) explained 22% of the variance in handgrip strength. Although there was an association between full body muscle strength and the composite uremic load independent of nutritional status, age and gender, the predictive power of composite uremic load for muscle weakness is limited. Single uremic toxins as well as composite uremic load were not associated with exercise capacity, coordination, and balance, indicating that the degree of uremia does not predict physical performance in patients on HD.
血液透析（HD）患者身体机能受损很常见，且与预后不良相关。目前缺乏一种与患者相关的透析充分性标志物。以往研究通过分别评估不同尿毒症毒素的影响来评估尿毒症毒性。然而，这种方法很可能无法反映真正的尿毒症毒性。因此，这项横断面研究旨在探讨将尿毒症综合征（通过岭回归法将不同尿毒症毒素合并为一个综合指标以反映透析过程中的动力学行为）与HD患者的身体机能是否相关。评估了对甲酚葡萄糖醛酸酯和硫酸盐、吲哚乙酸、硫酸吲哚酚、尿酸、马尿酸以及3-羧基-4-甲基-5-丙基-2-呋喃丙酸的水平，并通过岭回归分析将其与肌肉力量、功能运动能力以及平衡和协调能力指标相关联。纳入了75例HD患者（平均年龄68岁，57%为男性）。不同尿毒症毒素的综合指标（即尿毒症负荷）解释了握力差异的22%。尽管全身肌肉力量与综合尿毒症负荷之间存在关联，且不受营养状况、年龄和性别的影响，但综合尿毒症负荷对肌肉无力的预测能力有限。单一尿毒症毒素以及综合尿毒症负荷与运动能力、协调性和平衡均无关联，这表明尿毒症程度并不能预测HD患者的身体机能。
