Yüksel Muharrem, Durmuş Dilek, Nalçacıoğlu Hülya, Alaylı Gamze
Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey.
Department of Pediatric Nephrology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey.
Pediatr Nephrol. 2025 Apr;40(4):1093-1101. doi: 10.1007/s00467-024-06633-w. Epub 2024 Dec 26.
The study evaluated the relationship between balance function and skeletal muscle mass index (ASMI), physical function, and fatigue in children with chronic kidney disease (CKD).
A cross-sectional study of 83 children with CKD (stages 1-4, dialysis, transplant) and 71 healthy controls was conducted. Functional performance tests, including gait speed, 6-min walk distance (6MWD), five-repetition sit-to-stand (5RST), and timed up-and-go (TUG) tests, were administered. Quadriceps muscle strength (QMS) and hand grip strength (HGS) were assessed alongside bioelectrical impedance analysis (BIA) for muscle mass evaluation. Fatigue was measured using the Child Fatigue Scale, and balance was assessed using the Pediatric Balance Scale. Multivariate linear regression, performed exclusively on the CKD cohort, was used to determine factors influencing balance.
Children with CKD exhibited significantly lower muscle strength, physical performance, and balance than controls. Specifically, QMS on the right side was 7.16 ± 5.36 kg in the dialysis group versus 16.51 ± 8.66 kg in the CKD stages 1-4 group and 18.58 ± 7.27 kg in controls (p < 0.001). The 6MWD was 392 ± 50.34 m in the dialysis group compared to 476 ± 49.67 m in CKD stages 1-4 and 425 ± 68.94 m in controls (p < 0.001). Fatigue levels were highest in the dialysis group (41.00 ± 11.51), and balance scores were lowest in this group (47.71 ± 8.55) (p = 0.001 for both). Regression analysis showed that QMS (β = 0.333, p = 0.042), ASMI (β = 0.259, p = 0.043), gait speed (β = -0.347, p = 0.012), TUG (β = -0.656, p = 0.001), GFR (β = 0.238, p = 0.033), and lean mass (β = 0.710, p = 0.028) were significant predictors of balance.
The dialysis group presented the most significant reductions in ASMI, muscle strength, balance, and functional performance, alongside the highest fatigue levels. Balance was mainly influenced by fatigue, ASMI, QMS, and declining functional capabilities. Considering the negative impact of balance impairments on prognosis, early implementation of rehabilitation programs is essential for improving outcomes in CKD patients.
本研究评估了慢性肾脏病（CKD）患儿平衡功能与骨骼肌质量指数（ASMI）、身体功能及疲劳之间的关系。
对83例CKD患儿（1 - 4期、透析、移植）和71例健康对照进行了横断面研究。进行了功能性能测试，包括步态速度、6分钟步行距离（6MWD）、五次坐立试验（5RST）和计时起立行走（TUG）测试。评估了股四头肌力量（QMS）和握力（HGS），并同时采用生物电阻抗分析（BIA）评估肌肉质量。使用儿童疲劳量表测量疲劳程度，使用儿科平衡量表评估平衡功能。仅对CKD队列进行多变量线性回归，以确定影响平衡的因素。
CKD患儿的肌肉力量、身体性能和平衡功能明显低于对照组。具体而言，透析组右侧QMS为7.16±5.36kg，而CKD 1 - 4期组为16.51±8.66kg，对照组为18.58±7.27kg（p<0.001）。透析组的6MWD为392±50.34m，CKD 1 - 4期组为476±49.67m，对照组为425±68.94m（p<0.001）。疲劳水平在透析组最高（41.00±11.51），该组的平衡得分最低（47.71±8.55）（两者p = 0.001）。回归分析显示，QMS（β = 0.333，p = 0.042）、ASMI（β = 0.259，p = 0.043）、步态速度（β = -0.347，p = 0.012）、TUG（β = -0.656，p = 0.001）、肾小球滤过率（GFR，β = 0.238，p = 0.033）和去脂体重（β = 0.710，p = 0.028）是平衡功能的重要预测因素。
透析组的ASMI、肌肉力量、平衡功能和功能性能下降最为显著，同时疲劳水平最高。平衡功能主要受疲劳、ASMI、QMS及功能能力下降的影响。考虑到平衡功能障碍对预后的负面影响，早期实施康复计划对于改善CKD患者的预后至关重要。
