Duarte Marvery P, Nóbrega Otávio T, Silva Maryanne Z C, Mondini Dario R, Sant'Helena Bruna M, Bundchen Daiana C, Bohlke Maristela, Adamoli Angélica N, Lima Ricardo M, Inda-Filho Antônio, Viana João L, Vogt Barbara P, Reboredo Maycon M, Ribeiro Heitor S
Faculty of Health Sciences, University of Brasilia, Brasília, Brazil.
Internal Medicine Department, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, Brazil.
Front Nutr. 2025 May 22;12:1583976. doi: 10.3389/fnut.2025.1583976. eCollection 2025.
Whether low muscle strength contributes to fatigue remains poorly understood. We investigated the association between dynapenia and self-reported fatigue in patients on hemodialysis.
A cross-sectional analysis of the multicenter SARC-HD study in 19 dialysis units across Brazil. Muscle strength was evaluated by handgrip strength (HGS) and five times sit-to-stand (STS-5). Low muscle strength (i.e., dynapenia) was defined based on the revised EWGSOP. Patients were stratified into four dynapenia phenotypes (i) no dynapenia; (ii) low HGS; (iii) low STS-5; and (iv) severe dynapenia (low HGS and STS-5). From the validated 36-item short-form health survey (SF-36) question about tiredness, patients self-reported their frequency of fatigue as (i) ; (ii) ; and (iii) .
Among 841 patients (58 ± 15 years, 38% female, and 49% Black), the prevalences of dynapenia by low HGS, low STS-5, and severe dynapenia were 13.9, 18.8, and 12.1%, respectively. Frequency of fatigue, self-reported as "," "" or "" was 39.5, 30.3, and 30.2%, respectively. The frequency of "Always or constantly" feeling fatigued was 24.2% among patients without dynapenia, 36.5% in dynapenia by low HGS, 37.2% in dynapenia by low STS-5, and 37.8% in severe dynapenia ( < 0.001). Adjusted logistic regressions showed a significant association between all dynapenia phenotypes and high frequency of fatigue compared to those without dynapenia (low HGS: odds ratio [OR] = 1.91; 95% confidence intervals [CI]: 1.12-3.23; low STS-5: OR = 2.35; 95%CI: 1.50-3.69; severe dynapenia: OR = 2.73; 95%CI: 1.55-4.81).
Patients on hemodialysis with low muscle strength were more likely to self-report a higher frequency of fatigue, independently of the dynapenia phenotype. This highlights the importance of recognizing low muscle strength as a potential contributor to fatigue in this population.
肌肉力量低下是否会导致疲劳仍未得到充分理解。我们调查了血液透析患者中肌肉减少症与自我报告的疲劳之间的关联。
对巴西19个透析单位的多中心SARC-HD研究进行横断面分析。通过握力（HGS）和五次坐立试验（STS-5）评估肌肉力量。根据修订后的EWGSOP定义低肌肉力量（即肌肉减少症）。患者被分为四种肌肉减少症表型：（i）无肌肉减少症；（ii）低HGS；（iii）低STS-5；（iv）严重肌肉减少症（低HGS和低STS-5）。根据经过验证的36项简短健康调查问卷（SF-36）中关于疲劳的问题，患者自我报告其疲劳频率为（i） ；（ii） ；和（iii） 。
在841名患者（年龄58±15岁，女性占38%，黑人占49%）中，低HGS、低STS-5和严重肌肉减少症导致的肌肉减少症患病率分别为13.9%、18.8%和12.1%。自我报告为“ ”“ ”或“ ”的疲劳频率分别为39.5%、30.3%和30.2%。在无肌肉减少症的患者中，“总是或持续”感到疲劳的频率为24.2%，低HGS导致的肌肉减少症患者中为36.5%，低STS-5导致的肌肉减少症患者中为37.2%，严重肌肉减少症患者中为37.8%（P<0.001）。调整后的逻辑回归显示，与无肌肉减少症的患者相比，所有肌肉减少症表型与高频率疲劳之间均存在显著关联（低HGS：优势比[OR]=1.91；95%置信区间[CI]：1.12-3.23；低STS-5：OR=2.35；95%CI：1.50-3.69；严重肌肉减少症：OR=2.73；95%CI：1.55-4.81）。
肌肉力量低下的血液透析患者更有可能自我报告更高频率的疲劳，且与肌肉减少症表型无关。这凸显了认识到低肌肉力量是该人群疲劳潜在因素的重要性。
