Kumru Gizem, Haktaniyan Busra, Ates Kenan, Erturk Sehsuvar, Nergizoglu Gokhan, Keven Kenan, Sengul Sule, Kutlay Sim
Ankara University Faculty of Medicine, Department of Nephrology, Ankara, Turkey.
Ankara University Faculty of Medicine, Department of Geriatrics, Ankara, Turkey.
Blood Purif. 2025 Jul 14:1-10. doi: 10.1159/000546941.
All dialysis modalities can potentially improve physical activity levels and patient well-being, primarily through better toxin clearance. We sought to assess the impact of medium cut-off hemodialysis (MCO-HD), high-flux hemodialysis (HF-HD), and high-flux hemodiafiltration (HF-HDF) on quantitative physical performance measures, which are prognostic for quality of life and mortality risk.
Ten maintenance hemodialysis patients received MCO-HD, HF-HD, and HF-HDF, each for a duration of 6 months. Outcomes encompassed alterations in physical activity levels, assessed with the International Physical Activity Questionnaire, and physical performance, evaluated through the 5-times sit-to-stand, 4-meter gait speed, grip strength tests, and bioelectrical impedance analysis.
The cohort comprised 7 men and 3 women with a median dialysis vintage of 96 months (IQR: 36). Dialysis adequacy (single-pool KtV ≥1.2) was attained across all modalities for 18 months, with no notable alterations in nutritional and inflammation markers, including serum albumin. Self-reported physical activity improved during MCO-HD (total MET min/week 234.5 [IQR: 1,188] vs. 1,229.5 [IQR: 1,683], p = 0.019). There were no significant changes in handgrip strength, gait speed, or muscle mass in either group, nor were there any notable differences between the groups. The 5-times sit-to-stand test has shown stability in the MCO-HD group, whereas a substantial enhancement over 6 months observed with the HF-HDF (12.34 [IQR: 3.88] vs. 10.18 [IQR: 3.14] seconds, p = 0.022]).
The MCO-HD group reported elevated physical activity levels, while the HF-HDF group demonstrated considerable enhancement in low extremity strength. The patient-centered selection of dialysis modality, including the implementation of exercises and nutritional interventions, may improve physical performance and patient outcomes.
所有透析方式都有可能主要通过更好地清除毒素来提高身体活动水平和患者幸福感。我们试图评估中截流血液透析（MCO-HD）、高通量血液透析（HF-HD）和高通量血液透析滤过（HF-HDF）对定量身体性能指标的影响，这些指标对生活质量和死亡风险具有预后意义。
10名维持性血液透析患者分别接受MCO-HD、HF-HD和HF-HDF治疗，每种治疗持续6个月。结果包括通过国际身体活动问卷评估的身体活动水平变化，以及通过5次坐立试验、4米步态速度、握力测试和生物电阻抗分析评估的身体性能。
该队列包括7名男性和3名女性，透析中位时间为96个月（四分位间距：36）。所有透析方式在18个月内均达到透析充分性（单池KtV≥1.2），营养和炎症指标（包括血清白蛋白）无明显变化。自我报告的身体活动在MCO-HD期间有所改善（每周总代谢当量分钟数234.5[四分位间距：1,188]对1,229.5[四分位间距：1,683]，p = 0.019）。两组的握力、步态速度或肌肉质量均无显著变化，两组之间也无明显差异。5次坐立试验在MCO-HD组显示稳定，而HF-HDF组在6个月内观察到显著改善（12.34[四分位间距：3.88]对10.18[四分位间距：3.14]秒，p = 0.022）。
MCO-HD组报告身体活动水平升高，而HF-HDF组显示下肢力量有显著增强。以患者为中心选择透析方式，包括实施运动和营养干预，可能会改善身体性能和患者预后。
