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Peso interdialítico e capacidade funcional em pessoas com Insuficiência Renal Crónica submetidas a hemodiálise: estudo transversal
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A insuficiência renal crónica (IRC) sob hemodiálise (HD) está associada a elevada morbimortalidade com impacto na capacidade funcional. O ganho de peso interdialítico (IDWG) é um indicador do estado volémico e valores elevados associam-se a sobrecarga hídrica e maior risco cardiovascular. A Prova de marcha de 6 minutos (6MWT) tem valor prognóstico e é amplamente utilizada para avaliar a capacidade funcional nesta população. Apesar da relevância destes indicadores a sua relação permanece pouco explorada.
Objetivos: Avaliar a relação entre IDWG e a capacidade funcional, medida através da distância percorrida na 6MWT, na pessoa com IRC sob HD e analisar a influência de variáveis clínicas como idade, sexo, tempo em diálise, a causa da DRC e a força da preensão manual nessa relação, bem como, explorar a diferença no desempenho funcional de pessoas com diferentes níveis IDWG.
Método: Estudo observacional e transversal com dados de 66 pessoas com IRC em programa HD numa clínica do norte de Portugal. Os dados clínicos e a distância percorrida na 6MWT foram estatisticamente analisados no SPSS Statistics v32.
Resultados: A amostra apresentou idade média de 69,76±15,34 anos sendo 60,6% do sexo masculino. A distância média percorrida foi de 289,03±144,17 metros (60,24%da distância prevista). Globalmente, entre o IDWG e a capacidade funcional não se observou uma relação significativa, apenas uma tendência negativa. Contudo, após ajuste das variáveis de confusão, o IDWG apresentou uma relação significativa com a percentagem da distância percorrida (β = -0,247; p = 0,045). As pessoas com IDWG ≥ 4% percorreram, em média, menos 16,57% da distância prevista (p = 0,014) e apresentaram um risco 4 a 4,5 vezes superior de baixo desempenho funcional em alguns modelos. A força de preensão manual foi o preditor mais forte (β até 0,515; p <0,001) e 81,8% da amostra apresentou força muscular baixa.
Conclusão: O IDWG não se revelou um preditor direto da capacidade funcional, mas ser um fator de risco clinicamente relevante. A capacidade funcional revelou-se multifatorial e a força de preensão manual o principal preditor. Estes achados sustentam a relevância da monitorização do estado hídrico e da capacidade funcional na prática do EEER, para a estratificação de risco e individualização das intervenções.
Chronic kidney disease (CKD) in patients undergoing hemodialysis (HD) is associated with high morbidity and mortality, negatively affecting functional capacity. Interdialytic weight gain (IDWG) is an indicator of volume status, and elevated values are associated with fluid overload and increased cardiovascular risk. The Six-Minute Walk Test (6MWT) has prognostic value and is widely used to assess functional capacity in this population. Despite the clinical relevance of these indicators, their relationship remains poorly understood. Objectives: To evaluate the relationship between IDWG and functional capacity, measured by the distance covered during the 6MWT, in individuals with CKD undergoing HD. Additionally, to analyse the influence of clinical variables, including age, sex, dialysis vintage, cause of CKD, and handgrip strength, on this relationship, and to explore differences in functional performance across different levels of IDWG. Methods: A cross-sectional observational study was conducted using data from 66 individuals with CKD enrolled in a maintenance HD programme at a dialysis clinic in northern Portugal. Clinical data and 6MWT performance were collected and analysed using IBM SPSS Statistics v32. Results: Participants had a mean age of 69.76 ± 15.34 years, and 60.6% were male. The mean distance covered in the 6MWT was 289.03 ± 144.17 metres, corresponding to 60.24% of the predicted distance. Overall, no significant association was observed between IDWG and functional capacity, although a negative trend was identified. However, after adjustment for potential confounding variables, IDWG was significantly associated with the percentage of predicted distance covered (β = −0.247, p = 0.045). Participants with IDWG ≥ 4% walked, on average, 16.57% less of the predicted distance (p = 0.014) and showed a four- to four-and-a-half-fold higher risk of poor functional performance in some models. Handgrip strength emerged as the strongest predictor of functional capacity (β up to 0.515, p < 0.001), and 81.8% of the sample presented low muscle strength. Conclusions: IDWG was not identified as a direct predictor of functional capacity but may represent a clinically relevant risk factor. Functional capacity was found to be multifactorial, with handgrip strength emerging as its strongest predictor. These findings support the importance of monitoring both volume status and functional capacity in Rehabilitation Nursing practice, contributing to risk stratification and the individualisation of rehabilitation interventions.
Chronic kidney disease (CKD) in patients undergoing hemodialysis (HD) is associated with high morbidity and mortality, negatively affecting functional capacity. Interdialytic weight gain (IDWG) is an indicator of volume status, and elevated values are associated with fluid overload and increased cardiovascular risk. The Six-Minute Walk Test (6MWT) has prognostic value and is widely used to assess functional capacity in this population. Despite the clinical relevance of these indicators, their relationship remains poorly understood. Objectives: To evaluate the relationship between IDWG and functional capacity, measured by the distance covered during the 6MWT, in individuals with CKD undergoing HD. Additionally, to analyse the influence of clinical variables, including age, sex, dialysis vintage, cause of CKD, and handgrip strength, on this relationship, and to explore differences in functional performance across different levels of IDWG. Methods: A cross-sectional observational study was conducted using data from 66 individuals with CKD enrolled in a maintenance HD programme at a dialysis clinic in northern Portugal. Clinical data and 6MWT performance were collected and analysed using IBM SPSS Statistics v32. Results: Participants had a mean age of 69.76 ± 15.34 years, and 60.6% were male. The mean distance covered in the 6MWT was 289.03 ± 144.17 metres, corresponding to 60.24% of the predicted distance. Overall, no significant association was observed between IDWG and functional capacity, although a negative trend was identified. However, after adjustment for potential confounding variables, IDWG was significantly associated with the percentage of predicted distance covered (β = −0.247, p = 0.045). Participants with IDWG ≥ 4% walked, on average, 16.57% less of the predicted distance (p = 0.014) and showed a four- to four-and-a-half-fold higher risk of poor functional performance in some models. Handgrip strength emerged as the strongest predictor of functional capacity (β up to 0.515, p < 0.001), and 81.8% of the sample presented low muscle strength. Conclusions: IDWG was not identified as a direct predictor of functional capacity but may represent a clinically relevant risk factor. Functional capacity was found to be multifactorial, with handgrip strength emerging as its strongest predictor. These findings support the importance of monitoring both volume status and functional capacity in Rehabilitation Nursing practice, contributing to risk stratification and the individualisation of rehabilitation interventions.
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Insuficiência renal crónica Diálise renal Ganho de peso Capacidade funcional