Raw data for hand and arm dysfunction following hemodialysis access placement

BACKGROUND: Patients with chronic or end-stage kidney disease (CKD/ESKD) often experience hand and arm dysfunction (HAD) following hemodialysis access placement, adversely affecting clinical outcomes and quality of life. Despite its prevalence, the underlying mechanisms of hemodialysis access-associated HAD remain largely unexplored. METHODS: We conducted a longitudinal study involving 30 patients with CKD/ESKD. Functional assessments, including grip strength, hand pressure, dexterity, sensory tests, and patient-reported HAD scores, were performed preoperatively and six weeks postoperatively. Brachioradialis muscle biopsies were analyzed for morphology, mitochondrial function, and transcriptomic profiles. Routine follow-up assessments were performed to determine functional hemoaccess success. RESULTS: Six weeks post-surgery, patients exhibited significant functional decline in the access limb. Postoperative grip strength declined by approximately 15% (P=0.0015), finger pressure decreased by ~30 mmHg (P&lt;0.0001), and the perceived HAD score increased significantly (P=0.0450) compared to the preoperative values. In contrast, dexterity and digital sensation remained unchanged postoperatively. Muscle morphology analysis revealed an ~12% reduction in mean myofiber cross-sectional area (P=0.0340) which was significantly correlated with grip strength (P=0.0425). Postoperative assessment uncovered an increase in mitochondrial respiration and content, which inversely correlated with finger pressure (P=0.0423). However, net oxidative phosphorylation and antioxidant capacity remained unchanged. RNA sequencing revealed the most significant postoperative alterations in genes related to myofiber development. Notably, patients with HAD exhibited a ~15% higher rate of unassisted dialysis access failure compared to those without HAD, suggesting a possible link between HAD and access failure. CONCLUSIONS: This study revealed that approximately 70% of patients undergoing hemodialysis access placement experience HAD, with significant functional impairments linked to altered myofiber morphology, mitochondrial content, and transcriptomic profiles in individuals with CKD/ESKD. Importantly, patients with HAD had a higher rate of access failure, highlighting the clinical importance of early recognition and intervention to address HAD in patients undergoing hemodialysis access surgery.背景：慢性或终末期肾病（chronic kidney disease/end-stage kidney disease, CKD/ESKD）患者在接受血液透析通路（hemodialysis access）置入术后常出现手与上肢功能障碍（hand and arm dysfunction, HAD），该并发症会对临床结局与生活质量造成不良影响。尽管其患病率较高，但血液透析通路相关HAD的潜在机制仍未得到充分阐明。 方法：本研究开展了一项纳入30例CKD/ESKD患者的纵向队列研究。分别于术前及术后6周对患者进行功能评估，评估内容包括握力（grip strength）、手部压力、灵巧度、感觉测试以及患者报告的HAD评分。同时对肱桡肌（brachioradialis）活检标本开展形态学、线粒体功能及转录组学（transcriptomic）特征分析。此外还进行常规随访评估，以明确血液透析通路的功能通畅成功率。 结果：术后6周时，患者的通路侧肢体出现显著的功能下降。与术前基线相比，术后握力下降约15%（P=0.0015），手指压力下降约30mmHg（P<0.0001），主观感知的HAD评分显著升高（P=0.0450）。与之相对，术后患者的灵巧度与手指感觉未发生明显变化。肌肉形态学分析显示，平均肌纤维横截面积减少约12%（P=0.0340），且该变化与握力显著相关（P=0.0425）。术后评估发现线粒体呼吸功能及含量均有所升高，且与手指压力呈负相关（P=0.0423）。但净氧化磷酸化水平与抗氧化能力未发生改变。RNA测序结果显示，术后与肌纤维发育相关的基因表达变化最为显著。值得注意的是，出现HAD的患者其无需辅助干预的透析通路失败（unassisted dialysis access failure）率较无HAD患者高约15%，提示HAD与通路失败之间可能存在关联。 结论：本研究表明，约70%接受血液透析通路置入术的患者会出现HAD，且存在显著功能障碍的患者，其肌纤维形态、线粒体含量及转录组学特征均发生改变。尤为重要的是，出现HAD的患者通路失败率更高，这凸显了早期识别并干预血液透析通路手术患者HAD的临床重要性。