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Sember V, Bogataj Š, Ribeiro JC, Paravlić A, Pajek M, Pajek J. Accelerometry Correlates in Body Composition, Physical Fitness, and Disease Symptom Burden: A Pilot Study in End-Stage Renal Disease. Front Physiol 2021; 12:737069. [PMID: 34950045 PMCID: PMC8688961 DOI: 10.3389/fphys.2021.737069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
There is strong evidence that hemodialysis (HD) patients with a sedentary lifestyle have a higher risk of death compared to peers who engage in regular physical activity. Therefore, monitoring physical activity is of utmost importance. However, there is a lack of data on objectively measured physical activity behaviors in HD patients. Therefore, this study aimed to objectively measure physical activity in HD patients throughout the week, with particular attention to dialysis and non-dialysis days. We also examined how objectively measured physical activity correlated with physical fitness, body composition, and disease burden. Daily physical activity, body composition, serum parameters, comorbidity index, sit-to-stand, and hand-grip strength tests were measured in 14 HD patients. Daily physical activity was measured using the Actigraph GT9X accelerometer. The Dialysis Symptom Index questionnaire was also used. We found significant differences in anthropometric variables (weight, body mass index, overhydration, lean tissue index, and fat tissue index, all p < 0.05) and phase angle (p < 0.01) between HD patients reaching and patients not reaching physical activity guidelines for patients with chronic diseases. HD patients showed to be less active during dialysis days compared to non-dialysis days as indicated in sedentary time (–11.7%; p = 0.001), light (–47.3%; p = 0.003), moderate (–51.5%; p = 0.001), moderate to vigorous (–49.3%; p = 0.001), and vigorous (–34.3%; p = 0.067) physical activity. No significant correlations were found among serum parameters, symptom burden, and comorbidity burden, but a very large and positive correlation was found between phase angle and total moderate to vigorous physical activity (p < 0.01). Our findings support the need to implement physical activity on dialysis days in HD units to mitigate the effects of sedentary behavior. Prospective, long-term studies evaluating the use of accelerometers in HD patients and their effects on physical activity are needed.
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Affiliation(s)
- Vedrana Sember
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Špela Bogataj
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.,Department of Nephrology, University Medical Centre, Ljubljana, Slovenia
| | - Jose Carlos Ribeiro
- Faculty of Sports, Research Centre in Physical Activity Health and Leisure, University of Porto, Porto, Portugal
| | - Armin Paravlić
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.,Science and Research Centre, Institute of Kinesiology Research, Koper, Slovenia
| | - Maja Pajek
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Pajek
- Department of Nephrology, University Medical Centre, Ljubljana, Slovenia
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Nunes CF, Carvalho TRD, Duarte RDS, Barboza YACO, Lemos MCCD, Pinho CPS. Prevalence of sarcopenia and associated factors in patients in hemodialysis. REVISTA CIÊNCIAS EM SAÚDE 2021. [DOI: 10.21876/rcshci.v11i4.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective: To assess the prevalence of sarcopenia and associated factors in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). Methods: This cross-sectional study evaluated patients with CKD undergoing HD from January to October 2016 in two dialysis centers located in Recife, Pernambuco. For the diagnosis of sarcopenia, the criteria proposed by the 2019 European Consensus on Sarcopenia, which advocates low muscle strength as the main criterion, were considered. Demographic, clinical, anthropometric, and behavioral covariates were evaluated. Results: 108 patients were included, with a mean age of 51.4 ± 17.0 years and homogeneous distribution between the sexes.Sarcopenia was present in 38.9% of the population, of which 69% had severe sarcopenia. A higher prevalence of sarcopenia was observed among men (60% vs. 17%; p < 0.001), in those without a partner (48.1% vs. 30.4%; p < 0.045), in smokers (50% vs. 30%; p < 0.034), with low weight (underweight 73.3%, eutrophic 33.9%, overweight 32.4%; p = 0.001) and those with normal albumin levels (47.5% vs. 28.6%; p = 0.045). Conclusion: Approximately one in three nephropathic patients on hemodialysis presented sarcopenia and, among these, most had the severe form of this condition.Uremic sarcopenia was more prevalent in males, in individuals without partners, underweight, in smokers, and among those with normal albumin levels.
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3
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Yoshioka M, Kosaki K, Matsui M, Shibata A, Oka K, Kuro-O M, Saito C, Yamagata K, Maeda S. Replacing sedentary time for physical activity on bone density in patients with chronic kidney disease. J Bone Miner Metab 2021; 39:1091-1100. [PMID: 34319455 DOI: 10.1007/s00774-021-01255-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study aimed to examine the cross-sectional associations of sedentary time and physical activity time with bone density in patients with chronic kidney disease (CKD). The isotemporal substitution (IS) modeling was used to estimate the beneficial effects of behavioral changes (e.g., replacing sedentary time with physical activity time) on bone density in these patients. MATERIALS AND METHODS A total of 92 patients with CKD (age: 65 ± 9 years; estimated glomerular filtration rate: 57 ± 22 mL/min/1.73 m2) were included in this cross-sectional study. The times spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were assessed using a triaxial accelerometer. Through quantitative ultrasound measurements, the stiffness index, as a measure of bone density, was calculated using the speed of sound and broadband ultrasound attenuation. RESULTS In multivariate analyses, the stiffness index was beneficially associated with the MVPA time (β = 0.748), but was not significantly associated with the SB and LPA times. The IS models showed that replacing 10 min/day of SB with the equivalent LPA time was not significantly associated with the stiffness index; however, replacing 10 min/day of SB with the equivalent MVPA time was beneficially associated with the stiffness index (β = 0.804). CONCLUSION These results suggest that a small increase in MVPA time (e.g., 10 min/day) may attenuate the decline in bone density in patients with CKD. Our findings may provide insight for the development of novel strategies for improving bone health in patients with CKD.
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Affiliation(s)
- Masaki Yoshioka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
- Japan Society for the Promotion of Science, 5-3-1 Kouzimachi, Chiyoda-ku, Tokyo, 102-8472, Japan
| | - Keisei Kosaki
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Masahiro Matsui
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
- Japan Society for the Promotion of Science, 5-3-1 Kouzimachi, Chiyoda-ku, Tokyo, 102-8472, Japan
| | - Ai Shibata
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, 2-579-15, Tokorozawa, Saitama, 359-1192, Japan
| | - Makoto Kuro-O
- Division of Anti-Aging Medicine, Center for Molecular Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, Japan
| | - Chie Saito
- Department of Nephrology, Factory of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Factory of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
- R&D Center for Smart Wellness City Policies, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Seiji Maeda
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan.
- Faculty of Sport Sciences, Waseda University, 2-579-15, Tokorozawa, Saitama, 359-1192, Japan.
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Li T, Lv A, Xu N, Huang M, Su Y, Zhang B, Li X. Barriers and facilitators to exercise in haemodialysis patients: A systematic review of qualitative studies. J Adv Nurs 2021; 77:4679-4692. [PMID: 34258784 DOI: 10.1111/jan.14960] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/08/2021] [Accepted: 06/15/2021] [Indexed: 01/24/2023]
Abstract
AIMS The purpose of this systematic review is to synthesize the results of qualitative research and to identify the barriers and facilitators to exercise in haemodialysis patients from the perspectives of haemodialysis patients, caregivers and dialysis staff members. DESIGN Systematic review of qualitative studies. DATA SOURCES Qualitative studies were extracted from MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, PubMed, CBM, CNKI and WanFang Database from inception of each database until July 2020. Qualitative research and mixed method research including barriers and/or facilitators to exercise in haemodialysis patients were included. REVIEW METHODS The systematic search method SPIDER (sample, phenomenon of interest, design, evaluation, research type) was used. Thematic synthesis of qualitative data was used. RESULTS 284 studies were screened and 10 studies published between 2007 and 2020 were finally included in this review. The review included 180 patients, 70 dialysis staff members and seven caregivers. Five analytical themes were identified: disease distress, perception of exercise, environmental restrictions, spirit strength and hospital management. Barriers include disease distress, perception of exercise (security issue), environmental restrictions and hospital management. Facilitators include perception of exercise (exercise being considered beneficial, preference for exercise) and spirit strength (from religious beliefs). It is the spiritual strength (from family and friends, from dialysis staff members) that is both the barrier and the facilitator. CONCLUSION There are many barriers in popularizing exercise among haemodialysis patients. Future intervention measures and health policies should strengthen the facilitators and reduce the barriers, so as to promote the clinical practice of exercise for haemodialysis patients. IMPACT This review summarizes the barriers and facilitators to exercise in haemodialysis patients. The results of this study have an impact on research, practice and health policy setting. The exercise level of haemodialysis patients can be improved by using the facilitators and solving the barriers.
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Affiliation(s)
- Tianzi Li
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Aili Lv
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Na Xu
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Mei Huang
- The Fourth Military Medical University, Xi'an, Shaan Xi, China
| | - Yan Su
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Bin Zhang
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - XiaoMei Li
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaan Xi, China
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β2-adrenergic receptor agonist counteracts skeletal muscle atrophy and oxidative stress in uremic mice. Sci Rep 2021; 11:9130. [PMID: 33911115 PMCID: PMC8080640 DOI: 10.1038/s41598-021-88438-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
In patients with chronic kidney disease, skeletal muscle dysfunction is associated with mortality. Uremic sarcopenia is caused by ageing, malnutrition, and chronic inflammation, but the molecular mechanism and potential therapeutics have not been fully elucidated yet. We hypothesize that accumulated uremic toxins might exert a direct deteriorative effect on skeletal muscle and explore the pharmacological treatment in experimental animal and culture cell models. The mice intraperitoneally injected with indoxyl sulfate (IS) after unilateral nephrectomy displayed an elevation of IS concentration in skeletal muscle and a reduction of instantaneous muscle strength, along with the predominant loss of fast-twitch myofibers and intramuscular reactive oxygen species (ROS) generation. The addition of IS in the culture media decreased the size of fully differentiated mouse C2C12 myotubes as well. ROS accumulation and mitochondrial dysfunction were also noted. Next, the effect of the β2-adrenergic receptor (β2-AR) agonist, clenbuterol, was evaluated as a potential treatment for uremic sarcopenia. In mice injected with IS, clenbuterol treatment increased the muscle mass and restored the tissue ROS level but failed to improve muscle weakness. In C2C12 myotubes stimulated with IS, although β2-AR activation also attenuated myotube size reduction and ROS accumulation as did other anti-oxidant reagents, it failed to augment the mitochondrial membrane potential. In conclusion, IS provokes muscular strength loss (uremic dynapenia), ROS generation, and mitochondrial impairment. Although the β2-AR agonist can increase the muscular mass with ROS reduction, development of therapeutic interventions for restoring skeletal muscle function is still awaited.
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Watanabe K, Kamijo Y, Yanagi M, Ishibashi Y, Harada T, Kohzuki M. Home-based exercise and bone mineral density in peritoneal dialysis patients: a randomized pilot study. BMC Nephrol 2021; 22:98. [PMID: 33736592 PMCID: PMC7977172 DOI: 10.1186/s12882-021-02289-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of osteopenia and osteoporosis is higher in patients with chronic kidney disease than that in the general population. Although physical exercise prevents bone loss in hemodialysis (HD) patients, previous studies have not focused on peritoneal dialysis (PD) patients. Therefore, we aimed to evaluate the effects of home-based exercise on bone mineral density (BMD) in patients with PD. METHODS Stable outpatients undergoing PD were randomly assigned to the intervention group (n = 26; male, 20; median age, 66 years) or usual-care group (n = 27; male, 21; median age, 64 years). Patients in the intervention group performed home-based exercises (resistance exercise, stretching, and aerobic exercise such as walking) for 6 months, whereas those in the usual-care group performed stretching and their usual physical activity. Based on dual X-ray absorptiometry, the primary outcomes were the BMD data of the lumbar spine and proximal femoral neck. Secondary outcomes included physical function and physical activity. Pre- and post-intervention values were compared. RESULTS There was no significant within-group change in the BMD of the lumbar spine, femoral neck, and hip after 6 months of the exercise program. The intervention group had significantly improved 30-s chair-stand test, 6-min walk test, and physical activity results. CONCLUSIONS Home-based exercises in patients with PD did not improve BMD at any of the sites evaluated. Improvement in physical function and physical activity may reduce the risk of falls in patients with PD. TRIAL REGISTRATION UMIN Clinical Trials Registry, UMIN000041678 . Registered September 4, 2020; retrospectively registered.
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Affiliation(s)
- Kumi Watanabe
- Department of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya, Tokyo, 150-8935, Japan.
| | - Yuka Kamijo
- Department of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya, Tokyo, 150-8935, Japan
| | - Mai Yanagi
- Department of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya, Tokyo, 150-8935, Japan
| | - Yoshitaka Ishibashi
- Department of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya, Tokyo, 150-8935, Japan
| | - Taku Harada
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba, Sendai, Miyagi, 980-8574, Japan
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Sato Y, Iino N. Snow removal maintained a high level of physical activity in patients undergoing hemodialysis in heavy snowfall areas. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Physical activity is an essential parameter associated with the prognosis of hemodialysis patients. Physical activity has regional characteristics; for example, snow removal is imperative in snowbelts during the winter. This study investigated the effects of removing snow on the physical activity levels of hemodialysis patients living in a snowbelt.
Methods
This study retrospectively examined 28 patients who underwent hemodialysis (age 69.6 ± 15.4 years, 19 males) in Uonuma Kikan Hospital between December 2019 and March 2020. Physical activity was assessed using the International Physical Activity Questionnaire. Patients were divided into a snow remover group and a non-snow remover group. We examined whether there were differences in physical or mental functioning and physical activity between the two groups. We also investigated the factors that influence high levels of physical activity among hemodialysis patients using multivariate linear regression analysis.
Results
The snow remover group had significantly greater grip strength, higher sit-to-stand test scores and gait speed, and a lower prevalence of frailty than the non-snow remover group. The level of physical activity was also significantly higher in the snow remover group. One of the patients in the snow remover group was frail. The univariate linear regression analysis showed that physical activity was related to age, grip strength, sit-to-stand test score, gait speed, and snow removal. In the multivariate linear regression analysis, snow removal and grip strength were significantly associated with a high level of physical activity.
Conclusions
Among hemodialysis patients living in a snowbelt, the snow remover group had significantly better physical functioning and a higher level of physical activity.
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Cardoso DF, Marques EA, Leal DV, Ferreira A, Baker LA, Smith AC, Viana JL. Impact of physical activity and exercise on bone health in patients with chronic kidney disease: a systematic review of observational and experimental studies. BMC Nephrol 2020; 21:334. [PMID: 32770949 PMCID: PMC7414574 DOI: 10.1186/s12882-020-01999-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronic Kidney Disease (CKD) patients frequently develop life-impairing bone mineral disorders. Despite the reported impact of exercise on bone health, systematic reviews of the evidence are lacking. This review examines the association of both physical activity (PA) and the effects of different exercise interventions with bone outcomes in CKD. Methods English-language publications in EBSCO, Web of Science and Scopus were searched up to May 2019, from which observational and experimental studies examining the relation between PA and the effect of regular exercise on bone-imaging or -outcomes in CKD stage 3–5 adults were included. All data were extracted and recorded using a spreadsheet by two review authors. The evidence quality was rated using the Cochrane risk of bias tool and a modified Newcastle-Ottawa scale. Results Six observational (4 cross-sectional, 2 longitudinal) and seven experimental (2 aerobic-, 5 resistance-exercise trials) studies were included, with an overall sample size of 367 and 215 patients, respectively. Judged risk of bias was low and unclear in most observational and experimental studies, respectively. PA was positively associated with bone mineral density at lumbar spine, femoral neck and total body, but not with bone biomarkers. Resistance exercise seems to improve bone mass at femoral neck and proximal femur, with improved bone formation and inhibited bone resorption observed, despite the inconsistency of results amongst different studies. Conclusions There is partial evidence supporting (i) a positive relation of PA and bone outcomes, and (ii) positive effects of resistance exercise on bone health in CKD. Prospective population studies and long-term RCT trials exploring different exercise modalities measuring bone-related parameters as endpoint are currently lacking.
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Affiliation(s)
- Daniela F Cardoso
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Av. Carlos Oliveira Campos - Castelo da Maia, 4475-690, Maia, Portugal
| | - Elisa A Marques
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Av. Carlos Oliveira Campos - Castelo da Maia, 4475-690, Maia, Portugal
| | - Diogo V Leal
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Av. Carlos Oliveira Campos - Castelo da Maia, 4475-690, Maia, Portugal
| | - Aníbal Ferreira
- Department of Nephrology, Curry Cabral Hospital, Lisbon, Portugal
| | - Luke A Baker
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - João L Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Av. Carlos Oliveira Campos - Castelo da Maia, 4475-690, Maia, Portugal.
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Uremic Sarcopenia: Clinical Evidence and Basic Experimental Approach. Nutrients 2020; 12:nu12061814. [PMID: 32570738 PMCID: PMC7353433 DOI: 10.3390/nu12061814] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Sustained physical activity extends healthy life years while a lower activity due to sarcopenia can reduce them. Sarcopenia is defined as a decrease in skeletal muscle mass and strength due not only to aging, but also from a variety of debilitating chronic illnesses such as cancer and heart failure. Patients with chronic kidney disease (CKD), who tend to be cachexic and in frail health, may develop uremic sarcopenia or uremic myopathy due to an imbalance between muscle protein synthesis and catabolism. Here, we review clinical evidence indicating reduced physical activity as renal function deteriorates and explore evidence-supported therapeutic options focusing on nutrition and physical training. In addition, although sarcopenia is a clinical concept and difficult to recapitulate in basic research, several in vivo approaches have been attempted, such as rodent subtotal nephrectomy representing both renal dysfunction and muscle weakness. This review highlights molecular mechanisms and promising interventions for uremic sarcopenia that were revealed through basic research. Extensive study is still needed to cast light on the many aspects of locomotive organ impairments in CKD and explore the ways that diet and exercise therapies can improve both outcomes and quality of life at every level.
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Ito K, Ookawara S, Hibino Y, Imai S, Fueki M, Bandai Y, Yasuda M, Kamimura T, Kakuda H, Kiryu S, Wada N, Hamashima Y, Kobayashi T, Shindo M, Sanayama H, Ohnishi Y, Tabei K, Morishita Y. Skeletal Muscle Mass Index Is Positively Associated With Bone Mineral Density in Hemodialysis Patients. Front Med (Lausanne) 2020; 7:187. [PMID: 32478086 PMCID: PMC7242614 DOI: 10.3389/fmed.2020.00187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with chronic kidney disease (CKD) are at risk for bone loss and sarcopenia because of associated mineral and bone disorders (MBD), malnutrition, and chronic inflammation. Both osteoporosis and sarcopenia are associated with a poor prognosis; however, few studies have evaluated the relationship between muscle mass and bone mineral density (BMD) in hemodialysis (HD) patients. The present study examined the association between skeletal muscle mass index (SMI) and BMD in the lumbar spine and femoral neck in HD patients. Methods: Fifty HD patients (mean age, 69 ± 10 years; mean HD duration, 9.0 ± 8.8 years) in Minami-Uonuma City Hospital were evaluated. BMD was measured by dual-energy X-ray absorptiometry, and SMI was measured by bioelectrical impedance analysis (InBodyTM) after HD. The factors affecting lumbar spine and femoral neck BMD were investigated, and multivariate analysis was performed. Results: In simple linear regression analysis, the factors that significantly affected the lumbar spine BMD were sex, presence of hypertension, presence of diabetes mellitus, body mass index, triglyceride level, grip strength, and SMI; the factors that significantly affected the femoral neck BMD were sex, HD duration, serum creatinine level, tartrate-resistant acid phosphatase 5b level, undercarboxylated osteocalcin (ucOC) level, N-terminal propeptide of type I procollagen level, grip strength, and SMI. In multivariate analysis, SMI (standardized coefficient: 0.578) was the only independent factor that affected the lumbar spine BMD; the independent factors that affected the femoral neck BMD were SMI (standardized coefficient: 0.468), ucOC (standardized coefficient: -0.366) and sex (standardized coefficient: 0.231). Conclusion: SMI was independently associated with the BMD in the lumbar spine and femoral neck in HD patients. The preservation of skeletal muscle mass could be important to prevent BMD decrease in HD patients, in addition to the management of CKD-MBD.
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Affiliation(s)
- Kiyonori Ito
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yutaka Hibino
- Department of Orthopaedic Surgery, Minami-Uonuma City Hospital, Niigata, Japan
| | - Sojiro Imai
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Mariko Fueki
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Yusaku Bandai
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Masatoshi Yasuda
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Tatsuya Kamimura
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Hideo Kakuda
- Department of Radiology, Minami-Uonuma City Hospital, Niigata, Japan
| | - Satoshi Kiryu
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Noriko Wada
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Yuri Hamashima
- Department of Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tadanao Kobayashi
- Department of Internal Medicine, Yuzawa-Machi Health Medical Center, Niigata, Japan
| | - Mitsutoshi Shindo
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hidenori Sanayama
- Department of Neurology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yasushi Ohnishi
- Department of Internal Medicine, Minami-Uonuma City Hospital, Niigata, Japan
| | - Kaoru Tabei
- Department of Internal Medicine, Minami-Uonuma City Hospital, Niigata, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Chang SC, Adami A, Lin HC, Lin YC, Chen CPC, Fu TC, Hsu CC, Huang SC. Relationship between maximal incremental and high-intensity interval exercise performance in elite athletes. PLoS One 2020; 15:e0226313. [PMID: 32396576 PMCID: PMC7217474 DOI: 10.1371/journal.pone.0226313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/27/2020] [Indexed: 12/05/2022] Open
Abstract
This descriptive study aimed to explore the physiological factors that determine tolerance to exertion during high-intensity interval effort. Forty-seven young women (15–28 years old) were enrolled: 23 athletes from Taiwan national or national reserve teams and 24 moderately active females. Each participant underwent a maximal incremental INC (modified Bruce protocol) cardiopulmonary exercise test on the first day and high-intensity interval testing (HIIT) on the second day, both performed on a treadmill. The HIIT protocol involved alternation between 1-min effort at 120% of the maximal speed, at the same slope reached at the end of the INC, and 1-min rest until volitional exhaustion. Gas exchange, heart rate (HR), and muscle oxygenation at the right vastus lateralis, measured by near-infrared spectroscopy, were continuously recorded. The number of repetitions completed (Rlim) by each participant was considered the HIIT tolerance index. The results showed a large difference in the Rlim (range, 2.6–12.0 repetitions) among the participants. Stepwise linear regression revealed that the variance in the Rlim within the cohort was related to the recovery rates of oxygen consumption ( V˙O2), HR at the second minute after INC, and muscle tissue saturation index at exhaustion (R = 0.644). In addition, age was linearly correlated with Rlim (adjusted R = −0.518, p < 0.0001). In conclusion, the recovery rates for V˙O2 and HR after the incremental test, and muscle saturation index at exhaustion, were the major physiological factors related to HIIT performance. These findings provide insights into the role of the recovery phase after maximal INC exercise testing. Future research investigating a combination of INC and HIIT testing to determine training-induced performance improvement is warranted.
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Affiliation(s)
- Shih-Chieh Chang
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Alessandra Adami
- Department of Kinesiology, University of Rhode Island, Kingston, RI, United States of America
| | - Hsin-Chin Lin
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yin-Chou Lin
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Taoyuan branch, Taiwan
| | - Carl P. C. Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Taoyuan branch, Taiwan
- College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan County, Taiwan
| | - Tieh-Cheng Fu
- College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan County, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Chin Hsu
- College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan County, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shu-Chun Huang
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan County, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, New Taipei Municipal Tucheng Hospital, Chang Gung Memorial Hospital, New Taipei, Taiwan
- * E-mail:
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12
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Nakagawa Y, Komaba H, Hamano N, Wada T, Hida M, Suga T, Kakuta T, Fukagawa M. Metacarpal bone mineral density by radiographic absorptiometry predicts fracture risk in patients undergoing maintenance hemodialysis. Kidney Int 2020; 98:970-978. [PMID: 32682522 DOI: 10.1016/j.kint.2020.02.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 01/24/2023]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) guideline update suggests bone mineral density testing to assess fracture risk in patients with chronic kidney disease, but dual-energy X-ray absorptiometry is not available in most dialysis facilities. Radiographic absorptiometry is an inexpensive and quick method for evaluating bone mineral density. Therefore, we analyzed a historical cohort of 456 maintenance hemodialysis patients to determine whether metacarpal bone mineral density measured by digital image processing, a computer-assisted radiographic absorptiometry technique, predicts fracture risk. At baseline, the median metacarpal bone mineral density T-score was -2.05 (interquartile range, -3.35 to -0.99). During a mean follow-up of 5.3 years, there were 16 clinical fractures and 11 asymptomatic vertebral fractures as estimated by height loss. Metacarpal bone mineral density T-score was significantly lower in patients who sustained a clinical fracture than in those remaining event-free. Decreasing metacarpal bone mineral density T-score was significantly associated with increased risk of clinical fracture (hazard ratio, 1.41 per 1 standard deviation decrease in bone mineral density T-score [95% confidence interval, 1.09 to 1.83]; the hazard ratio for lowest versus highest tertile was 4.86 [1.03 to 22.92]. Similar associations were observed between metacarpal bone mineral density T-score and vertebral fracture or any fracture. The results were robust to different analysis strategies and were consistent across different subgroups. Thus, radiographic absorptiometry could be a useful tool for primary screening of hemodialysis patients at high risk for fracture. Additional studies are required to determine the predictive ability of radiographic absorptiometry techniques compared to dual-energy X-ray absorptiometry or other established methods.
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Affiliation(s)
- Yosuke Nakagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Hirotaka Komaba
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan; The Institute of Medical Sciences, Tokai University, Isehara, Japan.
| | - Naoto Hamano
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Takehiko Wada
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Miho Hida
- Medical Corporation Kuratakai, Hiratsuka, Japan
| | - Takao Suga
- Medical Corporation Showakai, Tokyo, Japan
| | - Takatoshi Kakuta
- Division of Nephrology, Endocrinology and Metabolism, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
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13
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A Systematic Review of the Acute Effects of Hemodialysis on Skeletal Muscle Perfusion, Metabolism, and Function. Kidney Int Rep 2019; 5:307-317. [PMID: 32154452 PMCID: PMC7056853 DOI: 10.1016/j.ekir.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/05/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction The underlying mechanisms of skeletal muscle wasting in hemodialysis patients are complex. We performed a systematic review to summarize evidence on whether hemodialysis has acute effects on skeletal muscle perfusion, metabolism, and function. Methods The protocol was registered on PROSPERO (Registration number CRD42018103682). A systematic search was performed in MEDLINE, PubMed, Cochrane, Embase, Scopus, and Web of Science. Citation, reference list, and gray literature searches were also performed. Studies were selected in 2 stages: title and abstract review, then full-text review. Results A total of 65 full-text articles were reviewed, and 14 studies were eligible for inclusion. No studies were identified that assessed muscle perfusion during dialysis. Two studies used near-infrared spectroscopy to indirectly measure skeletal muscle oxygen consumption, which increased during dialysis in 1 study but only in patients with diabetes in the second. Metabolism was examined in 9 studies. A number of acute metabolic changes were reported (e.g., caspase-3 activity, polyubiquitin, and interleukin-6 protein increased in response to hemodialysis) as was a net negative protein balance over the dialysis session. Three studies examining muscle function did not produce consistent findings. Conclusion Gaps remain in understanding the acute effects of hemodialysis on skeletal muscle, particularly for changes in perfusion and function, although there does appear to be an acute effect on muscle metabolism.
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14
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Young HML, Orme MW, Song Y, Dungey M, Burton JO, Smith AC, Singh SJ. Standardising the measurement of physical activity in people receiving haemodialysis: considerations for research and practice. BMC Nephrol 2019; 20:450. [PMID: 31801480 PMCID: PMC6894215 DOI: 10.1186/s12882-019-1634-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/20/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical activity (PA) is exceptionally low amongst the haemodialysis (HD) population, and physical inactivity is a powerful predictor of mortality, making it a prime focus for intervention. Objective measurement of PA using accelerometers is increasing, but standard reporting guidelines essential to effectively evaluate, compare and synthesise the effects of PA interventions are lacking. This study aims to (i) determine the measurement and processing guidance required to ensure representative PA data amongst a diverse HD population, and; (ii) to assess adherence to PA monitor wear amongst HD patients. METHODS Clinically stable HD patients from the UK and China wore a SenseWear Armband accelerometer for 7 days. Step count between days (HD, Weekday, Weekend) were compared using repeated measures ANCOVA. Intraclass correlation coefficients (ICCs) determined reliability (≥0.80 acceptable). Spearman-Brown prophecy formula, in conjunction with a priori ≥ 80% sample size retention, identified the minimum number of days required for representative PA data. RESULTS Seventy-seven patients (64% men, mean ± SD age 56 ± 14 years, median (interquartile range) time on HD 40 (19-72) months, 40% Chinese, 60% British) participated. Participants took fewer steps on HD days compared with non-HD weekdays and weekend days (3402 [95% CI 2665-4140], 4914 [95% CI 3940-5887], 4633 [95% CI 3558-5707] steps/day, respectively, p < 0.001). PA on HD days were less variable than non-HD days, (ICC 0.723-0.839 versus 0.559-0.611) with ≥ 1 HD day and ≥ 3 non-HD days required to provide representative data. Using these criteria, the most stringent wear-time retaining ≥ 80% of the sample was ≥7 h. CONCLUSIONS At group level, a wear-time of ≥7 h on ≥1HD day and ≥ 3 non-HD days is required to provide reliable PA data whilst retaining an acceptable sample size. PA is low across both HD and non- HD days and future research should focus on interventions designed to increase physical activity in both the intra and interdialytic period.
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Affiliation(s)
- Hannah M L Young
- Department of Respiratory Science, University of Leicester, Leicester Kidney Lifestyle Team, Academic Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK.
| | - Mark W Orme
- Department of Respiratory Science, University of Leicester, Leicester Kidney Lifestyle Team, Academic Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yan Song
- Department of Health Sciences, University of Leicester, Leicester, UK
- Nantong University, Nantong, China
| | - Maurice Dungey
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester Kidney Lifestyle Team, Academic Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
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15
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Avin KG, Allen MR, Chen NX, Srinivasan S, O'Neill KD, Troutman AD, Mast G, Swallow EA, Brown MB, Wallace JM, Zimmers TA, Warden SJ, Moe SM. Voluntary Wheel Running Has Beneficial Effects in a Rat Model of CKD-Mineral Bone Disorder (CKD-MBD). J Am Soc Nephrol 2019; 30:1898-1909. [PMID: 31501355 DOI: 10.1681/asn.2019040349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/16/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Reduced bone and muscle health in individuals with CKD contributes to their higher rates of morbidity and mortality. METHODS We tested the hypothesis that voluntary wheel running would improve musculoskeletal health in a CKD rat model. Rats with spontaneous progressive cystic kidney disease (Cy/+ IU) and normal littermates (NL) were given access to a voluntary running wheel or standard cage conditions for 10 weeks starting at 25 weeks of age when the rats with kidney disease had reached stage 2-3 of CKD. We then measured the effects of wheel running on serum biochemistry, tissue weight, voluntary grip strength, maximal aerobic capacity (VO2max), body composition and bone micro-CT and mechanics. RESULTS Wheel running improved serum biochemistry with decreased creatinine, phosphorous, and parathyroid hormone in the rats with CKD. It improved muscle strength, increased time-to-fatigue (for VO2max), reduced cortical porosity and improved bone microarchitecture. The CKD rats with voluntary wheel access also had reduced kidney cystic weight and reduced left ventricular mass index. CONCLUSIONS Voluntary wheel running resulted in multiple beneficial systemic effects in rats with CKD and improved their physical function. Studies examining exercise interventions in patients with CKD are warranted.
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Affiliation(s)
- Keith G Avin
- Division of Nephrology and .,Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Matthew R Allen
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Departments of Medicine, Anatomy and Cell Biology, and
| | - Neal X Chen
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Shruthi Srinivasan
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Kalisha D O'Neill
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Ashley D Troutman
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and
| | - Garrison Mast
- Departments of Medicine, Anatomy and Cell Biology, and
| | | | - Mary Beth Brown
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and
| | - Joseph M Wallace
- Division of Nephrology and.,Departments of Medicine, Anatomy and Cell Biology, and
| | - Teresa A Zimmers
- Medicine and General Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and.,Departments of Medicine, Anatomy and Cell Biology, and
| | - Sharon M Moe
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Departments of Medicine, Anatomy and Cell Biology, and
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16
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Lipotoxicity in Kidney, Heart, and Skeletal Muscle Dysfunction. Nutrients 2019; 11:nu11071664. [PMID: 31330812 PMCID: PMC6682887 DOI: 10.3390/nu11071664] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022] Open
Abstract
Dyslipidemia is a common nutritional and metabolic disorder in patients with chronic kidney disease. Accumulating evidence supports the hypothesis that prolonged metabolic imbalance of lipids leads to ectopic fat distribution in the peripheral organs (lipotoxicity), including the kidney, heart, and skeletal muscle, which accelerates peripheral inflammation and afflictions. Thus, lipotoxicity may partly explain progression of renal dysfunction and even extrarenal complications, including renal anemia, heart failure, and sarcopenia. Additionally, endoplasmic reticulum stress activated by the unfolded protein response pathway plays a pivotal role in lipotoxicity by modulating the expression of key enzymes in lipid synthesis and oxidation. Here, we review the molecular mechanisms underlying lipid deposition and resultant tissue damage in the kidney, heart, and skeletal muscle, with the goal of illuminating the nutritional aspects of these pathologies.
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17
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Song Y, Wang J, Chen X, Guo Y, Wang X, Liang W. Facilitators and Barriers to Exercise Influenced by Traditional Chinese Culture: A Qualitative Study of Chinese Patients Undergoing Hemodialysis. J Transcult Nurs 2019; 30:558-568. [PMID: 30702029 DOI: 10.1177/1043659618823908] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Exercise is recommended for patients undergoing hemodialysis to decrease morbidity and mortality. However, their exercise level is lower than healthy people. Understanding reasons behind their sedentary lifestyle is required. Traditional Chinese culture may have a profound impact on patients’ perceptions of exercise, particularly with regard to the relationship of overwork and kidney function and family members’ attitudes toward patients’ participation in exercise. Therefore, we sought to explore the facilitators and barriers to exercise influenced by traditional Chinese culture. Methods: We conducted semistructured interviews with 44 Chinese patients residing in Nantong of Jiangsu Province undergoing hemodialysis, aged 25 to 77 years. Interview questions focused on their perceptions of, attitudes to, and experiences with exercise. Each interview was digitally recorded and lasted from 40 to 60 minutes. Conventional content analysis was used to understand facilitators and barriers to exercise within their experience and perceptions. Findings: We found that specific Chinese cultural health beliefs informed by traditional Chinese medicine strongly affected patients’ attitudes and behaviors toward exercise. Participants in this study tended to believe that overwork impairs kidney functions and viewed strenuous exercise as overwork. Although participants admitted the benefits of exercise, they rejected strenuous exercise and regarded nearly all modalities of exercise with or without facilities (except walking) as strenuous exercise. The most common barriers to exercise were lack of motivation, bad weather, negative attitudes of family members toward patients’ doing exercise, and insufficient exercise information resources. The most common facilitators found in this study were their increased physical well-being and confidence from exercise. Group exercise supported by family members and positive attitudes toward obtaining exercise information were also motivators. Discussion: Chinese patients undergoing hemodialysis reported more barriers than facilitators to exercise. Perceptions and attitudes toward exercise informed by traditional Chinese culture may be hidden barriers to exercising. Our findings indicated that culturally sensitive and patient-centered exercise interventions for Chinese patients are urgently needed.
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Affiliation(s)
- Yan Song
- Nantong University School of Nursing, Nantong, China
- University of Leicester, Leicester, UK
| | - Jing Wang
- Nantong University School of Nursing, Nantong, China
- Duke University School of Nursing, Durham, NC, USA
| | - Xiaolan Chen
- Affiliated Hospital of Nantong University, Nantong, China
| | - Yujie Guo
- Nantong University School of Nursing, Nantong, China
| | - Xinmei Wang
- Affiliated Hospital of Nantong University, Nantong, China
| | - Wen Liang
- Affiliated Hospital of Nantong University, Nantong, China
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18
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Sheshadri A, Kittiskulnam P, Johansen KL. Higher Physical Activity Is Associated With Less Fatigue and Insomnia Among Patients on Hemodialysis. Kidney Int Rep 2018; 4:285-292. [PMID: 30775625 PMCID: PMC6365400 DOI: 10.1016/j.ekir.2018.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 02/08/2023] Open
Abstract
Introduction Patients on hemodialysis experience a heavy burden of symptoms that may be related to the low levels of physical activity reported in this population. We hypothesized that physical activity would be inversely related to symptom severity and that depression might mediate this association. Methods We designed a cross-sectional study of 48 patients receiving hemodialysis at 3 San Francisco dialysis clinics. Physical activity was measured using pedometers and recorded within 1 week of symptom assessment. Symptoms were assessed using total symptom burden and severity on the Dialysis Symptom Index (DSI; burden 0–29, severity 0–145), individual symptoms on the DSI (0–5), Kidney Disease Quality of Life Vitality scores, (0–100), and the Center for Epidemiologic Study-Depression (0–60). Results Median daily step count was 2631 (25th, 75th percentile 1125, 5278). Seventy-three percent of patients reported fatigue. After adjustment for age, sex, diabetes, and serum albumin, physical activity was associated with 0.2 points lower fatigue severity per 1000 steps per day (95% confidence interval [CI] −0.3 to 0.0), P = 0.04. Physical activity was also associated with higher Vitality score (2.36 points per 1000 steps; 95% CI 0.07–4.65) and lower insomnia scores (−0.1 points per 1000 steps; 95% CI −0.3 to 0.0], P < 0.05) in our adjusted models. Physical activity was not associated with other symptoms. Conclusion Because the study was cross-sectional, we cannot determine whether physical activity lowers fatigue and insomnia or whether less insomnia and fatigue increase physical activity. However, interventions to increase physical activity should be considered alongside current strategies as a possible approach to managing fatigue and insomnia.
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Affiliation(s)
- Anoop Sheshadri
- Division of Nephrology, University of California, San Francisco, San Francisco, California, USA
| | | | - Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco, San Francisco, California, USA
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19
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Schardong J, Marcolino MAZ, Plentz RDM. Muscle Atrophy in Chronic Kidney Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:393-412. [PMID: 30390262 DOI: 10.1007/978-981-13-1435-3_18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The renal damage and loss of kidney function that characterize chronic kidney disease (CKD) cause several complex systemic alterations that affect muscular homeostasis, leading to loss of muscle mass and, ultimately, to muscle atrophy. CKD-induced muscle atrophy is highly prevalent and, in association with common CKD comorbidities, is responsible for the reduction of physical capacity, functional independence, and an increase in the number of hospitalizations and mortality rates. Thus, this chapter summarizes current knowledge about the complex interactions between CKD factors and the pathophysiological mechanisms that induce muscle atrophy that, despite growing interest, are not yet fully understood. The current treatments of CKD-induced muscle atrophy are multidisciplinary, including correction of metabolic acidosis, nutritional supplementation, reducing insulin resistance, administration of androgenic steroids, resisted and aerobic exercise, neuromuscular electrical stimulation, and inspiratory muscle training. However, further studies are still needed to strengthen the comprehension of CKD-induced muscle atrophy and the better treatment strategies.
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Affiliation(s)
- Jociane Schardong
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Miriam Allein Zago Marcolino
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Della Méa Plentz
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil. .,Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil. .,Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil.
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20
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Blood transfusion during haemodialysis improves systemic tissue oxygenation: A case report. Nefrologia 2017; 37:435-437. [DOI: 10.1016/j.nefro.2016.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/22/2022] Open
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21
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Marinho S, Carraro Eduardo J, Mafra D. Effect of a resistance exercise training program on bone markers in hemodialysis patients. Sci Sports 2017. [DOI: 10.1016/j.scispo.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Abstract
PURPOSE OF REVIEW To summarize the latest information on body composition among patients with chronic kidney disease and its association with outcomes. RECENT FINDINGS Obesity is increasing among patients with end-stage renal disease and is more prevalent when direct measures of adiposity are used rather than BMI. High BMI is not associated with better survival among patients with earlier chronic kidney disease or after kidney transplantation, suggesting that excess fat is most protective among the sickest patients. Despite the positive association between BMI and survival among patients with end-stage renal disease, visceral fat is associated with coronary artery calcification and adverse cardiovascular events. Muscle wasting is prominent among patients with chronic kidney disease, sometimes even in the setting of obesity. Obesity and muscle wasting are associated with worse physical functioning. Indicators of low muscle size and strength are associated with higher mortality. Some interventions can affect body composition, but whether they affect survival has not been determined. SUMMARY Recent studies show that a high BMI is not protective for all patients with chronic kidney disease and is associated with poor physical functioning and frailty. Visceral adiposity is associated with adverse cardiovascular outcomes. Sarcopenia is common among patients with end-stage renal disease and is associated with worse physical performance and higher mortality.
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23
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Bučar Pajek M, Svilan K, Vivoda T, Škoberne A, Pajek J. Isolated Effects of Renal Failure, Anthropometric Indices, and Serum Total Iron-Binding Capacity as Determinants of Muscle Performance in Hemodialysis Patients. J Ren Nutr 2016; 26:245-52. [PMID: 26827132 DOI: 10.1053/j.jrn.2015.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/03/2015] [Accepted: 12/15/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE We quantified the isolated impact of end-stage renal disease (ESRD) on physical performance under contemporary hemodialysis treatment independent of comorbid diseases, characterized principal anthropometric components, and adjusted for their influence and compared associations of C-reactive protein (CRP), albumin, and serum total iron-binding capacity (TIBC) with muscle function. DESIGN A case-control cross-sectional study. SETTING University medical hospital and outpatient hemodialysis units. SUBJECTS Ninety prevalent hemodialysis patients without important comorbidities and 140 controls. MAIN OUTCOME MEASURES Handgrip strength (HGS) and 10-repetition sit-to-stand time (STS-10). RESULTS Principal component analysis revealed 3 representative anthropometric measures to be included in explanatory models of muscle performance additional to body height: lean body mass, fat mass, and joint size. Controlling for these covariates, age, sex, and residual comorbidity, ESRD was associated with a modest 7.5% reduction in HGS (B = -2.57 kg; 95% confidence interval: -4.81 to -0.39; P = .005; model R(2) 0.74) and a relatively larger prolongation of 27% in STS-10 time (B = 4s; 95% confidence interval: 2.61 to 5.4; P < .001; model R(2) 0.53). Lean body mass and height significantly predicted both tests, fat mass, and wrist size predicted HGS. In the subgroup of dialysis patients, only TIBC showed a significant association with HGS independently from age, sex, wrist size, whereas CRP and albumin did not. STS-10 time was not associated with any of these biomarkers. Results remained stable in sensitivity analyses excluding patients with reported chronic regional motor difficulties and aches. CONCLUSIONS ESRD with contemporary hemodialysis therapy has a relatively modest negative comorbidity-free association with HGS and a larger effect on STS-10 lower extremity performance. Nonmodifiable anthropometric indices (body height and for HGS wrist size) have a significant independent impact and should be consistently adjusted for in future studies. In low-comorbidity dialysis patients, TIBC is a superior predictor of HGS compared with albumin and CRP.
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Affiliation(s)
| | - Katarina Svilan
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tjaša Vivoda
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Škoberne
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jernej Pajek
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Ratio of Dietary n-6/n-3 Polyunsaturated Fatty Acids Independently Related to Muscle Mass Decline in Hemodialysis Patients. PLoS One 2015; 10:e0140402. [PMID: 26466314 PMCID: PMC4605692 DOI: 10.1371/journal.pone.0140402] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/24/2015] [Indexed: 12/25/2022] Open
Abstract
Background n-3 polyunsaturated fatty acids (PUFAs) might be useful nutritional strategy for treating patients with sarcopenia. We evaluated the effect of the intake of dietary n-3 PUFAs on the skeletal muscle mass (SMM), appendicular skeletal muscle mass (ASM), and its determinants in patients receiving standard hemodialysis (HD) treatment for the management of end stage renal disease. Methods In this cross-sectional study, data of 111 HD patients were analyzed. Anthropometric and bioelectrical impedance measurements used to estimate the muscle mass were performed the day of dialysis immediately after the dialysis session. Routine laboratory and 3-day dietary data were also collected. The cutoff value of adequate intake (AI) for both n-3 PUFAs and alpha-linolenic acid (ALA) was 1.6 g/day and 1.1 g/day for men and women, respectively. Results The mean age, mean dietary n-3 PUFAs intake, ALA intake, ratio of n-6/n-3 PUFAs intake, SMM, and ASM of patients were 61.4 ± 10.4 years, 2.0 ± 1.3 g/day, 1.5 ± 1.0 g/day, 9.5 ± 6.7 g/day, 23.9 ± 5.5 kg, and 17.5 ± 4.5 kg, respectively. A higher SMM and ASM significantly observed in patients who achieved an AI of n-3 PUFAs. Similar trends appeared to be observed among those patients who achieved the AI of ALA, but the difference was not significantly, except for ASM (P = 0.047). No relevant differences in demographics, laboratory and nutritional parameters were observed, regardless of whether the patients achieved an AI of n-3 PUFAs. Multivariate analysis showed that the BMI and equilibrated Kt/V were independent determinants of the muscle mass. Moreover, the ratio of n-6/n-3 PUFAs was an independent risk determinant of reduced ASM in HD patients. Conclusion Patients with an AI of n-3 PUFAs had better total-body SMM and ASM. A higher dietary ratio of n-6/n-3 PUFAs seemed to be associated with a reduced muscle mass in HD patients.
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Morishita Y, Nagata D. Strategies to improve physical activity by exercise training in patients with chronic kidney disease. Int J Nephrol Renovasc Dis 2015; 8:19-24. [PMID: 25792851 PMCID: PMC4362894 DOI: 10.2147/ijnrd.s65702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Decreased physical activity resulting in muscle loss is often observed in patients with chronic kidney disease and is one of the main predictors of mortality in these patients. Exercise training may improve physical activity and prevent muscle loss in patients with chronic kidney disease. Efforts to introduce exercise training to these patients may be clinically beneficial by reducing their mortality rates.
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Affiliation(s)
- Yoshiyuki Morishita
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
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Mendoza M, Han M, Meyring-Wösten A, Wilund K, Kotanko P. It's a Non-Dialysis Day… Do You Know How Your Patient Is Doing? A Case for Research into Interdialytic Activity. Blood Purif 2015; 39:74-83. [DOI: 10.1159/000369430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hemodialysis (HD) patients are less active than their healthy counterparts; this is associated with higher mortality. Healthcare workers observe their patients only during HD, which accounts for about 7% of the week. Knowing more about what occurs in between sessions, particularly with respect to physical activity, may improve patient care and prognosis. Yet without a standard method to measure interdialytic activity, it is difficult to compare the effect of interventions. However, it is unclear how interdialytic activity can be accurately measured. Since activity associated with quality of life is multi-dimensional, objective and subjective tools should be used in conjunction. While commercially available tracking devices can be seamlessly incorporated into everyday life and can increase awareness of user's activity, their validation is needed in the HD population. Fertile topics for research should include the relationship between objective and subjective measures in HD patients, and the investigation of physical activity in non-ambulatory HD patients.
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