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Tavares FS, de Luca Corrêa H, Wilund KR, Deus LA, de Araújo TB, Tzanno-Martins C, da Motta Vilalva Mestrinho VM, Dos Santos RL, Reis AL, Souza FH, de Sousa Ulisses LR, Cardoso HSS, Pascoal IJF, Guimarães VCC, de Oliveira Gomes L, Neves RVP, Dos Santos Rosa T. Exploring the impact of short daily haemodialysis on muscle strength and bone health in end-stage kidney disease patients. J Cachexia Sarcopenia Muscle 2024; 15:718-725. [PMID: 38272859 PMCID: PMC10995248 DOI: 10.1002/jcsm.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Short-daily haemodialysis (SDH) has been strongly recommended over conventional haemodialysis (CHD) for end-stage kidney disease patients, though few studies have directly compared the effects of these two haemodialysis (HD) modalities on clinical variables related to patient's health. METHODS We conducted a cross-sectional study in individuals undergoing HD, comparing epidemiological, clinical, metabolic, inflammatory, anthropometric, bone health/metabolism, and skeletal muscle function according to dialysis modality. One-hundred seventy-eight patients (20.8% females, 62 ± 2.5 years old), were analysed in this study, 86 (48%) of whom were undergoing CHD versus 92 (51%) who were undergoing SDH. RESULTS SDH patients had significantly higher serum albumin levels (3.93 vs. 3.66 g/dL, P < 0.0001) and higher Kt/v (2.6 vs. 2.38, P < 0.0001). SDH group presented a significantly lower number of erythropoietin-stimulating agents compared with CHD group (percentage: 53.3 vs. 83.7%, P < 0.0001) and had lower levels of serum phosphate (4.9 vs. 5.3 mg/dL, P = 0.004) and parathyroid hormone (PTH) (398.4 vs. 480.4 pg/mL, P < 0.001) compared with CHD patients. In terms of bone health and metabolism, SDH patients had significantly higher total BMD, femur BMD, lumbar BMD, and femoral neck BMD compared with CHD patients (all P < 0.05). SDH patients also had lower anti-osteogenic and inflammatory biomarkers, including FGF23, sclerostin, TNF, IL-18, IL-17a, and C-reactive peptide (all P < 0.05). CHD modality was demonstrated to be a risk factor for low BMD (odds ratio: 4.02; 95% CI: 1.59-10.2, P = 0.003). In terms of skeletal muscle function, SDH patients had significantly higher 6-minute walking test (444.6 vs. 424.9 m, P = 0.04) and higher fat-free mass (52.3 vs. 51.68 kg, P = 0.02) compared with CHD patients. Higher fat-free mass and handgrip strength were associated with a 34% and 23% lower risk of low BMD, respectively. SDH patients had lower levels of the uremic toxin asymmetric dimethyl-l-arginine (ADMA) (1.8 vs. 2.07 μM, P = 0.002) and fasting blood glucose (132.6 vs. 141.7 mg/dL, P < 0.02) than CHD group. SDH patients also displayed higher levels of haemoglobin when compared with CHD group (11.9 vs. 10.2 g/dL, P < 0.0001). CONCLUSIONS The present study improves our understanding of the relationship between dialysis modality and clinical variables that may influence HD patient's health. Grip strength and lean mass were positively correlated with bone mineral density in HD patients regardless of dialysis modality. SDH was associated with better bone mineral density, inflammatory profile, and skeletal muscle function when compared with CHD patients. These findings provide more evidence of the clinical benefits of SDH that should be explored in greater detail.
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Affiliation(s)
| | - Hugo de Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Lysleine Alves Deus
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Brazil
| | | | | | | | - Rafael Lavarini Dos Santos
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Brazil
| | - Andrea Lucena Reis
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | | | | | | | | | | | | | | | - Thiago Dos Santos Rosa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Brazil
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Corrêa HL, Deus LA, Araújo TB, Reis AL, Amorim CEN, Gadelha AB, Santos RL, Honorato FS, Motta-Santos D, Tzanno-Martins C, Neves RVP, Rosa TS. Phosphate and IL-10 concentration as predictors of long-covid in hemodialysis patients: A Brazilian study. Front Immunol 2022; 13:1006076. [PMID: 36248863 PMCID: PMC9562993 DOI: 10.3389/fimmu.2022.1006076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/15/2022] [Indexed: 01/10/2023] Open
Abstract
Background The global burden of persistent COVID-19 in hemodialysis (HD) patients is a worrisome scenario worth of investigation for the critical care of chronic kidney disease (CKD). We performed an exploratory post-hoc study from the trial U1111-1237-8231 with two specific aims: i) to investigate the prevalence of COVID-19 infection and long COVID symptoms from our Cohort of 178 Brazilians HD patients. ii) to identify whether baseline characteristics should predict long COVID in this sample. Methods 247 community-dwelling older (>60 years) patients (Men and women) undergoing HD (glomerular filtration rate < 15 mL/min/1.73m2) with arteriovenous fistula volunteered for this study. All patients presented hypertension and diabetes. Patients were divided in two groups: without long-COVID and with long-COVID. Body composition, handgrip strength, functional performance, iron metabolism, phosphate, and inflammatory profile were assessed. Patients were screened for 11-months after COVID-19 infection. Results were considered significant at P < 0.05. Results We found that more than 85% of the COVID-19 infected patients presented a severe condition during the infection. In our sample, the mortality rate over 11-month follow was relatively low (8.4%) when compared to worldwide (approximately 36%). Long COVID was highly prevalent in COVID-19 survivors representing more than 80% of all cases. Phosphate and IL-10 were higher in the long COVID group, but only phosphate higher than 5.35 mg/dL appears to present an increased prevalence of long COVID, dyspnea, and fatigue. Conclusion There was a high prevalence of COVID-19 infection and long COVID in HD patients from the Brazilian trial ‘U1111-1237-8231’. HD clinics should be aware with phosphate range in HD patients as a possible target for adverse post-COVID events.
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Affiliation(s)
- Hugo L. Corrêa
- Department of Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Lysleine A. Deus
- Department of Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Thaís B. Araújo
- Department of Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Andrea L. Reis
- Department of Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Carlos E. N. Amorim
- Physical Education Department, Federal University of Maranhão, Maranhão, Brazil
| | - André B. Gadelha
- Department of Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
- Serviço de Preparação Física/COPSA/COSAU/DIGEP/SA/SG/Presidência da República, Brasília, Brazil
- Seção de Educação Física do Colégio Militar de Brasília, Brasília, Brazil
| | - Rafael L. Santos
- Department of Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Fernando S. Honorato
- Department of Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Daisy Motta-Santos
- Pontifical Catholic University of Minas Gerais and Sports Department, EEFFTO, UFMG, Belo, Horizonte, Brazil
| | | | - Rodrigo V. P. Neves
- Department of Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Thiago S. Rosa
- Department of Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
- *Correspondence: Thiago S. Rosa,
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