Objective To explore the potential categories and influencing factors of chronic comorbidity treatment burden in maintenance hemodialysis (MHD) patients. Methods Convenience sampling method was used to select MHD patients between April and May 2023 at Northern Jiangsu People’s Hospital and Jiangdu People’s Hospital as the research subjects. The general information questionnaire, Chronic Disease Comorbidity Treatment Burden Scale, and Health Literacy Scale for Chronic Disease Patients were used for the questionnaire survey. The latent class analysis was used to explore the classification of chronic comorbidity treatment burden in MHD patients, and the multi-class logistic regression analysis was used to explore the influencing factors of comorbidity treatment burden. Results A total of 450 survey questionnaires were distributed, and 406 valid questionnaires were collected, with an effective response rate of 90.22%. According to the latent class analysis results, the comorbidity treatment burden of MHD patients was divided into three potential categories. Among them, there were 26 cases in the low-burden group, 194 cases in the medium-burden group, and 186 cases in the high-burden group. The results of the ordered multi-class logistic regression analysis showed that patient age, educational level, dialysis age, number of comorbidities, and level of economic support were potential factors affecting the comorbidity treatment burden in MHD patients (P<0.05). Conclusions The comorbidity treatment burden of MHD patients can be divided into three potential categories. The age, educational level, dialysis age, number of comorbidities, and level of economic support of patients are potential factors affecting the comorbidity treatment burden in MHD patients.
ObjectiveTo discuss and analyze the sense of dignity and its influencing factors of maintenance hemodialysis (MHD) patients.MethodsPatients with MHD in hemodialysis center of West China Hospital of Sichuan University were selected from November 2019 to January 2020. Patients were selected by convenience sampling. The patients were investigated with Patient Dignity Inventory (PDI), Connor-Davidson Resilience Scale (CD-RISC) and Hospital Anxiety and Depression Scale.ResultsA total of 150 patients were included. The average scores of CD-RISC, anxiety, depression and PDI were 61.20±14.54, 4.97±1.38, 5.90±2.42 and 41.32±16.24, respectively. Among them, 121 cases (80.67%) had mild dignity impairment, 22 cases (14.67%) had moderate dignity impairment, 6 cases (4.00%) had severe dignity impairment, and 1 case (0.67%) had very serious dignity impairment. The results of multiple linear stepwise regression showed that depression, economic burden, social support, and vascular access were all positive predictors of esteem scores (P<0.001).ConclusionsClinical nurses can aim at the main factors affecting the sense of dignity of MHD patients. And individualized nursing plan and intervention measures can be formulated to improve the sense of dignity of patients and improve the quality of life of maintenance hemodialysis patients.
ObjectiveTo preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).MethodsThirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤?2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.ResultsThe DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤?2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.ConclusionsPostmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.
Objective To investigate the mediating effect of phase angle between muscle strength and muscle function in maintenance hemodialysis (MHD) patients, aiming to provide a reference basis for clinical improvement of muscle strength and muscle function in MHD patients. Methods Random sampling was used to collect patients undergoing outpatient MHD in the Wenjiang Hemodialysis Room of the Department of Nephrology, West China Hospital, Sichuan University between September and December 2023 as the subjects of this study. Muscle strength was assessed by handgrip strength, muscle function was assessed by Short Physical Performance Battery (SPPB), and phase angle was measured by bioelectrical impedance analysis. The mediating effect of phase angle between muscle strength and muscle function was analyzed. Results A total of 239 MHD patients were included, including 125 males (52.3%) and 114 females (47.7%). The mean phase angle of MHD patients was (5.77±1.17)°, 89 patients (37.2%) showed decreased muscle strength, and 109 patients (45.6%) showed muscle hypoplasia. Spearman’s correlation analyses showed that phase angle was significantly and positively correlated with both handgrip strength and SPPB in MHD patients (P<0.001). The results of mediation effect analysis showed that handgrip strength was able to positively predict phase angle (β=0.535, P<0.001); handgrip strength was able to positively predict SPPB (β=0.481, P<0.001); phase angle was able to positively predict SPPB (β=0.296, P<0.001); and when both handgrip strength and phase angle entered in the regression equation, both handgrip strength (β=0.392, P<0.001) and phase angle (β=0.165, P<0.05) could positively predict SPPB. Phase angle in MHD patients partially mediated the association between muscle strength and muscle function, with the mediating effect accounting for 32.5% of the total effect. Conclusions There is a close relationship between phase angle, muscle strength and muscle function in MHD patients, and muscle strength can affect muscle function directly or indirectly through phase angle. Medical professionals should pay attention to the muscle function of MHD patients and further improve their muscle function by improving their phase angle and muscle strength.
The incidence of sarcopenia and frailty in maintenance hemodialysis patients are high, and there are often comorbidities, which easily lead to more complications, thus increasing the hospitalization rate and reducing the quality of life of patients. This article reviews the definition, physiological mechanism, incidence and diagnosis, relationship and treatment strategies of sarcopenia and frailty in maintenance hemodialysis patients, in order to better prevent and intervene the occurrence of sarcopenia and frailty and provide a reference for prevention and treatment.
Objective To explore the current status of electronic health (eHealth) literacy and online health information seeking behavior of maintenance hemodialysis (MHD) patients, and to explore the relationship between them. Methods MHD patients in the Hemodialysis Center of West China Hospital of Sichuan University between January and April 2022 were selected by convenient sampling method. The patients were investigated with general condition questionnaire, eHealth Literacy Scale and internet health information retrieval behavior questionnaire. According to the score of eHealth literacy, patients were divided into high eHealth literacy group and low eHealth literacy group, to compare the differences between the two groups, and analyze the factors that affected the internet health information retrieval behavior. Results A total of 194 MHD patients were included. Among them, 112 were male and 82 were female. The average score of eHealth literacy was 24.84±9.24. There were 136 cases in low eHealth literacy group, and the average score of eHealth literacy was 20.76±7.91. There were 58 cases in high eHealth literacy group, and the average score of eHealth literacy was 34.36±3.01. Multivariate analysis showed that eHealth literacy and education level were the influencing factors of health information search behavior (P<0.05). Conclusions The overall eHealth literacy of MHD patients is low, and the online health information search means is single and behaviorally inconsistent. It is necessary to improve the eHealth literacy of hemodialysis patients, and at the same time, provide various health information publicity and education for patients with different levels of eHealth literacy, which will help them better carry out disease management.
ObjectiveTo understand the maintenance hemodialysis (MHD) patients’ intention to exercise rehabilitation and discuss the influencing factors.MethodsFrom January to March 2019, 141 MHD patients’ intention to exercise rehabilitation was investigated by cross-sectional survey, and the influencing factors of MHD patients’ intention to exercise rehabilitation were analyzed by multiple linear stepwise regression.ResultsA total of 141 questionnaires were issued and 139 valid ones were recovered. The mean score of exercise rehabilitation intention of MHD patients was 39.99±9.29, which was in the middle and high level. Age [unstandardized partial regression coefficient (b)=?5.277, 95% confidence interval (CI) (?8.640, ?1.915), P=0.002], educational level [b=2.412, 95%CI (1.161, 3.663), P<0.001], and 6-minute walking distance [b=3.526, 95%CI (0.032, 7.021), P=0.048] were the influencing factors of exercise rehabilitation intention of MHD patients.ConclusionMHD patients have high intension to exercise rehabilitation, and special attention should be paid to elderly patients and patients with low education level in clinical work to improve their intension to exercise rehabilitation.
Objective
To study the influence of calcium acetate tablets combined with compound alpha-keto acid on calcium and phosphorus metabolism in maintenance hemodialysis (MHD) patients.
Methods
A total of 112 MHD patients with hyperphosphatemia treated between May 2014 and May 2015 were included in this study. Based on random number table method, they were divided into calcium acetate group (n=37), compound alpha-keto acid group (n=36) and combined drug use group (n=39). All the patients were given a low protein diet. Twelve weeks after treatment, we compared the calcium and phosphorus metabolic indexes, nutrition indicator levels and adverse reactions within and across the three groups.
Results
Before treatment, there was no significant difference among the three groups in terms of serum calcium, phosphorus, calcium-phosphorus product, and parathyroid hormone (PTH) level (P>0.05). After treatment, the combined drug use group had significantly lower levels of serum phosphorus, calcium-phosphorus product and PTH than the other two groups (P<0.05). Before treatment, the levels of creatinine, serum total protein and albumin were not significantly different among the three groups (P>0.05). After treatment, the serum total protein and albumin level in the combined drug use group were significantly higher than those in the other two groups (P<0.01). Three was no significant difference among the three groups in terms of adverse reactions (P>0.05).
Conclusions
For MHD patients with hyperphosphatemia, the combined use of calcium acetate tablets and compound alpha-keto acid is better than the use of single drugs, which can effectively improve patients’ symptoms and reduce the level of serum phosphorus with high security. It is worthy of clinical recommendation.
Objective To understand the incidence of frailty in maintenance hemodialysis (MHD) patients, and to explore the correlation and influencing factors of frailty in MHD patients, so as to provide some basis for the intervention of frailty in MHD patients. Methods Patients who underwent MHD in the Department of Nephrology of West China Hospital of Sichuan University from January to March 2021 were selected. Frail scale and Pittsburgh Sleep Quality Index (PSQI) were used for evaluation, and the influencing factors of frail in patients with MHD and its correlation with frail were analyzed. Results A total of 141 patients with MHD were included, including 57 cases without frailty (40.43%), 71 cases in early frailty (50.35%), and 13 cases in frailty (9.22%). 54 cases (38.30%) had very good sleep quality, 56 cases (39.72%) had good sleep quality, 24 cases (17.02%) had average sleep quality, and 7 cases (4.96%) had very poor sleep quality. The frailty of MHD patients was positively correlated with age (rs=0.265, P=0.002), PSQI (rs=0.235, P=0.005) and magnesium (rs=0.280, P=0.001). Logistic regression analysis showed that the influencing factors of MHD patients’ frailty were gender [odds ratio (OR) =4.321, 95%confidence interval (CI) (1.525, 12.243), P=0.006], PSQI [OR=1.110, 95%CI (1.009, 1.222), P=0.032], magnesium [OR=122.072, 95%CI (4.752, 3 135.528), P=0.004], hypertension [OR=0.112, 95%CI (0.023, 0.545), P=0.007] and other diseases [OR=0.102, 95%CI (0.019, 0.552), P=0.008]. Conclusions The incidence of frailty in MHD patients is high. Gender, PSQI, magnesium, hypertension and other diseases are the influencing factors of frailty in MHD patients, and there is a correlation between frailty and sleep. It is suggested that renal medical staff should pay more attention to the assessment of MHD frailty and sleep, and carry out multi-disciplinary personalized intervention to improve the quality of life of MHD patients.
Objective To explore the current situation and influencing factors of self-regulatory fatigue in maintenance hemodialysis (MHD) patients, so as to provide good dialysis treatment for MHD patients, reduce their level of self-regulated fatigue and improve their quality of life. Methods The convenient sampling method was used to select the MHD patients in the Wenjiang Hemodialysis Center of West China Hospital of Sichuan University between April 12 and April 30, 2022. The patients were investigated by self-made basic information scale and self-regulatory fatigue scale. Results A total of 131 patients were included. The average score of self-regulatory fatigue was 53.47±6.45, cognitive dimension was 20.21±2.39, emotional dimension was 20.85±2.85, behavioral dimension was 12.40±3.63. The results of multiple linear stepwise regression analysis showed that age, duration of dialysis and educational background could inversely predict the score of self-regulatory fatigue (P<0.05). Conclusions MHD patients have a high level of self-regulatory fatigue. Clinical nurses can make individual dialysis programs according to the actual situation of MHD patients, improve their self-regulated level and physical and mental health, and improve the quality of life of MHD patients.
