Associação entre função física e medidas de desfechos relatados por pacientes em hemodiálise

Abstract

Introduction: Chronic kidney disease is an important public health problem, with high prevalence and substantial clinical impact, particularly in advanced stages when patients require dialysis. Patients undergoing hemodialysis frequently present impaired physical function, sleep disturbances, chronic pain, and symptoms related to anxiety and depression, factors that negatively affect quality of life and contribute to worse clinical outcomes. This study aimed to investigate the association between physical function and patient-reported outcome measures (PROMs) in patients undergoing hemodialysis. Methods: This multicenter cross-sectional study was conducted between May 2024 and June 2025 in four dialysis units. Patients aged ≥18 years undergoing regular hemodialysis for at least three months were included. Physical function was assessed using handgrip strength, usual 4-meter gait speed, and the five-times sit-to-stand test. In addition, validated questionnaires were applied to assess PROMs, including the Pittsburgh Sleep Quality Index, the Chronic Pain Grade Scale, and the Hospital Anxiety and Depression Scale. Comparisons between groups, defined according to established cutoff points for the physical function tests, were performed using Student’s t-test, Mann–Whitney test, and chisquare test, as appropriate. Associations between physical function tests and the evaluated outcomes were investigated using binary logistic regression in unadjusted and adjusted models, (age, sex, body mass index, and Charlson Comorbidity Index, use of psychotropic medications and use of analgesics), considering p < 0.05 as statistically significant. Results: A total of 189 patients were included, with a mean age of 59.6 ± 13.6 years, and 55.6% were male. Low handgrip strength, low usual gait speed, and low lower limb muscle strength were observed in 39.2%, 29.1%, and 39.2% of the patients, respectively. Persistent pain was reported by 38.1% of participants, while 58.7% presented poor sleep quality. Symptoms of anxiety and depression were present in 32.8% and 19.0% of the patients, respectively. In the binary logistic regression analysis, low usual gait speed was associated with persistent pain (OR: 2.12; 95%CI: 1.12– 4.02) and depressive symptoms (OR: 2.33; 95%CI: 1.10–4.95). However, after adjustment for potential confounders, the association remained significant only for depressive symptoms (adjusted OR: 2.53; 95%CI: 1.10–5.82). Conclusion: Low performance on the usual gait speed test was associated with the presence of depressive symptoms in patients undergoing hemodialysis.