Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium.
PLoS One. 2022 May 19;17(5):e0268115. doi: 10.1371/journal.pone.0268115. eCollection 2022.
Physical performance is an important determinant of quality of life in patients on haemodialysis. An association between physical performance and survival could further enhance the importance of physical performance. We aimed to assess the association between different measures of physical performance and survival in dialysis patients.
117 patients on haemodialysis were included from December 2016 and followed up to September 2020. Muscle strength (quadriceps, handgrip strength, and sit-to-stand), exercise capacity (six-minute walking test, 6MWT) and the risk of falls (Dialysis Fall Index, Tinetti, and Frailty and Injuries: Cooperative Studies of Intervention Techniques) were measured at the time of inclusion. Hospitalisation, morbidity (Davies Stoke index) and death were recorded. Data were analysed by least squares linear regression models and competing risks survival hazard models.
During the observation period (median 33, min 30 max 45 months), 45 patients died (= 38.5%), resulting in a mortality rate of 15% per year. Cardiovascular disease (42.9%) was the most common cause of death. All domains of physical performance were associated with mortality, with the highest hazards for an increased risk of falls (Hazard Ratio (HR) = 20.4, p = 0.003) and poor exercise capacity (HR = 7.4, p<0.001). A score lower than 298 meters (specificity = 0.583; sensitivity = 0.889) on the 6MWT was established as a haemodialysis-specific cut-off point for mortality risk. Each increase in 6MWT (m) corresponded with a 0.4% decrease in mortality risk (HR = 0.996, 95%CI [0.994; 0.998]). The 6MWT as also associated with comorbidity (F-value = 6.1, p = 0.015). Physical performance was not associated with hospitalisation.
The 6MWT is associated with mortality in patients on haemodialysis and can be considered as a valid assessment tool to identify high-risk patients.
身体表现是血液透析患者生活质量的重要决定因素。身体表现与生存之间的关联可以进一步提高身体表现的重要性。我们旨在评估透析患者不同身体表现测量指标与生存之间的关联。
我们纳入了 2016 年 12 月至 2020 年 9 月期间的 117 名血液透析患者，并进行了随访。在纳入时测量了肌肉力量（股四头肌、手握力、从座位到站立）、运动能力（六分钟步行试验、6MWT）和跌倒风险（透析跌倒指数、Tinetti 和虚弱和损伤：合作干预技术研究）。记录了住院、发病率（戴维斯中风指数）和死亡情况。数据通过最小二乘线性回归模型和竞争风险生存风险模型进行分析。
在观察期内（中位数 33 个月，最小 30 个月，最大 45 个月），45 名患者死亡（=38.5%），死亡率为每年 15%。心血管疾病（42.9%）是最常见的死亡原因。身体表现的所有领域都与死亡率相关，跌倒风险增加（风险比（HR）=20.4，p=0.003）和运动能力差的风险最高（HR=7.4，p<0.001）。6MWT 低于 298 米（特异性=0.583；敏感性=0.889）被确定为血液透析患者死亡率风险的特定截止点。6MWT 每增加 1 米（m），死亡率风险降低 0.4%（HR=0.996，95%CI[0.994；0.998]）。6MWT 还与合并症相关（F 值=6.1，p=0.015）。身体表现与住院无关。
6MWT 与血液透析患者的死亡率相关，可以作为识别高危患者的有效评估工具。
