9种运动方式对提高血液透析患者透析充分性效果的网状Meta分析

doi:10.3761/j.issn.0254-1769.2022.23.016

摘要/Abstract

摘要：

目的系统评价不同运动方式对提高血液透析患者透析充分性的效果。方法系统检索PubMed、Cochrane Library、Embase、Web of Science和万方数据库、中国知网、维普数据库、中国生物医学文献数据库等中英文数据库中关于运动干预对改善血液透析患者透析充分性的文献，检索时限为建库至2022年1月1日。经文献筛选和资料提取，采用随机对照试验Cochrane偏倚评估工具2.0版本进行文献质量评价，采用RevMan 5.3和STATA 16.0软件进行统计分析。结果最终纳入30项研究，共1 216例患者，9种运动方式。网状Meta分析结果显示，透析中有氧联合抗阻运动和透析中有氧运动对提高血液透析患者单室尿素清除指数的效果在9种运动中位于前2名；透析中有氧运动和透析中有氧联合抗阻运动对提高血液透析患者尿素减少率的效果在6种运动中位于前2名。结论多种运动方式能够提高血液透析患者的透析充分性，尤其以透析中有氧联合抗阻运动、透析中有氧运动的效果最为明显。

关键词: 血液透析, 终末期肾脏病, 运动, 透析充分性, 网状Meta分析, 循证护理学

Abstract:

Objective To systematically evaluate the effect of different types of exercise in improving the dialysis adequacy of patients undergoing hemodialysis. Methods The databases of PubMed，Cochrane Library，Embase，Web of Science，WanFang，CNKI，VIP，and CBM were searched for the articles related to the effectiveness of exercise on the dialysis adequacy of patients undergoing hemodialysis，from inception to 1st January，2022. After literature screening and data extraction，Cochrane risk of bias tool 2.0 was used for quality evaluation. RevMan 5.3 and STATA 16.0 software were used for statistical analysis. Results 30 studies with 1 216 participants and 9 types of exercise were included. The results of the network meta-analysis showed that intradialytic combined aerobic and resistance exercise and intradialytic aerobic exercise were the top 2 types in improving the single pool clearance index on hemodialysis patients. Intradialytic aerobic exercise and intradialytic combined aerobic and resistance exercise were the top 2 types in improving the urea reduction ratio of hemodialysis patients. Conclusion The dialysis adequacy of hemodialysis patients can be improved by a variety of exercise，especially intradialytic combined aerobic and resistance exercise，and intradialytic aerobic exercise.

Key words: Hemodialysis, End-Stage Renal Disease, Exercise, Dialysis Adequacy, Network Meta-Analysis, Evidence-Based Nursing

罗细菊, 邓思妍, 陈静, 刘一秀, 胡化刚, 于翔. 9种运动方式对提高血液透析患者透析充分性效果的网状Meta分析[J]. 中华护理杂志, 2022, 57(23): 2921-2929.

LUO Xiju, DENG Siyan, CHEN Jing, LIU Yixiu, HU Huagang, YU Xiang. The effect of 9 types of exercise in improving the dialysis adequacy on patients undergoing hemodialysis：a network meta-analysis[J]. Chinese Journal of Nursing, 2022, 57(23): 2921-2929.

图/表 7

图1 文献筛查流程图

Figure 1 Flow chart of literature search

表1 纳入文献的基本特征（n=30）

Table 1 The basic characteristics of included studies（n=30）

表2 运动对提高血液透析患者透析充分性的传统Meta分析结果

Table 2 Results of traditional meta-analysis of exercises on improving dialysis adequacy

图2 单室尿素清除指数网状Meta分析证据网络图

Figure 2 Network meta-analysis evidence network diagram for spKt/V

表3 运动干预对提高血液透析患者单室尿素清除指数效果的网状Meta分析（MD，95%CI）

Table 3 Network meta-analysis of the effect of exercise intervention on improving spKt/V in patients undergoing hemodialysis（MD，95%CI）

图3 尿素减少率网状Meta分析证据网络图

Figure 3 Network meta-analysis evidence network diagram for URR

表4 运动干预对提高血液透析患者尿素减少率效果的网状Meta分析（MD，95%CI）

Table 4 Network meta-analysis of the effect of exercise intervention on improving URR in patients undergoing hemodialysis（MD，95%CI）

参考文献 39

[1]	GBD Chronic Kidney Disease Collaboration. and national burden of chronic kidney disease,1990-2017:a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2020, 395(10225):709-733. DOI URL
[2]	中国医师协会肾脏病医师分会血液透析充分性协作组. 中国血液透析充分性临床实践指南[J]. 中华医学杂志, 2015, 95(34):2748-2753.
	Hemodialysis Adequacy Collaborative Group of Nephrologists Branch of Chinese Medical Doctor Association. Clinical practice guidelines for hemodialysis adequacy in China[J]. Natl Med J China, 2015, 95(34):2748-2753.
[3]	Fang HY, Burrows BT, King AC, et al. A comparison of intradialytic versus out-of-clinic exercise training programs for hemodialysis patients[J]. Blood Purif, 2020, 49(1/2):151-157. DOI URL
[4]	冷成香, 曹文媚, 赵岳. 有氧运动对维持性血液透析患者的干预效果[J]. 中华护理杂志, 2012, 47(8):698-700.
	Leng CX, Cao WM, Zhao Y. Effects of aerobic exercise intervention in patients receiving maintenance hemodialysis[J]. Chin J Nurs, 2012, 47(8):698-700.
[5]	Zhao JR, Qi QG, Xu SS, et al. Combined aerobic resistance exercise improves dialysis adequacy and quality of life in patients on maintenance he-modialysis[J]. Clin Nephrol, 2020, 93(6):275-282. DOI URL
[6]	Tayebi M, Tayebi A, Einollahi B, et al. Isometric resistance training and bran-ched-chain amino acids supplementation can improve dialysis adequacy:a clinical trial[EB/OL].(2019-05-04)[2021-07-31]. https://go.exlibris.link/ycqvZbQT.
[7]	Dobsak P, Homolka P, Svojanovsky J, et al. Intra-dialytic electrostimulation of leg extensors may improve exercise tolerance and quality of life in hemo-dialyzed patients[J]. Artif Organs, 2012, 36(1):71-78. DOI PMID
[8]	Scapini KB, Bohlke M, Moraes OA, et al. Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease:systematic review and network meta-analysis[J]. J Physiother, 2019, 65(1):4-15. DOI PMID
[9]	Higgins J, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions[M]. 2nd ed. Hoboken, NJ:Wiley-Blackwell, 2019.
[10]	Gadelha AB, Cesari M, Corrêa HL, et al. Effects of pre-dialysis resistance training on sarcopenia,inflammatory profile,and anemia biomarkers in older community-dwelling patients with chronic kidney disease:a randomized controlled trial[J]. Int Urol Nephrol, 2021, 53(10):2137-2147. DOI URL
[11]	戴珊珊, 马迎春. 透析中递增式抗阻运动对维持性血液透析患者营养状况及体脂成分的影响[J]. 中华肾脏病杂志, 2021, 37(5):434-437. DOI
	Dai SS, Ma YC. Effect of intradialytic progressive resistance training on nutritional status and body composition in maintenance hemodialysis patients[J]. Chin J Nephrol, 2021, 37(5):434-437. DOI
[12]	郭思如. 维持性血液透析患者透析中运动与脑氧关系的研究[D]. 长春: 吉林大学, 2021.
	Guo SR. Study on the relationship between intradialytic exercise and cerebral regional oxygen saturation in patients with maintenance hemodialysis[D]. Changchun: Jilin University, 2021.
[13]	于新涛, 曹松梅, 吉小静, 等. 透析中运动干预对维持性血液透析患者的影响[J]. 护理学杂志, 2021, 36(17):5-8.
	Yu XT, Cao SM, Ji XJ, et al. Effect of intradialytic exercise program in maintenance hemodialysis patients[J]. J Nurs Sci, 2021, 36(17):5-8.
[14]	Bogataj Š, Pajek J, ButuroviĆ Ponikvar J, et al. Functional training added to intradialytic cycling lowers low-density lipoprotein cholesterol and improves dialysis adequacy:a randomized controlled trial[J]. BMC Nephrol, 2020, 21(1):352. DOI PMID
[15]	Huang M, Lü AL, Wang J, et al. The effect of intradialytic combined exercise on hemodialysis efficiency in end-stage renal disease patients:a randomized-controlled trial[J]. Int Urol Nephrol, 2020, 52(5):969-976. DOI PMID
[16]	Martins Do Valle F, Valle Pinheiro B, Almeida Barros AA, et al. Effects of intradialytic resistance training on physical activity in daily life,muscle strength,physical capacity and quality of life in hemodialysis patients:a randomized clinical trial[J]. Disabil Rehabil, 2020, 42(25):3638-3644. DOI
[17]	连芬, 吴靖, 沈华娟, 等. 低强度卧位体操对维持性血液透析患者透析充分性的重复测量方差分析[J]. 护理与康复, 2020, 19(2):55-58.
	Lian F, Wu J, Shen HJ, et al. Repeated measures ANOVA of low-intensity lying gymnastics on dialysis adequacy in maintenance hemodialysis patients[J]. J Nurs Rehabilitation, 2020, 19(2):55-58.
[18]	Dong ZJ, Zhang HL, Yin LX. Effects of intradialytic resistance exercise on systemic inflammation in maintenance hemodialysis patients with sarcopenia:a randomized controlled trial[J]. Int Urol Nephrol, 2019, 51(8):1415-1424. DOI URL
[19]	de Olival Fernandes A, Dos Santos Sens YA, Xavier VB, et al. Functional and respiratory capacity of patients with chronic kidney disease undergoing cycle ergometer training during hemodialysis sessions:a randomized clinical trial[J]. Int J Ne-phrol, 2019, 2019:7857824.
[20]	Oliveira E Silva VR, Stringuetta Belik F, Hueb JC, et al. Aerobic exercise training and nontraditional cardiovascular risk factors in hemodialysis patients:results from a prospective randomized trial[J]. Cardiorenal Med, 2019, 9(6):391-399. DOI PMID
[21]	García Testal A, García Maset R, Hervás Marín D, et al. Influence of physical exercise on the dialytic adequacy parameters of patients on hemodialysis[J]. Ther Apher Dial, 2019, 23(2):160-166. DOI URL
[22]	Paluchamy T, Vaidyanathan R. Effectiveness of intradialytic exercise on dialysis adequacy,physiological parameters,bioche-mical markers and quality of life-a pilot study[J]. Saudi J Kid-ney Dis Transpl, 2018, 29(4):902-910.
[23]	Abreu CC, Cardozo LFMF, Stockler-Pinto MB, et al. Does resistance exercise performed during dialysis modulate Nrf2 and NF-κB in patients with chronic kidney disease?[J]. Life Sci, 2017, 188:192-197. DOI PMID
[24]	尹丽霞, 胡晓艳, 张海林, 等. 透析中运动对维持性血液透析患者透析充分性及睡眠质量的影响[J]. 中国护理管理, 2017, 17(11):1478-1481.
	Yin LX, Hu XY, Zhang HL, et al. Effects of intradialytic exercise on dialysis adequacy and sleep quality in patients undergoing maintenance hemodialysis[J]. Chin Nurs Manag, 2017, 17(11):1478-1481.
[25]	Liao MT, Liu WC, Lin FH, et al. Intradialytic aerobic cycling exercise alleviates inflammation and improves endothelial progenitor cell count and bone density in hemodialysis patients[J]. Medicine(Baltimore), 2016, 95(27):e4134.
[26]	Roxo RS, Xavier VB, Miorin LA, et al. Impact of neuromuscular electrical stimulation on functional capacity of patients with chronic kidney disease on hemodialysis[J]. J Bras Nefrol, 2016, 38(3):344-350.
[27]	Groussard C, Rouchon-Isnard M, Coutard C, et al. Beneficial effects of an intradialytic cycling training program in patients with end-stage kidney disease[J]. Physiol Appliquee Nutr Metab, 2015, 40(6):550-556.
[28]	Mohseni R, Emami Zeydi A, Ilali E, et al. The effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients:a randomized controlled trial[J]. Oman Med J, 2013, 28(5):345-349. DOI URL
[29]	Pellizzaro CO, Thomé FS, Veronese FV. Effect of peripheral and respiratory muscle training on the functional capacity of hemodialysis patients[J]. Ren Fail, 2013, 35(2):189-197. DOI PMID
[30]	Afshar R, Shegarfy L, Shavandi N, et al. Effects of aerobic exercise and resistance training on lipid profiles and inflammation status in patients on maintenance hemodialysis[J]. Indian J Nephrol, 2010, 20(4):185-189. DOI PMID
[31]	Reboredo MDEM, Pinheiro BDOV, Neder JA, et al. Effects of aerobic training during hemodialysis on heart rate variability and left ventricular function in end-stage renal disease patients[J]. J Bras Nefrol, 2010, 32(4):367-373.
[32]	Cheema B, Abas H, Smith B, et al. Progressive exercise for anabolism in kidney disease(PEAK):a randomized,controlled trial of resistance training during hemodialysis[J]. J Am Soc Nephrol, 2007, 18(5):1594-1601. DOI PMID
[33]	Kopple JD, Wang HY, Casaburi R, et al. Exercise in maintenance hemodialysis patients induces transcriptional changes in genes favoring anabolic muscle[J]. J Am Soc Nephrol, 2007, 18(11):2975-2986. DOI PMID
[34]	de Greef MHG, Huisman RM. The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands:results of a randomized clinical trial[J]. Nephrol Dial Transplant, 2005, 20(1):141-146. DOI URL
[35]	Parsons TL, Toffelmire EB, King-VanVlack CE. The effect of an exercise program during hemodialysis on dialysis efficacy,blood pressure and quality of life in end-stage renal disease (ESRD) patients[J]. Clin Nephrol, 2004, 61(4):261-274. PMID
[36]	DePaul V, Moreland J, Eager T, et al. The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO:a randomized controlled trial[J]. Am J Kidney Dis, 2002, 40(6):1219-1229. PMID
[37]	Wald RM, Tentori FM, Tighiouart HM, et al. Impact of the ki-dney disease outcomes quality initiative(KDOQI) clinical practice guidelines for bone metabolism and disease in a large dialysis network[J]. Am J Kidney Dis, 2007, 49(2):257-266. PMID
[38]	陈管洁, 张海林, 尹丽霞, 等. 维持性血液透析合并肌少症患者运动干预方案的构建及应用[J]. 中华护理杂志, 2022, 57(7):798-806. DOI
	Chen GJ, Zhang HL, Yin LX, et al. Construction and application of intradialytic exercise intervention program in maintenance hemodialysis patients with sarcopenia[J]. Chin J Nurs, 2022, 57(7):798-806. DOI
[39]	孙柳, 王星燕, 李莉, 等. 血液透析患者透析过程中运动锻炼行为阶段的调查研究[J]. 中华护理杂志, 2014, 49(5):547-551.
	Sun L, Wang XY, Li L, et al. The stages of intra-dialytic exercise behavior in patients undergoing maintenance hemodialysis[J]. Chin J Nurs, 2014, 49(5):547-551.