Bogataj Špela, Pajek Jernej, Slonjšak Blaž, Peršič Vanja
Department of Nephrology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
J Clin Med. 2023 Oct 20;12(20):6634. doi: 10.3390/jcm12206634.
Impaired physical mobility in hemodialysis (HD) patients is considered an important modifiable risk factor of increased all-cause morbidity and mortality. To our knowledge, no study to date has determined the overall burden of limited physical mobility in prevalent HD patients. The aim of this research is to investigate impaired physical mobility and its clinical correlates. We conducted a cross-sectional observational study in all patients of the Centre for Acute and Complicated Dialysis at the University Medical Centre of Ljubljana, where the most complex patients receive HD on average three times per week. The data were collected through interviews based on a prepared questionnaire and medical history review. A total of 205 patients were included in this study (63.9 ± 15.4 years). Sixty percent (122/205) of the patients had little or no physical mobility impairment, and others were categorized with a minor or severe mobility limitation. A minor mobility impairment was found in 21% (43/205) of patients: 10 patients (5%) used a mobility aid in the form of a crutch, 9 patients (4%) were dependent on two crutches or a walker, and 24 patients (12%) were temporarily dependent on the assistance of a third person. Severe mobility limitations were observed in 22% (40/205) of patients, ranging from being confined to bed (19/205, 9%), confined to bed but able to perform some movements (19/205, 9%), and ambulatory but dependent on the assistance of a third person for locomotion (2/205, 1%). The most common causes of the limitation of mobility were neurological (19/40, 47.5%), cardiovascular (9/40, 22.5%), musculoskeletal (8/40, 20%), and other causes (4/40, 10%). A significant, moderate positive correlation was observed between mobility problems and the age of the participants (r = 0.36, < 0.001), while a significant, small positive correlation was obtained between the mobility problems and C-reactive protein (r = 0.15, = 0.044). Moreover, mobility problems had a small but significant negative correlation with albumin levels (r = -0.15, = 0.042). When controlling for age, results yield no significant correlations, and, in regression analysis, only the age ( < 0.001) and male gender ( = 0.007) of the participants were independent predictors of mobility impairment. We conclude that impaired mobility has a high overall prevalence among chronic HD patients. Strategies to prevent and improve mobility limitations are strongly needed.
血液透析（HD）患者身体活动能力受损被认为是全因发病率和死亡率增加的一个重要可改变风险因素。据我们所知，迄今为止尚无研究确定现存HD患者身体活动受限的总体负担。本研究的目的是调查身体活动能力受损情况及其临床相关性。我们在卢布尔雅那大学医学中心急性和复杂透析中心的所有患者中进行了一项横断面观察性研究，该中心最复杂的患者平均每周接受3次HD治疗。数据通过基于预先准备好的问卷进行访谈和回顾病史来收集。本研究共纳入205例患者（年龄63.9±15.4岁）。60%（122/205）的患者几乎没有或没有身体活动能力受损，其他患者则被归类为轻度或重度活动受限。21%（43/205）的患者存在轻度活动能力受损：10例患者（5%）使用拐杖作为活动辅助工具，9例患者（4%）依赖双拐或助行器，24例患者（12%）暂时依赖他人协助。22%（40/205）的患者存在重度活动受限，范围从卧床不起（19/205，9%）、卧床但能进行一些活动（19/205，9%）到能行走但依赖他人协助行动（2/205，1%）。活动受限最常见的原因是神经方面（1%，19/40）、心血管方面（22.5%，9/40）、肌肉骨骼方面（20%，8/40）和其他原因（10%，4/40）。在活动问题与参与者年龄之间观察到显著的中度正相关（r = 0.36，<0.001），而在活动问题与C反应蛋白之间观察到显著的轻度正相关（r = 0.15 = 0.044）。此外，活动问题与白蛋白水平之间存在轻度但显著的负相关（r = -0.15， = 0.042）。在控制年龄后，结果未显示显著相关性，并且在回归分析中，只有参与者年龄（<0.001）和男性性别（ = 0.007）是活动能力受损的独立预测因素。我们得出结论，慢性HD患者中活动能力受损的总体患病率较高。强烈需要预防和改善活动受限的策略。
