Abstract: 【Abstract】Objective To explore the risk factors of debilitation in maintenance hemodialysis (maintenance hemodialysis，MHD) patients and observe the efficacy of exercise combined with nutritional support group intervention. Methods 195 MHD patients who were treated in the hemodialysis center of "the 3rd degree and grade A" hospitals in Nanjing were recruited in this study, and 75 of them were screened according to the weakness diagnostic criteria of Tilburg weakness scale. Then analyze the influencing factors of debilitation in these MHD patients. According to the different intervention methods, these debilitating patients were
divided into the following groups: group A included 20 cases of routine nursing intervention; group B included 20 cases of simple exercise intervention, group C included 18 cases of simple nutrition support and group D included 17 cases of exercise combined nutrition intervention. In this study, the effects of debilitating state of patients before and after intervention were compared. Results The multivariate regression analysis shown that, age (or value (95% CI) = 1.041 (1.012～1.183), P=0.008), serum albumin [(OR value (95% CI)=0.841 (0.812～1.192), P =0.001], 25-hydroxyvitamin D [OR value (95%CI) = 0.782 (0.223～0.892), P = 0.018[, nutritional risk assessment score [or value (95% CI) = 1.157 (1.092-～1.523), P ＜ 0.001)], walking speed [OR value (95% CI) = 0.632 (0.191～0.972), P = 0.032] and grip strength [OR value (95% CI) = 0.767 (0.309～0.589), P = 0.026)] were risk factors of debilitation in MHD patients. After different interventions, the mean debilitation scores were decreased in all the groups, and the effect was better in group B, C and D than that in group A (t = 3.956, P ＜ 0.001, t= 3.258, P = 0.002, t= 0.254, P=0.036), and the effect was better in group D than that in group B and C (t = 2.463, P = 0.024, t= 2.421, P = 0.025). Conclusion The occurrence of debilitation in MHD patients was related to age, serum albumin, 25-hydroxyvitamin D, nutritional risk assessment score, walking speed and grip strength. Moreover, nutritional support combined with exercise can effectively improve the debilitation state of MHD patients.

Key words: Hemodialysis, Weakness, Influencing Factors, Nutrition group, Resistance exercise