Abstract
Abstract Introduction: Hemodialysis (HD) sessions associated with the chronic kidney disease (CKD) repercussions may cause respiratory muscle impairment and limitations of daily living activities, which may compromise the quality of life. Objective: To evaluate respiratory muscle strength and quality of life in HD patients. Methods: A cross-sectional study involving CKD patients of both sexes undergoing HD. All were evaluated during HD, using an evaluation form containing personal and clinical data, presence of comorbidities, lifestyle (including self-reported physical activity) and vital signs. Respiratory muscle strength was analyzed by maximum inspiratory (MIP) and maximum expiratory (MEP) pressures by manovacuometer and quality of life using the SF-36 questionnaire. Results: Sixty-eight patients were evaluated (69.1% men), with a mean age of 54.9 ± 13.6 years. The MEP% was below of predicted (79.5 ± 25.7) and the MIP% was reduced only in women (77.8 ± 38.7). The MIP% was related to CKD time (p = 0.04) in men. The SF-36 domain that showed the most impairment was physical limitation [25.0 (13.0-67.0)], while mental health was the least impaired domain [72.0 (62.0-84.0)]. Those who reported the practice of physical activity obtained better results in vitality domain (p = 0.01). In the analysis stratified by sex, the functional capacity domain was less compromised in men who practiced self-reported physical activity (p = 0.02). Conclusion: CKD patients undergoing HD had a reduction in MEP relative to predicted, in addition to a greater impairment of MIP in men with longer CKD time and in women alone, although the clinical relevance of this finding is uncertain. Quality of life was more compromised in the physical limitation domain, where those who self-reported physical activity achieved better results in the domains of vitality (total sample) and functional capacity (men).
Highlights
Hemodialysis (HD) sessions associated with the chronic kidney disease (CKD) repercussions may cause respiratory muscle impairment and limitations of daily living activities, which may compromise the quality of life
Our findings showed that expiratory muscle strength was reduced relative to predicted in a sample of CKD patients undergoing hemodialysis, and quality of life was more compromised in the physical limitation domain
We identified a significant relationship (p = 0.04) of lower maximum inspiratory (MIP)% in men with longer disease duration when comparing different categories of CKD time in our study, there was no relationship with hemodialysis time
Summary
Hemodialysis (HD) sessions associated with the chronic kidney disease (CKD) repercussions may cause respiratory muscle impairment and limitations of daily living activities, which may compromise the quality of life. Quality of life was more compromised in the physical limitation domain, where those who self-reported physical activity achieved better results in the domains of vitality (total sample) and functional capacity (men). Negative impacts have been attributed to dialysis treatment, which when associated with the repercussions of CKD further compromise the clinical status of patients, which may result in changes in calcium and phosphorus metabolism, functionality, independence, well-being and social life, which tend to be worsen as the disease progresses.[4,5] In addition, several systems may be affected, including the respiratory and musculoskeletal systems, when compared to the general population.[2]. Multiple factors have been attributed as an explanation for the occurrence of musculoskeletal structure abnormalities in CKD patients undergoing hemodialysis, such as uremic myopathy, deficit in muscle oxygenation, decrease in muscle ATP synthesis, modification of glycolytic enzymes, low fatty acid oxidation and changes in muscle proteins, which may compromise the peripheral and respiratory muscles.[6,7] the function and respiratory mechanics impacts may result in ventilatory deficit and decreased lung capacity, with consequent respiratory diseases development which may result from the possible respiratory muscles degradation.[7,8]
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