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Sakkas GK, Giannaki CD, Wilund KR, Karatzaferi C. How to cultivate sustainable physical health and wellness in transplant recipients: the emerging and enduring role of exercise scientists. Curr Opin Organ Transplant 2024; 29:294-298. [PMID: 38841870 DOI: 10.1097/mot.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW The aim of the current review is to highlight the importance of exercise training as an important section of transplant recipient rehabilitation process and explain the role of the exercise scientist in the development, implementation, and assessment of the exercise regime. RECENT FINDINGS Transplant patients face a unique set of challenges in their recovery and rehabilitation process, often requiring a multifaceted approach to address the physical, emotional, and psychological aspects of their condition. Exercise training has emerged as a crucial component in the care of these patients, providing a means to improve functional capacity, enhance quality of life, and mitigate the adverse effects of transplant-related complications. Exercise scientists who are trained to assess patient's physical limitations, develop and deliver personalized exercise programs, and monitor their progress are uniquely positioned to play a crucial role in the treatment of patients with chronic conditions that require exercise training as a mean of improving and maintaining health and quality of life. SUMMARY Exercise scientists are the appropriate professionals for providing transplant recipients with the recommended exercise training for maintaining and improving their health status as part of the overall plan of long-term care and support.
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Affiliation(s)
- Giorgos K Sakkas
- Department of PA and Sports Sciences, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Christoforos D Giannaki
- Department of Life Sciences, School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Kenneth R Wilund
- Department of Leadership, School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA
| | - Christina Karatzaferi
- Department of PA and Sports Sciences, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
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2
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Marco E, Pérez-Sáez MJ, Muñoz-Redondo E, Curbelo YG, Ramírez-Fuentes C, Meza-Valderrama D, Acuña-Pardo C, Muns MD, Vázquez-Ibar O, Chamoun BO, Faura-Vendrell A, Bach A, Crespo M, Pascual J. Phase Angle as Surrogate Marker of Muscle Weakness in Kidney Transplant Candidates Referred to Prehabilitation. Nutrients 2024; 16:2245. [PMID: 39064689 PMCID: PMC11280164 DOI: 10.3390/nu16142245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Phase angle (PhA), a marker of nutritional status obtained by bioelectrical impedance analysis (BIA), is associated with the integrity of cell membranes. Damage to muscle fiber membranes can impact muscle strength, which is related to adverse outcomes in adults with advanced chronic kidney disease (CKD). The main objective of this study was to determine the usefulness of the PhA in identifying muscle weakness in candidates for kidney transplants (KTs). Secondly, it aimed to examine the associations of PhA with other parameters of body composition, exercise performance, and muscle structure. Sensitivity, specificity, and area under the receiver operating characteristics curve were used to evaluate the PhA (index test) as a biomarker of muscle weakness. Muscle strength was estimated with maximal voluntary isometric contraction of the quadriceps (MVCI-Q) of the dominant side. Muscle weakness was defined as MVIC-Q < 40% of body weight. A total of 119 patients were evaluated (mean age 63.7 years, 75.6% men). A phase angle cut-off of 5.1° was identified to classify men with a higher likelihood of having low muscle strength in upper limbs (MVIC-Q 40% of their body weight). Male KT candidates with PhA < 5.1° had poorer exercise capacity, lower muscle strength, less muscle mass, and smaller muscle size. A PhA < 5.1° was significantly associated with an eight-fold higher muscle weakness risk (OR = 8.2, 95%CI 2.3-29.2) in a binary regression model adjusted by age, frailty, and hydration status. Remarkably, PhA is an easily obtainable objective parameter in CKD patients, requiring no volitional effort from the individual. The associations of PhA with aerobic capacity, physical activity, muscle mass, and muscle size underscore its clinical relevance and potential utility in the comprehensive evaluation of these patients.
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Affiliation(s)
- Ester Marco
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr. Aiguader Building (Mar Campus), 08003 Barcelona, Spain
| | - María José Pérez-Sáez
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Elena Muñoz-Redondo
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Yulibeth G. Curbelo
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Cindry Ramírez-Fuentes
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFRE), Panama City 0819, Panama
| | - Carolina Acuña-Pardo
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
| | - Mª Dolors Muns
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain;
| | - Olga Vázquez-Ibar
- Department of Geriatrics, Centre-Fòrum Hospital del Mar, 08019 Barcelona, Spain;
| | - Betty Odette Chamoun
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Anna Faura-Vendrell
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Anna Bach
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Julio Pascual
- Department of Nephrology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
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Sertorio ES, Colugnati FAB, Denhaerynck K, De Smet S, Medina JOP, Reboredo MM, De Geest S, Sanders-Pinheiro H. Factors Associated With Physical Inactivity of Recipients of a Kidney Transplant: Results From the ADHERE BRAZIL Multicenter Study. Phys Ther 2024; 104:pzae058. [PMID: 38591795 DOI: 10.1093/ptj/pzae058] [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: 04/23/2023] [Revised: 11/27/2023] [Accepted: 02/13/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant. METHODS This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (<150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression. RESULTS At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97-6.06), obesity (odds ratio = 1.79; 95% CI = 1.26-2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20-8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17-2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48-0.90), and student status (odds ratio = 0.58; 95% CI = 0.37-0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46-0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01-2.13). CONCLUSIONS This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity. IMPACT In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity.
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Affiliation(s)
- Emiliana S Sertorio
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Fernando A B Colugnati
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Stefan De Smet
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jose O P Medina
- Fundação Oswaldo Ramos, Disciplina de Nefrologia, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Maycon M Reboredo
- School of Medicine, Federal University of Juiz de Fora, Minas Gerais, Brazil, and Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Helady Sanders-Pinheiro
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil, and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
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Pérez-Sáez MJ, Pascual J. Unmet Questions About Frailty in Kidney Transplant Candidates. Transplantation 2024:00007890-990000000-00795. [PMID: 38886883 DOI: 10.1097/tp.0000000000005093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Frailty occurs frequently among patients with advanced chronic kidney disease, especially among women. Assessing frailty in kidney transplant (KT) candidates is crucial for informing them about associated risks. However, there is poor agreement between frailty scales and research on their correlation with transplant outcomes. Being prefrail significantly impacts both graft and patient survival, often beginning with just 1 Fried criterion. Rather than viewing frailty as a categorical state, it should be regarded as a spectrum ranging from 1 to 5 criteria, with the risk of adverse outcomes escalating as frailty worsens. Frailty status fluctuates during the waiting period for KT; hence, a 1-time frailty evaluation is insufficient to determine risks and implement strategies for improving functional status. Further research should investigate the components of frailty that most frequently change during this waiting period and establish strategies to prevent or reverse frailty. Although careful evaluation of frail KT candidates is necessary to prevent early complications and mortality, exclusion based solely on a frailty score is unwarranted. Instead, efforts should focus on timely interventions to enhance their condition before transplantation. Although evidence is limited, exercise programs appear feasible and yield positive results. A pretransplant clinical framework encompassing multimodal prehabilitation-comprising physical therapy, nutritional measures, and psychological support-during the waiting list period may help alleviate the effects of frailty and poor fitness after KT, ultimately improving key outcomes. Despite logistical challenges, there is a pressing need for interventional trials in this area.
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Affiliation(s)
- María José Pérez-Sáez
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Julio Pascual
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Institute for Research i+12, Madrid, Spain
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5
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Bates A, Letton ME, Arnold R, Lambert K. Barriers and enablers to exercise in kidney transplant recipients: Systematic review of qualitative studies. J Ren Care 2024. [PMID: 38806247 DOI: 10.1111/jorc.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Exercise has the potential to reduce the susceptibility to comorbidity and cardiovascular disease in kidney transplant recipients. However, kidney transplant recipients report lower levels of exercise compared to the general population, prompting an investigation into the barriers and enablers to exercise in this transplant cohort. OBJECTIVES This systematic review aimed to explore and map the barriers and enablers to exercise in kidney transplant recipients. METHODS Seven electronic databases were systematically searched. Themes were synthesised and then deductively categorised using the Theoretical Domains Framework. RESULTS Eleven studies were included in the review. Commonly reported barriers to exercise were lack of exercise guidance (n = 9 studies), physical limitations (n = 5 studies) and a fear of harming the kidney (n = 7 studies). Enablers were a desire to return to normality (n = 5 studies), physical and mental benefits (n = 3 studies), goal setting and tracking improvements (n = 3 studies). At the local level, barriers identified by kidney transplant recipients were a lack of knowledge, fear of injuring the kidney, bad weather and physical limitations. Perceived enablers were already living an active lifestyle, mental benefits, exercise preferences and social support. CONCLUSION Key findings of this research were an increased demand for specific/explicit exercise information regarding type and intensity, and personalised guidance and support for kidney transplant recipients after transplantation. These findings can be used to inform the development of exercise resources and interventions for kidney transplant recipients and their health care professionals within the local community and at a greater level.
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Affiliation(s)
- Alexander Bates
- School of Medical, Indigenous & Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Meg E Letton
- School of Medical, Indigenous & Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ria Arnold
- School of Medical, Indigenous & Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Department of Renal Medicine, Concord Repatriation and General Hospital, Sydney, New South Wales, Australia
- Concord Clinical School, University of Sydney, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous & Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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Kim S, Jung JH, Lee K, Jeon J, Shin DW, Jang HR, Lee JE, Han K, Huh W. Association of physical activity with fractures in kidney transplant recipients: A Korean nationwide cohort study. Clin Transplant 2024; 38:e15308. [PMID: 38581296 DOI: 10.1111/ctr.15308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
Kidney transplant recipients are at high risk for fractures, primarily due to post-transplant bone disease. This retrospective cohort study analyzed data from the Korean National Health Insurance Service, including 10 083 kidney transplant recipients examined from 2009 to 2017. We assessed fracture incidence, emphasizing vertebral and hip fractures, and the association of physical activity and traditional risk factors with fracture risk. Kidney transplant recipients were categorized into three groups according to physical activity levels: non-activity, metabolic equivalent of task (MET) 1-499, and MET ≥500. Physical activity was associated with a decreased risk of all types of fractures: any (MET 1-499: adjusted hazard ratio (aHR) .75; 95% confidence interval (CI) .62-.92, MET ≥500: aHR .84; 95% CI .70-1.00), vertebral (MET 1-499: aHR .69; 95% CI .49-.98, MET ≥500: aHR .67; 95% CI .49-.91), and hip (MET 1-499: aHR .43; 95% CI .23-.81) fractures. Additionally, older age, female sex, and diabetes were associated with an increased fracture risk. The assessment of physical activity and traditional risk factors could improve fracture risk prediction. Our findings emphasize the need for further research to establish optimal physical activity recommendations for fracture prevention in kidney transplant recipients.
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Affiliation(s)
- Sungmi Kim
- Division of nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Kyungho Lee
- Division of nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junseok Jeon
- Division of nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Ryoun Jang
- Division of nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Eun Lee
- Division of nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Wooseong Huh
- Division of nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Huang L, Wang H, Bai Y, Zhang H, Zhang F, Zhong Y. Objectively measured daily steps as an outcome in a clinical trial of chronic kidney disease: a systematic review. BMC Nephrol 2024; 25:10. [PMID: 38172696 PMCID: PMC10765814 DOI: 10.1186/s12882-023-03412-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Physical inactivity is prevalent among individuals with chronic kidney disease (CKD) and is linked to unfavorable outcomes. In recent years, daily steps have emerged as a prominent target for interventions in clinical trials. The present study endeavors to scrutinize the effectiveness and/or efficacy of various interventions on daily steps in patients with full-spectrum CKD. METHODS In December 2022, a systematic search was conducted across three databases, namely PubMed, Embase, and Web of Science, and subsequently updated in June 2023. The inclusion criteria included randomized controlled studies, quasi-experimental studies, and single-arm trials that assessed an intervention's impact on objectively measured daily steps in patients with chronic kidney disease. The Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool was used to assess the risk of bias in non-randomized controlled trials (RCT), while the Cochrane revised tool (ROB-2) was utilized for RCTs. RESULTS Seventeen studies were deemed eligible for inclusion in this review, with a focus on examining the efficacy and/or effectiveness of exercise training-based interventions (n = 10), daily step goal-oriented interventions (n = 4), mobile health (mHealth) interventions (n = 1), different dialysis modalities (n = 1), and a "Sit Less, Interact, Move More" intervention (n = 1). The studies exhibit variability in their characteristics and assessment tools, reflecting the findings' heterogeneity. The results indicate that increasing physical activity levels remain challenging, as only a limited number of studies demonstrated significant improvements in participants' daily step counts from baseline to endpoint. CONCLUSION Clinical trials with daily steps as an outcome are still lacking in the CKD population. Well-designed clinical trials that objectively assess the physical activity of CKD patients are needed.
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Affiliation(s)
- Liuyan Huang
- First Branch of Nephrology Department, Longhua Hospital Shanghai University of Traditional Chinese Medicine, No.725, Wanping South Road, Xuhui District, Shanghai, China
| | - Hui Wang
- Department of Anorectology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- First Branch of Nephrology Department, Longhua Hospital Shanghai University of Traditional Chinese Medicine, No.725, Wanping South Road, Xuhui District, Shanghai, China
| | - Huachun Zhang
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fan Zhang
- First Branch of Nephrology Department, Longhua Hospital Shanghai University of Traditional Chinese Medicine, No.725, Wanping South Road, Xuhui District, Shanghai, China.
| | - Yifei Zhong
- First Branch of Nephrology Department, Longhua Hospital Shanghai University of Traditional Chinese Medicine, No.725, Wanping South Road, Xuhui District, Shanghai, China.
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8
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Knobbe TJ, Kremer D, Eisenga MF, van Londen M, Annema C, Bültmann U, Kema IP, Navis GJ, Berger SP, Bakker SJL. Sleep quality, fatigue, societal participation and health-related quality of life in kidney transplant recipients: a cross-sectional and longitudinal cohort study. Nephrol Dial Transplant 2023; 39:74-83. [PMID: 37418245 PMCID: PMC10730797 DOI: 10.1093/ndt/gfad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Fatigue and impaired health-related quality of life (HRQoL) are common among kidney transplant recipients (KTR). We hypothesized that both may partially be attributable to poor sleep. METHODS Cross-sectional and longitudinal data of KTR enrolled in the TransplantLines Biobank and Cohort Study were used. Sleep quality was assessed using the Pittsburgh Sleep Quality Index questionnaire. Individual strength (i.e. a composite of fatigue, concentration, motivation and physical activity), societal participation and HRQoL were assessed using validated questionnaires. RESULTS We included 872 KTR (39% female, age 56 ± 13 years) and 335 healthy controls. In total, 33% of male KTR and 49% of female KTR reported poor sleep quality, which was higher compared with male and female healthy controls (19% and 28%, respectively, P < .001 for both). In logistic regression analyses, female sex, anxiety, active smoking, low protein intake, physically inactive lifestyle, low plasma magnesium concentration, using calcineurin inhibitors, not using mTOR inhibitors and using benzodiazepine agonists were associated with poor sleep quality. In adjusted linear regression analyses, poor sleep was strongly and independently associated with lower individual strength [standardized β (st.β) = 0.59, 95% confidence interval (CI) 0.45 to 0.74, P < .001], poorer societal participation (frequency: st.β = -0.17, 95% CI -0.32 to -0.01, P = .04; restrictions: st.β = -0.36, 95% CI -0.51 to -0.21, P < .001; satisfaction: st.β = -0.44, 95% CI -0.59 to -0.28, P < .001) and lower HRQoL (physical: st.β = -0.53, 95% CI -0.68 to -0.38, P < .001; mental: st.β = -0.64, 95% CI -0.78 to -0.50, P < .001). The associations with poorer societal participation and lower HRQoL were strongly mediated by individual strength (P < .001 for all), yet the suggested direct effects of poor sleep quality on HRQoL remained significant (Pphysical = .03, Pmental = .002). Longitudinal data of 292 KTR showed that sleep quality improves after kidney transplantation in males (P < .001), but not in females (P = .9). CONCLUSIONS Poor sleep quality is common among KTR, and may be a potential target to improve fatigue, societal participation and HRQoL among KTR.
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Affiliation(s)
- Tim J Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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9
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Faraldo-Cabana A, Sánchez-Fructuoso A, Pérez-Flores I, Beneit-Montesinos JV, Muñoz-Jiménez D, Peix Jiménez B, Asensio Arredondo S, Nuño Santana EI, Santana Valeros MJ, Hidalgo González V, González García F, Ortuño-Soriano I. Development of an Information Guideline for Kidney Transplant Recipients in a Clinical Trial: Protocol for a Modified Delphi Method. JMIR Res Protoc 2023; 12:e46961. [PMID: 37930773 PMCID: PMC10660209 DOI: 10.2196/46961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/20/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Renal transplantation is the treatment of choice for most cases of end-stage renal disease. Recipients need to lead a healthy lifestyle to minimize the potential side effects of immunosuppressive drugs and improve transplant outcomes. There is not much evidence about the best way to increase adherence to healthy lifestyles in kidney transplant recipients, so one of the objectives set by the nursing team is to train people to acquire the necessary skills and tools to be able to take care of themselves. In this sense, the consensual development of appropriate materials may be useful and of interest. OBJECTIVE The aim of this study was to develop an information guide for adults with kidney transplants to be assessed in a subsequent clinical trial as an intervention to increase adherence to healthy habits. METHODS We used a 3-step, methodological, sequential approach: (1) training from a group of experts and item consensus; (2) review of the medical literature available; and (3) use of the Delphi technique with on-site meetings. A total of 5 nurses from the Community of Madrid Kidney Transplantation Unit in Spain were asked to participate. The patients' lifestyle factors that, according to the medical literature available and experts' opinions, have the greatest impact on the survival of the transplanted organ and the recipients themselves were all described. RESULTS After using the modified Delphi method to reach a consensus on the items to be included and the information needed in each, an information guide for adult kidney transplant patients was developed. This guide facilitates the structuring of health care, information, and recommendations necessary for effective self-care for each person. The result is considered to be an easy-to-understand tool, useful for transplant doctors and nurses, in simple language, with information based on the latest scientific-medical evidence published to date, aspects of which will be evaluated in a clinical trial designed for this purpose. CONCLUSIONS Currently, this guide is the main intervention variable of a clinical trial (registered on ClinicalTrials.gov; NCT05715580) aimed at improving compliance with healthy habits in kidney transplant recipients in the Community of Madrid, Spain. The method used in its development has been useful and agile, and the result is a guide that can be easily updated periodically following the same procedure. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46961.
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Affiliation(s)
- Araceli Faraldo-Cabana
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Ana Sánchez-Fructuoso
- Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Isabel Pérez-Flores
- Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Juan Vicente Beneit-Montesinos
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Daniel Muñoz-Jiménez
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud. Unidad de Investigación en Cuidados y Servicios de Salud del Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | - Ismael Ortuño-Soriano
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
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10
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Bozkurt HN, Yıldırım M, Çelik A, Yıldız S. Predictors of static and dynamic balance control in kidney transplant recipients. Wien Klin Wochenschr 2023:10.1007/s00508-023-02292-3. [PMID: 37904031 DOI: 10.1007/s00508-023-02292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 09/24/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND We aimed to evaluate balance control and lower extremity muscle strength in kidney transplant recipients (KTRs) including a comparison to a healthy control group and determine the predictors of static and dynamic balance control after kidney transplantation. METHODS In this study 40 KTRs and 40 healthy controls were included. Balance control was assessed using the Biodex balance system. The static postural stability test (SPST) and clinical test of sensory integration and balance (CTSIB) were used to assess static balance control whereas the dynamic postural stability test (DPST) and limits of stability test (LOST) were used for dynamic balance control. Lower extremity muscle strength was measured with a hand-held dynamometer. Renal functions and laboratory findings of KTRs were recorded. RESULTS All the stability index scores of SPST and sway index in CTSIB were significantly higher in KTRs compared to healthy controls. The right anteroposterior stability index score in DPST and the reaction time in LOST were significantly higher whereas overall score in LOST and lower extremity muscle strength were significantly lower in KTRs. The linear regression analysis revealed that hemoglobin was the predictor of static balance control accounting for 11% of the variance and body weight was the predictor of dynamic balance control accounting for 34% of the variance. CONCLUSION Balance control, both static and dynamic, are impaired in KTRs as well as lower extremity muscle strength. Hemoglobin level is a predictor of static balance control whereas body weight is a predictor of dynamic balance control after kidney transplantation.
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Affiliation(s)
- Hatice Nihan Bozkurt
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Mithatpaşa Street, Number: 56/15 Balçova, 35340, Izmir, Turkey.
| | - Meriç Yıldırım
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Mithatpaşa Street, Number: 56/15 Balçova, 35340, Izmir, Turkey
| | - Ali Çelik
- Division of Nephrology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Serkan Yıldız
- Division of Nephrology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
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11
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Zhang H, Wang H, Huang L, Bai Y, Zhang F. Interventions to increase physical activity level in patients with whole spectrum chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2023; 45:2255677. [PMID: 37724555 PMCID: PMC10512821 DOI: 10.1080/0886022x.2023.2255677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
Background: Little is known about effective interventions to increase physical activity levels in this population. This systematic review and meta-analysis evaluated the effectiveness of different interventions for physical activity levels in whole-spectrum CKD patients.Methods: In this systematic review and meta-analysis, PubMed, Embase, and Web of Science were searched from inception to December 2022, with an update in March 2023. Studies of clinical interventions based on assessing physical activity outcomes (e.g., daily steps, time spent doing physical activity) in patients with whole-spectrum CKD were included. The pooled effect size was calculated using a restricted maximum likelihood method and reported as a standardized mean difference (SMD) with 95% confidence interval (95% CI).Results: The systematic review included 2,156 participants (59.9 ± 8.7 years) from 35 studies. Interventions aimed at modifying physical activity were associated with significantly higher physical activity levels in patients with CKD (SMD = 0.22; 95% CI: 0.08 to 0.36; I2 = 55%). Exercise-based interventions and real-time step feedback increased physical activity by 0.26 (95% CI: 0.07 to 0.45; I2 = 59%) and 0.36 (95% CI: 0.12 to 0.60; I2 = 0%) standard deviations, respectively. Effect sizes did not vary by disease stage or study duration; however, there was evidence of small study or publication bias for the primary analysis.Conclusion: In this systematic review and meta-analysis, intervention strategies aimed at modifying physical activity were associated with significantly increased physical activity levels in patients with whole-spectrum CKD.
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Affiliation(s)
- Huachun Zhang
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Hui Wang
- Department of Anorectology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Liuyan Huang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Yan Bai
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
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12
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Gibson CA, Gupta A, Naik A, Sullivan DK, Doshi M, Backes J, Harvey S, Lee J, Mount R, Valentine H, Shaffer K. Developing a Healthy Lifestyle Program for Recent Kidney Transplant Recipients. Prog Transplant 2023; 33:193-200. [PMID: 37469164 DOI: 10.1177/15269248231189878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Many kidney transplant recipients experience weight gain in the first year after transplantation. RESEARCH QUESTION The objective of this research study was to assess the desires of recent kidney transplant patients about the design features of a healthy lifestyle program to counter unnecessary weight gain. DESIGN In this descriptive study, recent recipients at 2 transplant centers were invited to participate in an online survey. Survey items included sociodemographic information, current medications, health conditions, weight change posttransplant, diet behaviors, physical activity participation, and desired features of a lifestyle program. RESULTS Fifty-three participants, mean age 60.5 (11.2) years, primarily males, completed surveys. Forty percent gained weight posttransplantation with many indicating struggling with their diet. Physical activity levels stayed the same (17%) or decreased (40%) posttransplantation. Eighty-seven percent of participants indicated they would participate in an online lifestyle program and 76% wanted online physical activity and nutrition sessions to meet at least once weekly. Suggestions about the type of information and activities, included eating strategies (eg, how to eat healthfully at restaurants, grocery shopping tips, and recipes), resources for at-home physical activities, access to cooking classes, and apps to track both activity and food intake. CONCLUSION Recent kidney transplant recipients would benefit from and desired to join a lifestyle program featuring tailored nutrition education and physical activity coaching. Gathered information will be used to inform and tailor a lifestyle program. Identifying features for the prevention of unnecessary weight gain with patients' input is essential for promoting and sustaining healthy behaviors.
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Affiliation(s)
- Cheryl A Gibson
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aditi Gupta
- Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abhijit Naik
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mona Doshi
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jim Backes
- Department of Pharmacy Practice, University of Kansas Medical Center, Kansas City, KS, USA
| | - Susan Harvey
- Department of Health, Sports, and Exercise Sciences, University of Kansas, Robinson Center, Lawrence, KS, USA
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, Texas Tech University, Lubbock, TX, USA
| | - Rebecca Mount
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Heather Valentine
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly Shaffer
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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13
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Febles RM, Miranda DM, Perera CDLCC, Martín LD, Rodríguez-Rodríguez AE, González Martín AR, Sánchez Báez DJ, Porrini E. Therapeutic Exercise on Metabolic and Renal Outcomes in Patients with Chronic Kidney Disease: A Narrative Review. Nephron Clin Pract 2023; 148:85-94. [PMID: 37611542 DOI: 10.1159/000531921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/28/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) affects 11-13% of the world population. The main risk factors for CKD include diabetes, hypertension, and obesity. Metabolic syndrome (MS) is associated with the onset of CKD in the nondiabetic population. Obesity and MS are also risk factors for a worse progression of established CKD. Therapeutic exercise is an effective option to treat and manage obesity, MS, and diabetes in the general population. However, the evidence on the effect of exercise on patients with CKD, obesity, and MS is scarce. SUMMARY We evaluated available evidence on the effect of therapeutic exercise in patients with CKD, excluding dialysis, particularly in improving the metabolic risk factors and main renal outcomes: renal function loss and albuminuria/proteinuria. This review includes prospective studies and clinical trials. A total of 44 studies were analysed in 1,700 subjects with renal disease (2-5), including patients with renal transplantation. Most studies did not prove a major effect of exercise on albuminuria/proteinuria, glomerular filtration rate (GFR), obesity, or MS. These results are intriguing and deserve attention. The exploratory nature of most studies, including a low number of cases and short follow-up, might explain the lack of efficacy of exercise in our analysis. Specific aspects like the type of exercise, frequency, intensity, duration, accommodation during follow-up, individualization, safety, and adherence are crucial to the success of therapeutic exercise. The beneficial role of exercise in patients with CKD remains to be determined. KEY MESSAGES Key messages of this review are as follows. (1) The effect of therapeutic exercise on renal and metabolic outcomes in patients with CKD remains to be determined. (2) According to the evidence selected, therapeutic exercise seems to be safe to treat patients with CKD. (3) Most studies are exploratory by nature, with results that need further investigation. (4) Therapeutic exercise is a complex procedure that must be specifically designed to treat patients with CKD.
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Affiliation(s)
- Raúl Morales Febles
- Faculty of Medicine, University of La Laguna, Tenerife, Spain,
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain,
| | - Domingo Marrero Miranda
- Instituto de Tecnologías Biomédicas (ITB), Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | - Coriolano de la Concepción Cruz Perera
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain
- Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain
| | - Laura Díaz Martín
- Laboratory of Renal Function (LFR), Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | | | | | | | - Esteban Porrini
- Faculty of Medicine, University of La Laguna, Tenerife, Spain
- Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain
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14
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Chong HJ, Kim HK. Adaptation Process After Kidney Transplantation in Older Adult Recipients: Applied Grounded Theory. Res Gerontol Nurs 2023; 16:183-193. [PMID: 37159389 DOI: 10.3928/19404921-20230503-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Despite the increase in older adults receiving kidney transplantation (KT), little is known about their experience and adaptation process after KT. The current study aimed to explore the process of adaptation after KT in older adult recipients using a qualitative design and grounded theory methodology. Sixteen recipients who had KT at age ≥60 years and received follow-up care were recruited at a university hospital in South Korea. Data were collected from July to December 2017 through in-depth interviews with individual participants. The core theme of the adaptation process after KT in older adult recipients was A Journey of Straining to Save the Last Lifeline. The adaptation process comprised three stages: confusion, depression, and compromise. Tailored interventions based on the in-depth understanding of the adaptation process found in the current study are needed to improve adaptation after KT in older adult recipients. [Research in Gerontological Nursing, 16(4), 183-193.].
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15
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Michou V, Nikodimopoulou M, Liakopoulos V, Anifanti M, Papagianni A, Zembekakis P, Deligiannis A, Kouidi E. Home-Based Exercise Training and Cardiac Autonomic Neuropathy in Kidney Transplant Recipients with Type-II Diabetes Mellitus. Life (Basel) 2023; 13:1394. [PMID: 37374177 DOI: 10.3390/life13061394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This randomized clinical trial aimed to examine the effects of a 6-month home-based, combined exercise training program on Cardiac Autonomic Neuropathy (CAN) in kidney transplant recipients (KTRs) with diabetes. Twenty-five KTRs (19 men (76.0%), with a mean age of 54.4 ± 11.3 years old, CAN and type II Diabetes Mellitus (DM-II)), were randomly assigned into two groups: A (n1 = 13 KTRs), who underwent a home-based exercise training program for 6 months, and B (n2 = 12 KTRs), who were assessed at the end of the study. A cardiopulmonary exercise testing (CPET), sit-to-stand test in 30 s (30-s STS), isokinetic muscle strength dynamometry, and 24-h electrocardiographic monitoring were applied to all participants, both at the baseline and at the end of the clinical trial. At first, there were no statistically significant differences between groups. After 6 months, group A showed higher values in exercise time by 8.7% (p = 0.02), VO2peak by 7.3% (p < 0.05), 30-s STS by 12.0% (p < 0.05), upper limb strength by 46.1% (p < 0.05), and lower limb strength by 24.6% (p = 0.02), respectively, compared to the B group. Furthermore, inter-group changes at the end of the 6-month study indicated that group A statistically increased the standard deviation of R-R intervals (SDNN) by 30.3% (p = 0.01), root mean square of successive differences between normal heartbeats (rMSSD) by 32.0% (p = 0.03), number of pairs of successive NN (R-R) intervals that differ by more than 50 ms (pNN50) by 29.0% (p = 0.04), high frequency (HF (ms2)) by 21.6% (p < 0.05), HF (n.u.) by 48.5% (p = 0.01), and turbulence slope (TS) by 22.5% (p = 0.02), and decreased the low frequency (LF (ms2)) by 13.2% (p = 0.01), LF (n.u.) by 24.9% (p = 0.04), and LF/HF ratio by 24% (p = 0.01), compared to group B. Linear regression analysis after the 6-month study showed that there was a strong positive correlation between VO2peak and SDNN (r = 0.701, p < 0.05) in group A. Moreover, multiple regression analysis showed that KTRs' participation in the exercise program showed favorable modifications to sympathovagal balance and aerobic capacity, as measured with SDNN and VO2peak, respectively. To summarize, diabetic KTRs' cardiac autonomic function and functional capacity can be improved after a home-based long-term exercise training program.
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Affiliation(s)
- Vassiliki Michou
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Maria Nikodimopoulou
- Transplant Surgery Clinic of Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, 54636 Thessaloniki, Greece
| | - Maria Anifanti
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University, 54642 Thessaloniki, Greece
| | - Pantelis Zembekakis
- Division of Internal Medicine, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, 54636 Thessaloniki, Greece
| | - Asterios Deligiannis
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
| | - Evangelia Kouidi
- Sports Medicine Laboratory, School of Physical Education & Sport Science, Aristotle University, 57001 Thessaloniki, Greece
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16
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Plante A, Bedrossian N, Cadotte G, Piché A, Michael F, Bédard S, Tessier H, Fernandez-Prada C, Sabiston CM, Dieudé M, Doré I. Pet ownership and lifestyle behaviours of immunosuppressed individuals and their relatives in the context of COVID-19 pandemic. Prev Med Rep 2023; 33:102210. [PMID: 37090822 PMCID: PMC10105381 DOI: 10.1016/j.pmedr.2023.102210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
The COVID-19 pandemic and containment measures will likely have a detrimental impact on immunosuppressed individuals' lifestyle behaviours. Increasing evidence suggests that pet ownership is positively associated with healthier lifestyle. Yet, no study has investigated the potential benefits of pet ownership on lifestyle behaviours of immunosuppressed individuals, a population at increased risk of COVID-19 complications. This study aims to examine 1) changes in light, moderate and vigorous intensity physical activity (LPA, MPA, VPA), sedentary time (SED), and sleep duration, assessed by comparing "before COVID-19 pandemic" and "past 7 days" (i.e., current, during pandemic) self-reported behaviours in immunosuppressed individuals and their relatives; 2) to assess if changes in lifestyle behaviours are associated with pet ownership status and whether age is a moderator of these associations. A convenience sample of 132 participants (65.2% female, 41.3% ≥55 years of age) provided self-reported LPA, MPA, VPA (days/week), SED and sleep (min/day) and pet ownership status using an online questionnaire (May-August 2020). Descriptive analyses, paired T-tests, Cohen's d effect size and linear regressions were conducted. Results show that participants reported a decrease in VPA (-0.56 days/week, d = 0.34; p < 0.01) and an increase in SED (106.79 min/day, d = -0.81; p < 0.01). Stratified analysis revealed that having at least one dog, compared to not owning pets, is associated with a reduced decline in LPA, MPA and VPA and an increase in sleep in participants aged < 55 years old only. Having a dog appears to be positively associated with healthy lifestyle behaviours in younger and middle age immunosuppressed individuals.
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Affiliation(s)
- Audrey Plante
- Centre de recherche du CHUM, Université de Montréal, 900 rue Saint-Denis, Montréal, QC H2X 0A9, Canada
| | - Nathalie Bedrossian
- Centre de recherche du CHUM, Université de Montréal, 900 rue Saint-Denis, Montréal, QC H2X 0A9, Canada
| | - Gabrielle Cadotte
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, QC H3T 1J4, Canada
| | - Alexia Piché
- Centre de recherche du CHUM, Université de Montréal, 900 rue Saint-Denis, Montréal, QC H2X 0A9, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, QC H3T 1J4, Canada
| | - Fady Michael
- Centre de recherche du CHUM, Université de Montréal, 900 rue Saint-Denis, Montréal, QC H2X 0A9, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Av du Parc, Montréal, QC H3N 1X9, Canada
| | - Sylvain Bédard
- Canadian Donation and Transplant Research Program (CDTRP), University of Alberta, Room 6002, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1, Canada
- Centre d'excellence sur le partenariat avec les patients et le public (CEPPP), Canada
| | - Hélène Tessier
- Canadian Donation and Transplant Research Program (CDTRP), University of Alberta, Room 6002, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1, Canada
| | - Christopher Fernandez-Prada
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, 3200 Rue Sicotte, Saint-Hyacinthe, QC J2S 2M2, Canada
- The Research Group on Infectious Diseases in Production Animals (GREMIP), Faculty of Veterinary Medicine, Université de Montréal, 3200 Rue Sicotte, Saint-Hyacinthe, QC J2S 2M2, Canada
- Department of Microbiology and Immunology, McGill Research Centre on Complex Traits, Montreal, Quebec, Canada, 1001 Bd Décarie, Montréal, QC H4A 3J1, Canada
| | - Catherine M Sabiston
- School of Kinesiology and Physical Education, University of Toronto, 27 King's College Cir, Toronto, ON M5S 1A1, Canada
| | - Mélanie Dieudé
- Centre de recherche du CHUM, Université de Montréal, 900 rue Saint-Denis, Montréal, QC H2X 0A9, Canada
- Canadian Donation and Transplant Research Program (CDTRP), University of Alberta, Room 6002, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1, Canada
- Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, QC H3T 1J4, Canada
- Héma-Québec, 4045, boulevard Côte-Vertu, Montréal, QC H4R 2W7, Canada
| | - Isabelle Doré
- Centre de recherche du CHUM, Université de Montréal, 900 rue Saint-Denis, Montréal, QC H2X 0A9, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, QC H3T 1J4, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Av du Parc, Montréal, QC H3N 1X9, Canada
- Canadian Donation and Transplant Research Program (CDTRP), University of Alberta, Room 6002, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1, Canada
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Mishra RK, Hamad A, Ibrahim R, Mathew M, Talal T, Al-Ali F, Park C, Davuluri V, Fernando ME, Najafi B. Objective assessment of mobility among adults with diabetes and end-stage renal disease using walking aid: A cross-sectional cohort study. Clin Biomech (Bristol, Avon) 2023; 107:106014. [PMID: 37290375 DOI: 10.1016/j.clinbiomech.2023.106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND This cross-sectional study aimed to compare physical activity levels, plantar sensation, and fear of falling between individuals with diabetes undergoing hemodialysis, with or without walking aids. METHODS Sixty-four participants were recruited, with 37 not using walking aids (age = 65.8 ± 0.7 years, 46% female) and 27 using walking aids (age = 69.2 ± 1.2 years, 63% female). Physical activity was measured using validated pendant sensors over two consecutive days. Concern for falling and plantar numbness were assessed using the Falls Efficacy Scale-International and vibration perception threshold test, respectively. FINDINGS Participants using walking aids exhibited a greater fear of falling (84% vs. 38%, p < 0.01) and fewer walking bouts (p < 0.01, d = 0.67) and stand-to-walk transitions (p < 0.01, d = 0.72) compared to those not using walking aids. The number of walking bouts was negatively correlated with concern for falling scores (ρ = -0.35, p = 0.034) and vibration perception threshold (R = -0.411, p = 0.012) among individuals not using walking aids. However, these correlations were not significant among those using the walking aid. There was no significant group difference in active behavior (walking + standing %) and sedentary behavior (sitting + lying %). INTERPRETATION Those undergoing hemodialysis often lead sedentary lives, with mobility affected by fear of falling and plantar numbness. Using walking aids can help, but it doesn't guarantee more walking. A combined psychosocial and physical therapy approach is key for managing fall concerns and improving mobility.
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Affiliation(s)
- Ram Kinker Mishra
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Abdullah Hamad
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Rania Ibrahim
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Mincy Mathew
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Talal Talal
- Diabetic Foot and Wound Clinic, Hamad Medical Co, Doha, Qatar
| | - Fadwa Al-Ali
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Catherine Park
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Vyshnavi Davuluri
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Malindu E Fernando
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Ulcer and wound Healing consortium, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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18
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Hu S, Hu Y, Wang S, Jin Q, Wang W, Liu H, Li J, Liu H. Predicting physical activity in kidney transplant recipients: an application of the Health Action Process Approach model. PSYCHOL HEALTH MED 2023; 28:772-784. [PMID: 35468024 DOI: 10.1080/13548506.2022.2067576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite numerous physical, psychological, and social benefits of physical activity (PA), few kidney transplant recipients (KTRs) positively participate in PA. It is essential to understand the influencing factors of PA in KTRs. This study aimed to apply the Health Action Process Approach (HAPA) model to explore the influencing factors of PA in KTRs. This was a prospective study involving 320 participants. Pre-actional self-efficacy, outcome expectancies, risk perception, social support, PA intention, and demographic and clinical data were measured at Time 1. Coping self-efficacy, planning, recovery self-efficacy, and PA behavior were assessed 3 months later. The hypothesized relationships were examined by structural equation modeling. Findings revealed significant direct effects of pre-actional self-efficacy, negative outcome expectancies, positive outcome expectancies, and social support on intention. Planning and recovery self-efficacy were significant predictors of PA. The HAPA model provided a validated and useful framework for predicting the factors influencing PA behavior in KTRs.
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Affiliation(s)
- Shujing Hu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Hu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Shasha Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Qing Jin
- Department of Urological Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Urological Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hang Liu
- Department of Urological Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Hongxia Liu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
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19
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Muñoz-Redondo E, Morgado-Pérez A, Pérez-Sáez MJ, Faura A, Sánchez-Rodríguez D, Tejero-Sánchez M, Meza-Valderrama D, Muns MD, Pascual J, Marco E. Low Phase Angle Values Are Associated with Malnutrition according to the Global Leadership Initiative on Malnutrition Criteria in Kidney Transplant Candidates: Preliminary Assessment of Diagnostic Accuracy in the FRAILMar Study. Nutrients 2023; 15:nu15051084. [PMID: 36904084 PMCID: PMC10005429 DOI: 10.3390/nu15051084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Malnutrition has a negative impact on patients with chronic diseases and its early identification is a priority. The primary objective of this diagnostic accuracy study was to assess the performance of the phase angle (PhA), a bioimpedance analysis (BIA)-derived parameter, for malnutrition screening using the Global Leadership Initiative for Malnutrition (GLIM) criteria as the reference standard in patients with advanced chronic kidney disease (CKD) waiting for kidney transplantation (KT); criteria associated with low PhA in this population were also analyzed. Sensitivity, specificity, accuracy, positive and negative likelihood ratios, predictive values, and area under the receiver operating characteristic curve were calculated for PhA (index test) and compared with GLIM criteria (reference standard). Of 63 patients (62.9 years old; 76.2% men), 22 (34.9%) had malnutrition. The PhA threshold with the highest accuracy was ≤4.85° (sensitivity 72.7%, specificity 65.9%, and positive and negative likelihood ratios 2.13 and 0.41, respectively). A PhA ≤ 4.85° was associated with a 3.5-fold higher malnutrition risk (OR = 3.53 (CI95% 1.0-12.1)). Considering the GLIM criteria as the reference standard, a PhA ≤ 4.85° showed only fair validity for detecting malnutrition, and thus cannot be recommended as a stand-alone screening tool in this population.
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Affiliation(s)
- Elena Muñoz-Redondo
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- PhD Program in Medicine, Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Andrea Morgado-Pérez
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
| | - María-José Pérez-Sáez
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain
- Kidney Disease Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), 08003 Barcelona, Spain
| | - Anna Faura
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Dolores Sánchez-Rodríguez
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, 1020 Brussels, Belgium
- Geriatrics Department, Parc de Salut Mar (Centre Fòrum), 08019 Barcelona, Spain
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, Université of Liège, Campus Sart Tilman, Quartier Hôpital, 4000 Liège, Belgium
| | - Marta Tejero-Sánchez
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
| | - Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFRE), Diagonal a la Universidad Tecnológica de Panamá, Panama City 0819, Panama
| | - María Dolors Muns
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain
| | - Julio Pascual
- Nephrology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), 08003 Barcelona, Spain
- Correspondence:
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20
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Zeitoun T, Plante A, Sabiston CM, Dieudé M, Doré I. The Association between Change in Lifestyle Behaviors and Mental Health Indicators in Immunosuppressed Individuals during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2099. [PMID: 36767466 PMCID: PMC9916248 DOI: 10.3390/ijerph20032099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Little is known on how changes in lifestyle behaviors affect mental health among immunosuppressed individuals who observed stricter physical and social distancing measures due to higher risk of complications during the COVID-19 pandemic. This study examines the association between changes in moderate-to-vigorous physical activity (MVPA), sedentary time (ST) and sleep duration following COVID-19 outbreak on mental health indicators of immunosuppressed individuals and their relatives. Participants (n = 132) completed an online questionnaire between May and August 2020. Linear regressions were conducted to assess the associations between an increase or decrease in lifestyle behaviors and mental health indicators. Individuals with decreased MVPA and increased ST experienced higher distress, anxiety and depressive symptoms. Those who reported an increase or decrease in sleep had higher levels of stress, distress and depressive symptoms. Decreases in sleep was associated with higher anxiety symptoms. Lifestyle behaviors in the context of a stressful life event such as the COVID-19 pandemic may impact mental health indicators of immunosuppressed individuals and their relatives.
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Affiliation(s)
- Tara Zeitoun
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | | - Catherine M. Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada
| | - Mélanie Dieudé
- CHUM Research Centre, Montréal, QC H2X 0A9, Canada
- Department of Microbiology, Infectiology and Immunology, Faculty of medicine, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Canadian Donation and Transplant Research Program (CDTRP), Edmonton, AB T6G 2E1, Canada
- Héma-Québec, Montréal, QC H4R 2W7, Canada
| | - Isabelle Doré
- CHUM Research Centre, Montréal, QC H2X 0A9, Canada
- Canadian Donation and Transplant Research Program (CDTRP), Edmonton, AB T6G 2E1, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
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21
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Wang Y, Van Der Boog P, Hemmelder MH, Dekker FW, De Vries A, Meuleman Y. Understanding Health-Related Quality of Life in Kidney Transplant Recipients: The Role of Symptom Experience and Illness Perceptions. Transpl Int 2023; 36:10837. [PMID: 37125387 PMCID: PMC10134035 DOI: 10.3389/ti.2023.10837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023]
Abstract
The purpose of our article is to investigate the impact of symptom experience on health related quality of life (HRQOL) in kidney transplant recipients (KTRs) and whether illness perceptions mediated this impact. Symptom experience, illness perceptions, and HRQOL were measured at transplantation and 6 weeks after transplantation in KTRs in an ongoing Dutch cohort study. Multivariable linear regression models were used for the analysis. 90 KTRs were analyzed. Fatigue and lack of energy were the most prevalent and burdensome symptoms at transplantation. Mental HRQOL at 6 weeks after transplantation was comparable to that of the general Dutch population (mean [standard deviation, SD]: 49.9 [10.7]) versus 50.2 [9.2]), while physical HRQOL was significantly lower (38.9 [9.1] versus 50.6 [9.2]). Experiencing more symptoms was associated with lower physical and mental HRQOL, and the corresponding HRQOL reduced by -0.15 (95%CI, -0.31; 0.02) and -0.23 (95%CI, -0.42; -0.04) with each additional symptom. The identified mediation effect suggests that worse symptom experiences could cause more unhelpful illness perceptions and consequently lead to lower HRQOL. Illness perceptions may explain the negative impact of symptom experience on HRQOL. Future studies at later stages after kidney transplantation are needed to further explore the mediation effect of illness perceptions and guide clinical practice to improve HRQOL.
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Affiliation(s)
- Yiman Wang
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, Netherlands
- *Correspondence: Yiman Wang,
| | - Paul Van Der Boog
- Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Marc H. Hemmelder
- Department of Nephrology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Aiko De Vries
- Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, Netherlands
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22
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Antoun J, Brown DJ, Clarkson BG, Shepherd AI, Sangala NC, Lewis RJ, McNarry MA, Mackintosh KA, Corbett J, Saynor ZL. Experiences of adults living with a kidney transplant-Effects on physical activity, physical function, and quality of life: A descriptive phenomenological study. J Ren Care 2022. [PMID: 36250752 DOI: 10.1111/jorc.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although kidney transplantation is the best treatment for kidney failure, scarce research has examined its effects on physical activity, physical function and quality of life. OBJECTIVES To investigate the experiences of a group of adults living with advanced kidney disease focusing on quality of life, physical activity and function and to see how findings differ in a group of kidney transplant recipients. APPROACH Individual semi-structured interviews were conducted with adults with advanced kidney disease (n = 10; 70.5 ± 8.9 years) and adults who had received a kidney transplant (n = 10; 50.7 ± 11.5 years; transplant age: 42.7 ± 20.9 months). Interviews were transcribed verbatim, thematically analysed and composite vignettes developed. FINDINGS Individuals with advanced kidney disease described a sense of loss and alteration to their life plans. Kidney transplant recipients reported increased freedom, independence and a return to near normality, with improved quality of life, physical activity and function compared with their pre-transplant lives. However, transplant recipients also described living with anxiety about the health of their transplant and fear it may fail. CONCLUSION Whilst adults living with advanced kidney disease often experience a reduced quality of life, physical activity and function, kidney transplantation can help facilitate a return to pre-disease levels of physical activity, physical function and quality of life. However, transplant recipients also reported living with anxiety around their new kidney failing. This study demonstrates the variability in the lived experiences of adults living with advanced kidney disease or a kidney transplant and highlights the need for patient-centred care.
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Affiliation(s)
- Joe Antoun
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Daniel J Brown
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Beth G Clarkson
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Anthony I Shepherd
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Nicholas C Sangala
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Robert J Lewis
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Melitta A McNarry
- Department of Sport and Exercise Sciences, Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Swansea, UK
| | - Kelly A Mackintosh
- Department of Sport and Exercise Sciences, Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Swansea, UK
| | - Jo Corbett
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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23
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Knobbe TJ, Kremer D, Eisenga MF, Corpeleijn E, Annema C, Spikman JM, Navis G, Berger SP, Bakker SJL. Hand dexterity, daily functioning and health-related quality of life in kidney transplant recipients. Sci Rep 2022; 12:16208. [PMID: 36171358 PMCID: PMC9519570 DOI: 10.1038/s41598-022-19952-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
Impaired interplay between sensory and motor function may be an important, often overlooked cause of the decreased daily functioning and impaired health-related quality of life (HRQoL) of kidney transplant recipients (KTR). We assessed this interplay using a hand dexterity test, and investigated its potential associations with daily functioning and HRQoL among KTR enrolled at the TransplantLines Biobank and Cohort Study. A total of 309 KTR (58% male, mean age 56 ± 13 years) at median 4 [IQR: 1-11] years after transplantation were included. Impaired hand dexterity, as defined by a test performance slower than the 95th percentile of an age- and sex-specific reference population, was observed in 71 (23%) KTR. Worse hand dexterity was independently associated with worse performance on almost all measures of physical capacity, activities of daily living and societal participation. Finally, hand dexterity was independently associated with physical HRQoL (standardized beta - 0.22, 95%CI - 0.34 to - 0.09, P < 0.001). In conclusion, impaired interplay between sensory and motor function, as assessed by hand dexterity, is prevalent among KTR. In addition, poor hand dexterity was associated with impaired daily functioning and limited physical HRQoL. Impaired interplay between sensory and motor function may be therefore an important, hitherto overlooked, phenomenon in KTR.
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Affiliation(s)
- Tim J Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands.
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9713 GZ, Groningen, The Netherlands.
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
| | - Joke M Spikman
- Department of Neurology, Division of Neuropsychology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
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24
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Ribeiro PAB, Gradassi M, Martin SM, Leenknegt J, Baudet M, Le V, Pomey MP, Räkel A, Tournoux F. Clinical Implementation of Different Strategies for Exercise-Based Rehabilitation in Kidney and Liver Transplant Recipients: A Pilot Study. Arq Bras Cardiol 2022; 119:246-254. [PMID: 35946686 PMCID: PMC9363074 DOI: 10.36660/abc.20210159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 11/10/2021] [Indexed: 12/17/2022] Open
Abstract
Fundamento: A doença cardiovascular está entre as principais causas de morte entre pacientes transplantados. Embora esses pacientes possam teoricamente se beneficiar de programas de reabilitação baseada em exercícios (RBE), sua implementação ainda é um desafio. Objetivo: Apresentamos nossa experiência inicial em diferentes modos de realização de um programa piloto de RBE em receptores de transplante de rim e fígado. Métodos: Trinta e dois pacientes transplantados renais ou hepáticos foram convidados para um programa de RBE de 6 meses realizado na academia do hospital, na academia comunitária ou em casa, de acordo com a preferência do paciente. O nível de significância adotado foi de 5%. Resultados: Dez pacientes (31%) não completaram o programa. Entre os 22 que completaram, 7 treinaram na academia do hospital, 7 na academia comunitária e 8 em casa. O efeito geral foi um aumento de 11,4% nos METs máximos (tamanho do efeito de Hedges g = 0,39). O grupo de academia hospitalar teve um aumento nos METs de 25,5% (g = 0,58, tamanho de efeito médio) versus 10% (g = 0,25) e 6,5% (g = 0,20) para os grupos de academia comunitária e em casa, respectivamente. Houve efeito benéfico nas pressões arteriais sistólica e diastólica, maior para os grupos academia hospitalar (g= 0,51 e 0,40) e academia comunitária (g= 0,60 e 1,15) do que para os pacientes treinando em casa (g= 0,07 e 0,10). Nenhum evento adverso significativo foi relatado durante o seguimento. Conclusão: Programas de RBE em receptores de transplante de rim e fígado devem ser incentivados, mesmo que sejam realizados fora da academia do hospital, pois são seguros com efeitos positivos na capacidade de exercício e nos fatores de risco cardiovascular.
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Affiliation(s)
- Paula A B Ribeiro
- Unité de recherche @coeurlab - Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec - Canadá
| | - Mathieu Gradassi
- Centre de Cardiologie Preventive du Centre Hospitalier de l'Université de Montréal, Quebec - Canadá
| | - Sarah-Maude Martin
- Unité de recherche @coeurlab - Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec - Canadá.,Département des sciences de l'activité physique, Université du Québec à Montréal, Québec - Canadá
| | - Jonathan Leenknegt
- Centre de Cardiologie Preventive du Centre Hospitalier de l'Université de Montréal, Quebec - Canadá
| | - Mathilde Baudet
- Unité de recherche @coeurlab - Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec - Canadá
| | - VyVan Le
- Centre de Cardiologie Preventive du Centre Hospitalier de l'Université de Montréal, Quebec - Canadá.,Département de Cardiologie du Centre Hospitalier de l'Université de Montréal, Québec - Canadá
| | - Marie-Pascale Pomey
- Unité de recherche @coeurlab - Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec - Canadá.,École de santé publique, Université de Montréal, Québec - Canadá
| | - Agnes Räkel
- Unité de recherche @coeurlab - Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec - Canadá.,Département d'Encrinologie du Centre Hospitalier de l'Université de Montréal, Québec - Canadá
| | - François Tournoux
- Unité de recherche @coeurlab - Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Quebec - Canadá.,Département de Cardiologie du Centre Hospitalier de l'Université de Montréal, Québec - Canadá
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25
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Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden. J Pers Med 2022; 12:jpm12081200. [PMID: 35893294 PMCID: PMC9329988 DOI: 10.3390/jpm12081200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Cardiovascular disease is a frequent complication after kidney transplantation and represents the leading cause of mortality in this population. Material and Methods. We searched for the relevant articles in the National Institutes of Health library of medicine, transplant, cardiologic and nephrological journals. Results. The pathogenesis of cardiovascular disease in kidney transplant is multifactorial. Apart from non-modifiable risk factors, such as age, gender, genetic predisposition and ethnicity, several traditional and non-traditional modifiable risk factors contribute to its development. Traditional factors, such as diabetes, hypertension and dyslipidemia, may be present before and may worsen after transplantation. Immunosuppressants and impaired graft function may strongly influence the exacerbation of these comorbidities. However, in the last years, several studies showed that many other cardiovascular risk factors may be involved in kidney transplantation, including hyperuricemia, inflammation, low klotho and elevated Fibroblast Growth Factor 23 levels, deficient levels of vitamin D, vascular calcifications, anemia and poor physical activity and quality of life. Conclusions. The timely and effective treatment of time-honored and recently discovered modifiable risk factors represent the basis of the prevention of cardiovascular complications in kidney transplantation. Reduction of cardiovascular risk can improve the life expectancy, the quality of life and the allograft function and survival.
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26
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Neutrophil-lymphocyte Ratio and C-Reactive Protein Levels are not Associated with Strength, Muscle Mass, and Functional Capacity in Kidney Transplant Patients. Inflammation 2022; 45:2465-2476. [PMID: 35727395 DOI: 10.1007/s10753-022-01705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/02/2021] [Accepted: 06/08/2022] [Indexed: 11/05/2022]
Abstract
Chronic inflammation has been associated with components of sarcopenia; however, these associations are unknown in kidney transplant patients (KTPs). The aim of this study was to associate neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) with strength, muscle mass, and functional capacity in KTPs. A cross-sectional study evaluating 108 KTPs was performed. Strength was evaluated by handgrip strength and five-times-sit-to-stand test (5STS), and appendicular skeletal muscle mass (ASM) was estimated by bioelectrical impedance analysis. The ASM index (ASMI) was calculated using the ASM (kg)/height (m2). Functional capacity was assessed by the 4-m gait speed test and short physical performance battery (SPPB). The electrochemiluminescence method was used for analyzing CRP levels, and the cytometric method XN-3000 Sysmex was used for obtaining leukogram values to calculate the NLR. Linear regression analysis was used to assess the association between systemic inflammation and sarcopenia components, adjusting for confounders. NLR and CRP levels were not associated with handgrip strength (β = - 0.231, p = 0.389; β = - 0.291, p = 0.577), 5STS (β = - 0.114, p = 0.288; β = - 0.202, p = 0.334), ASM (β = - 0.027, p = 0.813; β = 0.062, p = 0.788), ASMI (β = - 0.036, p = 0.242; β = 0.040, p = 0.505), 4-m gait speed (β = 0.013, p = 0.082; β = 0.004, p = 0.769), and SPPB (β = 0.076, p = 0.170; β = 0.152, p = 0.157), respectively. In conclusion, NLR and CRP levels were not associated with muscle mass, strength, and functional capacity in KTPs.
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Rice CM, Singh PP, Judd NS, Jimenez EY, Blair CK, Washburn A, Calvin C, Steiber A, Zhu Y, Argyropoulos C, Unruh M, Dew MA, Myaskovsky L. Protocol for the IMPACT Trial: Improving Healthcare Outcomes in American Transplant Recipients Using Culturally-Tailored Novel Technology. J Ren Nutr 2022; 32:e1-e12. [PMID: 35227873 PMCID: PMC9058226 DOI: 10.1053/j.jrn.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/11/2022] Open
Abstract
Kidney transplant (KT) recipients face post-transplant health issues. Immunosuppressive agents can cause hyperlipidemia, hypertension, post-transplant diabetes, and glomerulopathy. Post-transplant weight gain and decreased activity are associated with poor quality of life, sleep, and cardiometabolic outcomes. This study will test the feasibility and acceptability of a culturally tailored diet and exercise intervention for KT patients delivered immediately post-transplant using novel technology. A registered dietitian nutritionist (RDN) and physical rehabilitation therapist will examine participants' cultural background, preferences, and health-related obstacles (with consultation from the transplant team) to create an individualized exercise and meal plan. The RDN will provide medical nutrition therapy via the nutrition care process throughout the course of the intervention. The Twistle Patient Engagement Platform will be used to deliver and collect survey data, communicate with participants, and promote retention. Outcomes to be assessed include intervention feasibility and acceptability and intervention efficacy on patients' adherence, medical, quality of life, and occupational outcomes.
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Affiliation(s)
- Claudia M Rice
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, New Mexico
| | - Pooja P Singh
- Nephrology Division, Department of Internal Medicine, University of New Mexico, School of Medicine, New Mexico
| | - Nila S Judd
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, New Mexico
| | - Elizabeth Yakes Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, New Mexico; Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Cindy K Blair
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico, New Mexico; University of New Mexico Comprehensive Cancer Center, New Mexico
| | - Amy Washburn
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, New Mexico; Presbyterian Healthcare Services, New Mexico
| | - Christine Calvin
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, New Mexico; Center for Diabetes and Nutrition Education, University of New Mexico Health Sciences Center, New Mexico
| | | | - Yiliang Zhu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico, New Mexico
| | - Christos Argyropoulos
- Nephrology Division, Department of Internal Medicine, University of New Mexico, School of Medicine, New Mexico
| | - Mark Unruh
- Nephrology Division, Department of Internal Medicine, University of New Mexico, School of Medicine, New Mexico
| | - Mary Amanda Dew
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Epidemiology and Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, New Mexico; Nephrology Division, Department of Internal Medicine, University of New Mexico, School of Medicine, New Mexico.
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Baker LA, March DS, Wilkinson TJ, Billany RE, Bishop NC, Castle EM, Chilcot J, Davies MD, Graham-Brown MPM, Greenwood SA, Junglee NA, Kanavaki AM, Lightfoot CJ, Macdonald JH, Rossetti GMK, Smith AC, Burton JO. Clinical practice guideline exercise and lifestyle in chronic kidney disease. BMC Nephrol 2022; 23:75. [PMID: 35193515 PMCID: PMC8862368 DOI: 10.1186/s12882-021-02618-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Mark D. Davies
- Betsi Cadwaladr University Health Board and Bangor University, Bangor, UK
| | | | | | | | | | | | - Jamie H. Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - James O. Burton
- University of Leicester and Leicester Hospitals NHS Trust, Leicester, UK
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Zhang F, Ren Y, Wang H, Bai Y, Huang L. Daily Step Counts in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Observational Studies. Front Med (Lausanne) 2022; 9:842423. [PMID: 35252275 PMCID: PMC8891233 DOI: 10.3389/fmed.2022.842423] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
BackgroundPhysical inactivity is an essential factor in the prognosis of patients with chronic kidney disease (CKD). Daily step count is a straightforward measure to assess physical activity levels. Understanding the step counts among different CKD stages is essential to change sedentary behavior.ObjectivesThis systematic review and meta-analysis aimed to investigate the daily step counts in patients with CKD at a different stage.DesignA systematic review and meta-analysis.Data SourcesThe literature search was performed in PubMed, Embase, and Web of Science from inception to November 3rd, 2021.Review MethodsObservational studies (cross-sectional, case-control, or cohort studies) reported specific values of step counts in CKD patients by the wearable device were included. A random-effects model was used to pool the data. Subgroup analysis explored differences in outcomes by stage of CKD. Heterogeneity between studies was assessed using the χ2 test of Cochrane's Q statistic. A contour-enhanced funnel plot was conducted to investigate publication bias. Univariate and multivariate meta-regression was conducted to examine possible sources of heterogeneity.ResultsTwenty-eight articles were identified and used for quantitative analysis. The result showed that the daily step count in patients with CKD was 4642.47 (95% CI: 4274.18–5010.76), and significantly lower than the healthy population. Subgroup analysis revealed that the step counts decreased before dialysis, dropped to a freezing point at the hemodialysis phase, and increased after kidney transplantation. Meta-regression analysis showed that daily step counts were relatively higher in the Americas or younger than 60 or kidney transplant recipients.ConclusionThe status of daily step counts in patients with CKD decreases with CKD severity and increases after kidney transplantation. Although studies have begun to focus on strategies to improve step counts in patients with CKD, future studies should focus more on step counts in pre-dialysis patients and changing their physically inactive lifestyle early to alleviate deteriorating renal function.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291551, identifier: CRD42021291551.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yibo Ren
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectal, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Cardiology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liuyan Huang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Liuyan Huang
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Kohlbrenner D, von Moos S, Schmid-Mohler G. Criterion Validity and Test-Retest Reliability of a Modified Version of the International Physical Activity Questionnaire–Short Form (IPAQ-SF) in Kidney Transplant Recipients. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:808476. [PMID: 36189067 PMCID: PMC9397873 DOI: 10.3389/fresc.2022.808476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022]
Abstract
Introduction Accelerometry, the clinically valued standard of physical activity monitoring, has limited acceptance in transplantation rehabilitation; therefore, the International Physical Activity Questionnaire (IPAQ) self-report instrument is widely used. However, while the IPAQ's repeatability is good, its criterion validity is unsatisfactory. We hypothesized that adding a concise oral introduction would help overcome this shortfall. Materials and Methods This is a secondary analysis of a RCT in a sample of kidney transplant recipients that underwent observational follow-up. We assessed criterion validity of our modified version of the four-item IPAQ–Short Form (mIPAQ–SF) via Pearson, and test-retest reliability via intraclass correlation coefficients. The main difference in the new version is an oral pre-measurement introduction to the questionnaire's concepts. We compared our results with those of published studies. Results Post-kidney-transplantation data of 92 patients were analyzed. Across the four IPAQ-SF/mIPAQ–SF items, values of correlations between mIPAQ-SF responses and accelerometry records ranged from 0.07 (min in vigorous activity) to 0.35 (min in moderate activity) for criterion validity, and from 0.19 (days with moderate activity) to 0.58 (min in moderate activity) for test-retest reliability. Discussion Regarding moderate-to-vigorous physical activity, mIPAQ-SF self-reports' correlations to accelerometry records improved considerably on those of the IPAQ-SF (r = 0.18 vs. r = 0.33), i.e., improved criterion validity. We therefore conclude that a pre-measurement oral explanation of key IPAQ-SF/mIPAQ concepts enhances criterion validity regarding self-reported moderate-to-vigorous physical activity.
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Affiliation(s)
- Dario Kohlbrenner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Seraina von Moos
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Gabriela Schmid-Mohler
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- *Correspondence: Gabriela Schmid-Mohler
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Ahmed A, Cote A, Lui S, Blydt-Hansen TD. Height-adjusted lean body mass and its associations with physical activity and kidney function in pediatric kidney transplantation. Pediatr Transplant 2022; 26:e14128. [PMID: 34486205 DOI: 10.1111/petr.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although LBM is positively associated with health outcomes, studies assessing determinants for the accrual of ht-LBM, such as physical activity, are limited. This study aimed to assess ht-LBM levels in pediatric kidney transplant recipients and test its association with baseline and contemporaneous variables, including physical activity. METHODS A retrospective cross-sectional review was performed on 46 pediatric kidney transplant recipients, and a longitudinal review was performed on a subset of recipients with serial post-transplant (n = 21) and pre/post-transplant (n = 11) ht-LBM measurements. Ht-LBM measurements were obtained using DXA scans. RESULTS This cohort was 16.0 (IQR 12.3, 17.7) years old, 56.5% male and 46 ± 45 months post-transplant with a mean ht-LBM of 15.1 ± 2.5 kg/m2 . A median ht-LBM increase of 1.6 kg/m2 (IQR - 0.1, 2.6 kg/m2 ; p < .01) was observed, over 29.2 ± 12.0 months from the earliest post-transplant scan obtained at 46 ± 25 months post-transplant until the most recent post-transplant scan. A 1.7 ± 1.4 kg/m2 (p < .01) increase was observed between pre- and post-transplant DXA scans which were taken at 12 ± 11 months pre-transplant and 13 ± 6 months post-transplant, respectively. In separate adjusted models, lower physical activity questionnaire scores (n = 17, beta = 1.55, p = .02), faster rate of estimated glomerular filtration rate decline (beta = 0.05, p < .048) adjusted for annualized change in BSA, and younger age at scan (beta = 0.32, p < .01) were each significant predictors of lower ht-LBM. CONCLUSIONS Physical activity and kidney function may influence ht-LBM in the pediatric kidney transplant population.
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Affiliation(s)
- Azim Ahmed
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Anita Cote
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,School of Human Kinetics, Trinity Western University, Langley, BC, Canada
| | - Samantha Lui
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Division of Nephrology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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O'Brien T, Tan A, Rose K, Focht B, Daloul R. Maintenance phase of a physical activity intervention in older kidney transplant recipients: A 12-month follow-up. Geriatr Nurs 2021; 42:1541-1546. [PMID: 34741827 DOI: 10.1016/j.gerinurse.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
Daily walking activities are associated with improving cardiovascular outcomes in older kidney transplant recipients. However, little is known regarding physical activity adherence outcomes in older kidney recipients. The purpose of this randomized controlled trial 12-month follow-up study was to evaluate the feasibility of the intervention (SystemCHANGE™ + activity tracker) during the maintenance period (7-12 months), compared to an attention-control group (activity tracker only) in older kidney recipients (age 60 and older). The sample included 60 participants (n = 30 IG; n = 30 ACG). Adherence rates for wearing the activity tracker daily were 96.5% in the IG and 80.8% in the ACG. The IG demonstrated within-group improvements for blood pressure at 12 months. Overall, there was a decrease in the average daily steps observed in both groups. These data suggest this intervention is feasible and additional boosters should be considered during the maintenance period to encourage physical activity.
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Affiliation(s)
- Tara O'Brien
- The Ohio State University College of Nursing, Columbus, OH Columbus, OH, Newton Hall,1585 Neil Ave, Columbus, OH 43210, USA.
| | - Alai Tan
- The Ohio State University College of Nursing Newton Hall, 1585 Neil Ave, Columbus, OH, USA 43210
| | - Karen Rose
- The Ohio State University College of Nursing Newton Hall, 1585 Neil Ave, Columbus, OH, USA 43210
| | - Brian Focht
- The Ohio State University College of Education and Human Ecology, 152 PAES, 305 Annie and John Glenn Ave, Columbus, OH, USA, 43210
| | - Reem Daloul
- The Ohio State University College of Medicine, 300 West 10th Avenue Suite 1150, Columbus, USA, OH 43210
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Pereira ES, Neto WK, Calefi AS, Georgetti M, Guerreiro L, Zocoler CAS, Gama EF. Extreme conditioning session augments brain-derived neurotrophic factor in healthy novice participants: a pilot study. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ponticelli C, Favi E. Physical Inactivity: A Modifiable Risk Factor for Morbidity and Mortality in Kidney Transplantation. J Pers Med 2021; 11:927. [PMID: 34575704 PMCID: PMC8470604 DOI: 10.3390/jpm11090927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
In patients with chronic kidney disease, sedentary behavior is widely recognized as a significant risk factor for cardiovascular disease, diabetes, obesity, osteoporosis, cancer, and depression. Nevertheless, the real impact of physical inactivity on the health of kidney transplant (KT) recipients remains uncertain. Over the last decade, there has been a renewed interest in exploring the effects of regular physical exercise on transplant-related outcomes. There is now mounting evidence that physical activity may reduce the burden of cardiovascular risk factors, preserve allograft function, minimize immunosuppression requirement, and ameliorate the quality of life of KT recipients. Many positive feedbacks can be detected in the early stages of the interventions and with a minimal exercise load. Despite these encouraging results, the perceived role of physical activity in the management of KT candidates and recipients is often underrated. The majority of trials on exercise training are small, relatively short, and focused on surrogate outcomes. While waiting for larger studies with longer follow-up, these statistical limitations should not discourage patients and doctors from initiating exercise and progressively increasing intensity and duration. This narrative review summarizes current knowledge about the deleterious effects of physical inactivity after KT. The benefits of regular physical exercise are also outlined.
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Affiliation(s)
| | - Evaldo Favi
- Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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35
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Lorenz EC, Kennedy CC, Rule AD, LeBrasseur NK, Kirkland JL, Hickson LJ. Frailty in CKD and Transplantation. Kidney Int Rep 2021; 6:2270-2280. [PMID: 34514190 PMCID: PMC8418946 DOI: 10.1016/j.ekir.2021.05.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
The population is aging. Although older adults have higher rates of comorbidities and adverse health events, they represent a heterogeneous group with different health trajectories. Frailty, a clinical syndrome of decreased physiological reserve and increased susceptibility to illness and death, has emerged as a potential risk stratification tool in older patients with chronic kidney disease (CKD). Frailty is commonly observed in patients with CKD and associated with numerous adverse outcomes, including falls, decreased quality of life, hospitalizations, and death. Multiple pathologic factors contribute to the development of frailty in patients with CKD, including biological mechanisms of aging and physiological dysregulation. Current interventions to reduce frailty are promising, but additional investigations are needed to determine whether optimizing frailty measures improves renal and overall health outcomes. This review of frailty in CKD examines frailty definitions, the impact of frailty on health outcomes across the CKD spectrum, mechanisms of frailty, and antifrailty interventions (e.g., exercise or senescent cell clearance) tested in CKD patients. In addition, existing knowledge gaps, limitations of current frailty definitions in CKD, and challenges surrounding effective antifrailty strategies in CKD are considered.
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Affiliation(s)
- Elizabeth C Lorenz
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Cassie C Kennedy
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
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Mathur S, Janaudis-Ferreira T, Hemphill J, Cafazzo JA, Hart D, Holdsworth S, Lovas M, Wickerson L. User-centered design features for digital health applications to support physical activity behaviors in solid organ transplant recipients: A qualitative study. Clin Transplant 2021; 35:e14472. [PMID: 34510558 DOI: 10.1111/ctr.14472] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 05/30/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Digital health tools may be effective in engaging solid organ transplant (SOT) recipients in physical activity (PA). This study examined the perspectives of SOT recipients regarding PA, and desired features for digital health tools. METHODS Semi-structured interviews were used to explore perspectives of SOT recipients about barriers and motivators to physical activity, and core features of a digital health tool to support PA. Interviews were analyzed via thematic analysis. RESULTS Participants included 21 SOT recipients (11 men, 10 women, 21-78 years, 1.5-16 years post-transplant) from various organ groups (four heart, five kidney, five liver, three lung, and four multi-organ). Barriers to PA included risk aversion, managing non-linear health trajectories, physical limitations and lack of access to appropriate fitness training. Facilitators of PA included desire to live long and healthy lives, renewed physical capabilities, access to appropriate fitness guidelines and facilities. Desired features of a digital health tool included a reward system, affordability, integration of multiple functions, and the ability to selectively share information with healthcare professionals and peers. CONCLUSIONS SOT recipients identified the desired features of a digital health tool, which may be incorporated into future designs of digital and mobile health applications to support PA in SOT recipients.
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Affiliation(s)
- Sunita Mathur
- School of Rehabilitation Therapy, Queen's University, Ontario, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada
| | - Tania Janaudis-Ferreira
- Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada.,School of Physical and Occupational Therapy, McGill University, Quebec, Canada.,Research Institute of the McGill University Health Centre, Quebec, Canada
| | - Julia Hemphill
- School of Rehabilitation Therapy, Queen's University, Ontario, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, University Health Network, Ontario, Canada
| | - Donna Hart
- Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada
| | - Sandra Holdsworth
- Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada
| | - Mike Lovas
- Healthcare Human Factors, University Health Network, Ontario, Canada
| | - Lisa Wickerson
- School of Rehabilitation Therapy, Queen's University, Ontario, Canada.,Canadian Donation and Transplantation Research Program, University of Alberta, Alberta, Canada.,Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, Ontario, Canada
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Letachowicz K, Bardowska K, Królicki T, Kamińska D, Banasik M, Zajdel K, Mazanowska O, Madziarska K, Janczak D, Krajewska M. The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients. Ren Fail 2021; 43:113-122. [PMID: 33397180 PMCID: PMC7801108 DOI: 10.1080/0886022x.2020.1865171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Arteriovenous fistulae (AVFs) may remain patent after kidney transplantation (KTx), contributing to maladaptive cardiac remodeling. The flow in AVFs is associated with the diameter of its vessels and thus with the AVF location. The main objective of this study is to assess the influence of AVF location and its patency on the self-reported quality of life (QOL) of kidney transplant recipients (KTRs) with past history of hemodialysis. Methods To gain clinical data, during a scheduled visit, 353 KTRs were asked to fill out an anonymous questionnaire. From this group, 284 respondents were found eligible for analysis. The outcome was defined as prevalence of symptoms and health status, measured with the Left Ventricular Dysfunction-36 (LVD-36) Questionnaire in symptomatic patients. Results The hemodialysis patients (n = 243) were divided into two groups according to AVF location, i.e., DAVF – distally located AVF – (n = 174) and PAVF – proximally located AVF – (n = 69). The proportion of patients with heart failure (HF) was higher in PAVF group (24% vs. 12%, p = 0.0482). In the multivariable regression, PAVF, serum creatinine levels, and the presence of HF or coronary artery disease (CAD) remained independent predictors of lower functional capacity. Among patients with heart disease, the presence of active AVF was independently associated with worse functional outcome (higher LVD-36 scores). Conclusions The influence of persistent PAVF in KTRs seems to be unfavorable, especially when coexisting with CAD or HF. Abbreviations: AVF arteriovenous fistula; BMI body mass index; CAD coronary artery disease; D-AVF distally-located arteriovenous fistula; EC exercise capacity; HD hemodialysis; HF heart failure; KTx kidney transplantation; KTR kidney transplant recipient; LVD-36 Left Ventricle Disfunction – 36; LVEF left ventricle ejection fraction; LVH left ventricle hypertrophy; NYHA New York Heart Association; P-AVF proximally located arteriovenous fistula; PD peritoneal dialysis; PRO patient-reported outcomes; QOL quality of life.
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Affiliation(s)
- Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Tomasz Królicki
- Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Mirosław Banasik
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Zajdel
- Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
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Wilkinson TJ, Clarke AL, Nixon DGD, Hull KL, Song Y, Burton JO, Yates T, Smith AC. Prevalence and correlates of physical activity across kidney disease stages: an observational multicentre study. Nephrol Dial Transplant 2021; 36:641-649. [PMID: 31725147 DOI: 10.1093/ndt/gfz235] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND People with chronic kidney disease (CKD) report high levels of physical inactivity, a major modifiable risk factor for morbidity and mortality. Understanding the biological, psychosocial and demographic causes of physical activity behaviour is essential for the development and improvement of potential health interventions and promotional initiatives. This study investigated the prevalence of physical inactivity and determined individual correlates of this behaviour in a large sample of patients across the spectrum of kidney disease. METHODS A total of 5656 people across all stages of CKD (1-2, 3, 4-5, haemodialysis, peritoneal dialysis and renal transplant recipients) were recruited from 17 sites in England from July 2012 to October 2018. Physical activity was evaluated using the General Practice Physical Activity Questionnaire. Self-reported cardiorespiratory fitness, self-efficacy and stage of change were also assessed. Binominal generalized linear mutually adjusted models were conducted to explore the associations between physical activity and correlate variables. This cross-sectional observational multi-centre study was registered retrospectively as ISRCTN87066351 (October 2015). RESULTS The prevalence of physical activity (6-34%) was low and worsened with disease progression. Being older, female and having a greater number of comorbidities were associated with greater odds of being physically inactive. Higher haemoglobin, cardiorespiratory fitness and self-efficacy levels were associated with increased odds of being active. Neither ethnicity nor smoking history had any effect on physical activity. CONCLUSIONS Levels of physical inactivity are high across all stages of CKD. The identification of stage-specific correlates of physical activity may help to prioritize factors in target groups of kidney patients and improve the development and improvement of public health interventions.
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Affiliation(s)
- Thomas J Wilkinson
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Amy L Clarke
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK
| | - Daniel G D Nixon
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Katherine L Hull
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Yan Song
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,School of Nursing, Nantong University Medical School, Nantong University, Nantong, PR China
| | - James O Burton
- NIHR Leicester Biomedical Research Centre, Leicester, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester, UK.,Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Alice C Smith
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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Marsicano-Souza EO, Colugnati F, Geest SD, Sanders-Pinheiro H. Nonadherence to immunosuppressives and treatment in kidney transplant: ADHERE BRAZIL Study. Rev Saude Publica 2021; 55:33. [PMID: 34076208 PMCID: PMC8139843 DOI: 10.11606/s1518-8787.2021055002894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and variability of nonadherence to immunosuppressives and nonpharmacological treatment across kidney transplantation centers and two health access-disparate regions in Brazil. METHODS In a cross-sectional design, a random multistage sample of 1,105 patients was included, based on center transplantation activity (low/moderate/high) and region (R1: North/Northeast/Mid-West; and R2: South/Southeast). Nonadherence to immunosuppressives (implementation phase) was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)©. Self-report questionnaires assessed nonadherence to physical activity, smoking cessation, alcohol intake, and appointment keeping. We compared regions using the adjusted-χ2 or t-test. RESULTS Most patients were men (58.5%), white (51.4%), and had a mean age of 47.5 (SD = 12.6) years. Regarding kidney transplantation centers, 75.9% were from R2 and 38.2% had low activity. The patients in R2 were older, white-majority, had more frequently steady partners, and received peritoneal dialysis. Nonadherence to immunosuppressives ranged from 11-65.2%; 44.5-90% to physical activity; 0-23.7% to appointment keeping; and 0-14% to smoking cessation. The total prevalence of nonadherence and by region (R1 versus R2) were: for immunosuppressives, 39.7% (44.9% versus 38.1%, p = 0.18); for smoking, 3.9% (1% versus 5%, p < 0.001); for physical activity, 69.1% (71% versus 69%, p = 0.48); for appointment keeping, 13% (12.7% versus 12%, p = 0.77); and for alcohol consumption, 0%. CONCLUSION Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation. We suppose that differences in healthcare access may have been overcome by other positive aspects of the post kidney transplantation treatment.
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Affiliation(s)
- Elisa Oliveira Marsicano-Souza
- Universidade Federal de Juiz de ForaHospital UniversitárioUnidade de Transplante RenalJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora. Hospital Universitário. Unidade de Transplante Renal. Juiz de Fora, MG, Brasil
- Núcleo Interdisciplinar de Estudos e Pesquisas em NefrologiaJuiz de ForaMGBrasilNúcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN). Juiz de Fora, MG, Brasil
| | - Fernando Colugnati
- Universidade Federal de Juiz de ForaHospital UniversitárioUnidade de Transplante RenalJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora. Hospital Universitário. Unidade de Transplante Renal. Juiz de Fora, MG, Brasil
- Núcleo Interdisciplinar de Estudos e Pesquisas em NefrologiaJuiz de ForaMGBrasilNúcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN). Juiz de Fora, MG, Brasil
| | - Sabina De Geest
- University of BaselInstitute of Nursing ScienceDepartment of Public HealthBaselSwitzerlandUniversity of Basel. Institute of Nursing Science. Department of Public Health. Basel, Switzerland
- KU LeuvenAcademic Centre for Nursing and MidwiferyDepartment of Public Health and Primary CareLeuvenBelgiumKU Leuven. Academic Centre for Nursing and Midwifery. Department of Public Health and Primary Care. Leuven, Belgium
| | - Helady Sanders-Pinheiro
- Universidade Federal de Juiz de ForaHospital UniversitárioUnidade de Transplante RenalJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora. Hospital Universitário. Unidade de Transplante Renal. Juiz de Fora, MG, Brasil
- Núcleo Interdisciplinar de Estudos e Pesquisas em NefrologiaJuiz de ForaMGBrasilNúcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN). Juiz de Fora, MG, Brasil
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Pérez-Sáez MJ, Morgado-Pérez A, Faura A, Muñoz-Redondo E, Gárriz M, Muns MD, Nogués X, Marco E, Pascual J. The FRAILMar Study Protocol: Frailty in Patients With Advanced Chronic Kidney Disease Awaiting Kidney Transplantation. A Randomized Clinical Trial of Multimodal Prehabilitation. Front Med (Lausanne) 2021; 8:675049. [PMID: 34095178 PMCID: PMC8170320 DOI: 10.3389/fmed.2021.675049] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/16/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction: Frailty is very frequent among patients with chronic kidney disease (CKD) who are awaiting deceased donor kidney transplantation (KT), and transplant outcomes are worsened in those frail recipients. Frailty and poor fitness powerfully predict mortality, kidney graft survival, and healthcare utilization after KT. Intervention is essential to improve survival and quality of life for frail CKD patients, regardless of their age. Studies of post-transplant physical therapy intervention have been met with limited success, in large part due to high dropout rates. A pre-transplant clinical framework for multimodal prehabilitation interventions including physical therapy, nutritional measures, and psychological support scheduled during the KT waiting list period may improve patient retention and compliance, better mitigate the effects of frailty and poor fitness after KT, and improve main outcomes in frail CKD patients. Main Objective: To study the effectiveness, feasibility, and safety of multimodal prehabilitation (exercise, nutritional plans, psychological advice) in KT candidates. Methods: Randomized controlled clinical trial in 38 frail and 76 non-frail KT candidates. The prehabilitation program will consist of physical exercise (24 sessions, 8 weeks), nutritional supplementation, and psychological advice. The primary endpoint will be a composite achievement of clinical and functional main outcomes in frail and non-frail KT candidates at 90 days post-transplantation. Secondary outcomes include changes in exercise capacity, physical activity, gait speed, respiratory and peripheral muscle strength, muscle size, body composition, performance in activities of daily living (basic and instrumental), anxiety and depression symptoms, and health-related quality of life. Feasibility of the intervention will be also analyzed. Expected Results: Multimodal prehabilitation is a feasible and effective intervention to decrease bad outcomes at 90 days post-KT by 25 and 12.5% in frail and non-frail patients, respectively. Clinical Trial Registration:clinicaltrials.gov (NCT04701398), date: 2021, January 8th (Protocol version: Frailmar_vers2).
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Affiliation(s)
| | - Andrea Morgado-Pérez
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, Spain.,Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Anna Faura
- Department of Nephrology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Elena Muñoz-Redondo
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, Spain.,Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Miguel Gárriz
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain
| | - Maria Dolors Muns
- Department of Endocrinology and Nutrition, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Xavier Nogués
- Department of Internal Medicine, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Ester Marco
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, Spain.,Rehabilitation Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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Madziarska K, Hap K, Mazanowska O, Sutkowska E. Comprehensive lifestyle modification as
complementary therapy to prevent and manage
post-transplant diabetes mellitus*. POSTEP HIG MED DOSW 2021. [DOI: 10.5604/01.3001.0014.8311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-transplant diabetes mellitus (PTDM) is one from the most common metabolic complications
after kidney transplantation. PTDM develops in the early period after transplantation.
The risk factors of PTDM are carbohydrate imbalances occurring in the patient prior to
transplantation, surgery and the inclusion of immunosuppressive treatment. Kidney transplant
patients tend to gain weight, which is associated with an increased risk of post-transplant
diabetes, cardiovascular diseases and abnormal transplanted kidney function.
Patients after kidney transplantation should be advised to adopt a lifestyle based on a proper
diet, exercise, weight control and smoking cessation. The strategy to reduce the risk factors
for PTDM development should start before transplantation and continue after kidney
transplantation. A targeted, non-pharmacological approach to patients already during the
dialysis period may have a significant impact on reducing post-transplantation diabetes.
Lifestyle interventions can effectively reduce the risk of development and inhibit the progression
of post-transplantation diabetes. The article describes elements of comprehensive
non-pharmacological management based on available knowledge of rehabilitation, dietetics
and psychology.
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Affiliation(s)
- Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Katarzyna Hap
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Edyta Sutkowska
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
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De Smet S, Van Craenenbroeck AH. Exercise training in patients after kidney transplantation. Clin Kidney J 2021; 14:ii15-ii24. [PMID: 33981416 PMCID: PMC8101622 DOI: 10.1093/ckj/sfab022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Next to the risk of allograft failure, major obstacles for disease-free survival after kidney transplantation include a higher incidence of cancer, infection and cardiovascular events. Risk factors for adverse clinical outcomes include pre-existent comorbidities, the introduction of an immunodeficient status and (lack of) lifestyle changes after transplantation. Indeed, physical inactivity and poor physical fitness are important targets to address in order to improve clinical outcomes after kidney transplantation. This review summarizes the current evidence on exercise training after kidney transplantation, derived from randomized controlled trials. As much as possible, results are discussed in the perspective of the Standardized Outcomes in Nephrology-Transplantation core outcomes, which were recently described as critically important outcome domains for trials in kidney transplant recipients.
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Affiliation(s)
- Stefan De Smet
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
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43
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Wiltshire G, Clarke NJ, Phoenix C, Bescoby C. Organ Transplant Recipients' Experiences of Physical Activity: Health, Self-Care, and Transliminality. QUALITATIVE HEALTH RESEARCH 2021; 31:385-398. [PMID: 33124516 PMCID: PMC7750649 DOI: 10.1177/1049732320967915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Physical activity (PA) is an important lifestyle component of long-term health management for organ transplant recipients, yet little is known about recipients' experiences of PA. The purpose of this study was to shed light on this experience and to investigate the possible implications of PA in the context of what is a complex patient journey. Phenomenological analysis was used to examine interviews with 13 organ transplant recipients who had taken part in sporting opportunities posttransplantation. Findings illuminate how participants' experiences of PA were commonly shaped by the transliminal nature of being an organ transplant recipient as well as a sense of duty to enact health, self-care, and donor-directed gratitude. This analysis underlines the potential role of PA in supporting organ transplant recipients' attempts to live well following transplantation and makes novel connections between PA and our existing knowledge about challenges related to identity, survivorship, obligation, and patient empowerment.
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Affiliation(s)
- Gareth Wiltshire
- Loughborough University,
Loughborough, United Kingdom
- Gareth Wiltshire, School of Sport
Exercise and Health Sciences, Loughborough University, John Beckwith
Building, Epinal Way, Loughborough LE11 3TU, UK.
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44
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Sanders-Pinheiro H, Colugnati FAB, Denhaerynck K, Marsicano EO, Medina JOP, De Geest S. Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients: The Multicenter ADHERE BRAZIL Study. Transplantation 2021; 105:255-266. [PMID: 32150041 DOI: 10.1097/tp.0000000000003214] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immunosuppressive nonadherence is a risk factor for worse outcomes after kidney transplantation (KT). Brazil, having the world's largest public, fully covered transplantation system and the second-highest KT volume worldwide, provides a unique setting for studying multilevel correlates of nonadherence (patient, healthcare provider, transplant center, and healthcare system levels) independent of patients' financial burden. METHODS By applying a multistage sampling approach, we included 1105 patients from 20 KT centers. Nonadherence to immunosuppressives (implementation phase) was defined as any deviation in taking or timing adherence and dose reduction assessed by the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Based on Bronfenbrenner's ecological model, we assessed multilevel factors using established instruments and measures specifically developed for this study and analyzed their independent contribution to nonadherence by performing sequential logistic regression analysis. RESULTS The nonadherence prevalence rate was 39.7%. The following factors were independently associated with nonadherence: Patient level-having a stable partner (odds ratio [OR]: 0.75; confidence interval [CI]: 0.58-0.97), nonadherence to appointments (OR: 2.98; CI: 2.03-4.39), and nonadherence to physical activity recommendations (OR: 1.84; CI: 1.38-2.46); and transplant center level-satisfaction with the waiting room structure (OR: 0.54; CI: 0.42-0.71), consultation >30 minutes (OR: 1.60; CI: 1.19-2.14), adequacy of the consultation frequency (OR: 0.62; CI: 0.43-0.90), and centers with >500 beds (OR: 0.58; CI: 0.46-0.73). CONCLUSIONS As the first multicenter study assessing multilevel correlates of nonadherence in KT, our findings point to the need for multilevel interventions beyond the patient level, targeting transplant center practice patterns as an approach to tackle nonadherence.
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Affiliation(s)
- Helady Sanders-Pinheiro
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Minas Gerais, Brazil and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Fernando A B Colugnati
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Minas Gerais, Brazil and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Elisa O Marsicano
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Minas Gerais, Brazil and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - José O P Medina
- Hospital do Rim e Hipertensão, Oswaldo Ramos Foundation, Nephrology Discipline, Federal University of São Paulo, São Paulo, Brazil
| | - Sabina De Geest
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
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45
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Hu S, Li Y, Quan M, Yang S, Wan Z, Yan X, Tan Z, Liang G. A Study on the Correlations of Anxiety and Depression With Self-Management Ability and Endogenous Creatinine Clearance Rate in Renal Transplant Recipients. Front Psychiatry 2021; 12:715509. [PMID: 34650453 PMCID: PMC8505718 DOI: 10.3389/fpsyt.2021.715509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To explore the effects of anxiety and depression on the self-management ability and endogenous creatinine clearance rate of renal transplant patients. Method: Eighty-eight renal transplant recipients who were followed up in the outpatient clinic of the Affiliated Hospital of Zunyi Medical University were selected using convenient sampling. The self-made general data sheet, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Self-Management Scale for Kidney Transplant Recipients were used. Correlation analysis was used to find factors related to endogenous creatinine clearance, while multiple linear regression was used to identify factors influencing endogenous creatinine clearance. Patients with or without anxiety and depression were divided into groups, and the indexes of the groups were compared using the independent samples t test, rank-sum test, or chi-squared test. Results: Anxiety was present in 12.5% of patients, depression in 25%, and a moderate level of self-management in 34.1%. Only 9.1% of renal transplant recipients had endogenous creatinine clearance within the normal range, and 34.1% had a body mass index not in the normal range (25% were overweight, and 9.1% were underweight). The endogenous creatinine clearance rate was negatively correlated with age and degree of depression, and positively correlated with body mass index, treatment management score, and psychosocial management score. The main influencing factors of endogenous creatinine clearance rate were age, sex, depression, body mass index, and treatment management score. The endogenous creatinine clearance rate and psychosocial management ability were significantly higher in patients without anxiety and depression than in patients with anxiety and depression (all P < 0.05). Conclusions: Anxiety and depression showed significant negative effects on the psychosocial self-management ability and endogenous creatinine clearance rate of renal transplant recipients and thus should be given more attention.
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Affiliation(s)
- ShiMin Hu
- Department of Nephropathy and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yu Li
- Department of Nephropathy and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - MingTao Quan
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - ShuJuan Yang
- Department of Nephropathy and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - ZhaoMei Wan
- Department of Nephropathy and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - XiaoYong Yan
- Department of Nephropathy and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - ZhouKe Tan
- Department of Nephropathy and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - GuoBiao Liang
- Department of Nephropathy and Rheumatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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46
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Kang AW, Bostom AG, Kim H, Eaton CB, Gohh R, Kusek JW, Pfeffer MA, Risica PM, Garber CE. Physical activity and risk of cardiovascular events and all-cause mortality among kidney transplant recipients. Nephrol Dial Transplant 2020; 35:1436-1443. [PMID: 32437569 DOI: 10.1093/ndt/gfaa038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Insufficient physical activity (PA) may increase the risk of all-cause mortality and cardiovascular disease (CVD) morbidity and mortality among kidney transplant recipients (KTRs), but limited research is available. We examine the relationship between PA and the development of CVD events, CVD death and all-cause mortality among KTRs. METHODS A total of 3050 KTRs enrolled in an international homocysteine-lowering randomized controlled trial were examined (38% female; mean age 51.8 ± 9.4 years; 75% white; 20% with prevalent CVD). PA was measured at baseline using a modified Yale Physical Activity Survey, divided into tertiles (T1, T2 and T3) from lowest to highest PA. Kaplan-Meier survival curves were used to graph the risk of events; Cox proportional hazards regression models examined the association of baseline PA levels with CVD events (e.g. stroke, myocardial infarction), CVD mortality and all-cause mortality over time. RESULTS Participants were followed up to 2500 days (mean 3.7 ± 1.6 years). The cohort experienced 426 CVD events and 357 deaths. Fully adjusted models revealed that, compared to the lowest tertile of PA, the highest tertile experienced a significantly lower risk of CVD events {hazard ratio [HR] 0.76 [95% confidence interval (CI) 0.59-0.98]}, CVD mortality [HR 0.58 (95% CI 0.35-0.96)] and all-cause mortality [HR 0.76 (95% CI 0.59-0.98)]. Results were similar in unadjusted models. CONCLUSIONS PA was associated with a reduced risk of CVD events and all-cause mortality among KTRs. These observed associations in a large, international sample, even when controlling for traditional CVD risk factors, indicate the potential importance of PA in reducing CVD and death among KTRs.
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Affiliation(s)
- Augustine W Kang
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Andrew G Bostom
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center for Primary Care and Prevention, Kent Hospital, Warwick, RI, USA
| | - Hongseok Kim
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center for Primary Care and Prevention, Kent Hospital, Warwick, RI, USA.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Reginald Gohh
- Division of Nephrology, Rhode Island Hospital, Providence, RI, USA
| | - John W Kusek
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Patricia M Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Carol E Garber
- Teachers' College, Columbia University, New York, NY, USA
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47
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Masiero L, Puoti F, Bellis L, Lombardini L, Totti V, Angelini ML, Spazzoli A, Nanni Costa A, Cardillo M, Sella G, Mosconi G. Physical activity and renal function in the Italian kidney transplant population. Ren Fail 2020; 42:1192-1204. [PMID: 33256487 PMCID: PMC7717861 DOI: 10.1080/0886022x.2020.1847723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The well-documented benefits of physical activity (PA) are still poorly characterized in long-term kidney transplant outcome. This study analyzed the impact over a 10-year follow-up of PA on graft function in Italian kidney transplant recipients (KTRs). Methods Since 2002, the Italian Transplant-Information-System collected donor and recipient baseline and transplant-related parameters in KTRs. In 2015, ‘penchant for PA’ (PA ≥ 30-min, 5 times/week) was added. Stable patients aged ≥18 years at the time of first-transplantation were eligible. KTRs with at least 10-year follow-up were also analyzed. Mixed-effect regression models were used to compare eGFR changes over time in active versus non-active patients. Results PA information was available for 6,055 KTRs (active 51.6%, non-active 48.4%). Lower penchant for PA was found in overweight and obese patients (OR = 0.84; OR = 0.48, respectively), in those with longer dialysis vintage (OR = 0.98 every year of dialysis), and older age at transplant. Male subjects showed greater penchant for PA (OR = 1.25). A slower decline of eGFR over time was observed in active KTRs compared to non-active, and this finding was confirmed in the subgroup with at least 10-year follow-up (n = 2,060). After applying the propensity score matching to reduce confounding factors, mixed-effect regression models corroborated such better long-term trend of graft function preservation in active KTRs. Conclusions Penchant for PA is more frequent among male and younger KTRs. Moreover, in our group of Italian KTRs, active patients revealed higher eGFR values and preserved kidney function over time, up to 10-years of follow-up.
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Affiliation(s)
| | | | - Lia Bellis
- Italian National Transplant Center, Rome, Italy
| | | | - Valentina Totti
- Department of Biomedical & Neuromotor Sciences, University of Bologna, Bologna, Italy.,ANED, Milan, Italy
| | - Maria Laura Angelini
- Nephrology and Dialysis Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Alessandra Spazzoli
- Nephrology and Dialysis Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | | | | | | | - Giovanni Mosconi
- Nephrology and Dialysis Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
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48
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O'Brien T, Russell CL, Tan A, Mion L, Rose K, Focht B, Daloul R, Hathaway D. A Pilot Randomized Controlled Trial Using SystemCHANGE™ Approach to Increase Physical Activity in Older Kidney Transplant Recipients. Prog Transplant 2020; 30:306-314. [PMID: 32912051 DOI: 10.1177/1526924820958148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in kidney transplant recipients. Physical activity after transplant is the most modifiable nonpharmacological factor for improving cardiovascular outcomes. Few studies have tested walking interventions to enhance daily steps and health outcomes in older kidney recipients. METHODS Using a pilot feasibility randomized clinical trial design, we tested the feasibility and efficacy of a 6-month SystemCHANGE™ (Change Habits by Applying New Goals and Experience) + Activity Tracker intervention for recruitment, retention, daily steps, and health outcomes (blood pressure, heart rate, body mass index, waist circumference, and physical function). The SystemCHANGE™ + Activity Tracker intervention taught participants to use a multicomponent intervention that connects person-centered systems solutions combined with visual feedback from a mobile activity tracker to achieve daily step goals. RESULTS Fifty-three participants (mean age 65 years, 66% male, and 57% white) participated with 27 in the intervention and 26 in the control group. The study protocol was feasible to deliver with high adherence to the protocol in both groups. The intervention group increased daily steps at 3 months (mean difference, 608; standard error = 283, P = .03) compared to the control group. The secondary outcome of heart rate decreased for the intervention group (baseline [mean] 74.4+ 10.8 [standard deviation, SD;] vs 6 months [mean] 67.6+ 11.3 [SD]; P = .002) compared to the control group (baseline [mean] 70.67+ 10.4 [SD]; vs 6 months [mean] 70.2 + 11.1 [SD]; P = .83). CONCLUSIONS SystemCHANGE™ + Activity Tracker intervention appears to be feasible and efficacious for increasing daily steps in older kidney recipients.
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Affiliation(s)
- Tara O'Brien
- 2647The Ohio State University College of Nursing, Columbus, OH, USA
| | - Cynthia L Russell
- School of Nursing and Health Studies, 12273University of Missouri-Kansas City, Kansas City, MO, USA
| | - Alai Tan
- 2647The Ohio State University College of Nursing, Columbus, OH, USA
| | - Lorraine Mion
- 2647The Ohio State University College of Nursing, Columbus, OH, USA
| | - Karen Rose
- 2647The Ohio State University College of Nursing, Columbus, OH, USA
| | - Brian Focht
- 15953The Ohio State University College of Education and Human Ecology, Columbus, OH, USA
| | - Reem Daloul
- 15953The Ohio State University College of Medicine, Columbus, OH, USA
| | - Donna Hathaway
- 16165University of Tennessee Health Science Center College of Nursing Memphis, TN, USA
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49
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Wilkinson TJ, McAdams-DeMarco M, Bennett PN, Wilund K. Advances in exercise therapy in predialysis chronic kidney disease, hemodialysis, peritoneal dialysis, and kidney transplantation. Curr Opin Nephrol Hypertens 2020; 29:471-479. [PMID: 32701595 PMCID: PMC7526394 DOI: 10.1097/mnh.0000000000000627] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is characterized by poor levels of physical activity which contribute to increased morbidity across the disease trajectory. The short nature, small samples, and poor methodology across most studies have failed to translate the role of exercise in CKD into its adoption as a frontline adjunct therapeutic option. This review focuses on recent advances surrounding the benefits of exercise interventions across the CKD spectrum. RECENT FINDINGS Key recent advances in exercise studies have focused on the efficacy of novel intervention strategies across the CKD spectrum. These include high-intensity interval training, virtual reality gaming, intradialytic yoga, electrical stimulation of muscles, blood flow restriction training, and protocols combining exercise with nutritional supplementation. Research is also beginning to explore the role of prehabilitation for patients prior to dialysis and kidney transplantation. SUMMARY Studies continue to demonstrate wide-ranging benefits of exercise across CKD; however, implementation of exercise remains scarce. Future research needs include evaluating the efficacy of larger and/or more comprehensive interventions on clinically important outcomes. It is hoped with increasing global evidence, high-quality clinical studies, and sustained clinician and patient engagement, exercise programs will become better prioritized in the nephrology field.
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Affiliation(s)
- Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mara McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul N Bennett
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California, USA
- Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Kenneth Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
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50
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Floriano JP, Nahas PC, de Branco FMS, dos Reis AS, Rossato LT, Santos HO, Limirio LS, Ferreira-Filho SR, de Oliveira EP. Serum Uric Acid Is Positively Associated with Muscle Mass and Strength, but Not with Functional Capacity, in Kidney Transplant Patients. Nutrients 2020; 12:nu12082390. [PMID: 32785016 PMCID: PMC7469022 DOI: 10.3390/nu12082390] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Our aim was to associate serum uric acid (UA) with muscle mass, strength and functional capacity in kidney transplant patients (KTPs). Methods: A cross-sectional study was performed on 113 KTPs. The fat-free mass and total and appendicular muscle mass were estimated by performing a bioelectrical impedance analysis. The strength was evaluated using the handgrip strength test (HGS) and the five times sit to stand test (5STS). The functional capacity was evaluated using the 4 m walk test and the short physical performance battery (SPPB). Results: Linear regression showed that the UA levels were positively associated with the muscle mass, fat-free mass, appendicular muscle mass, muscle mass index and appendicular muscle mass index. The 5STS results (seconds) were inversely associated with the UA levels, showing that individuals with higher UA were more likely to have more strength. However, UA was not associated with the HGS, 4 m walk test and SPPB results. Conclusion: UA levels were positively associated with muscle mass and strength, but not with functional capacity, in KTPs.
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Affiliation(s)
- João Pedro Floriano
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais 38400-902, Brazil; (J.P.F.); (P.C.N.); (F.M.S.d.B.); (A.S.d.R.); (L.T.R.); (H.O.S.); (L.S.L.)
| | - Paula C. Nahas
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais 38400-902, Brazil; (J.P.F.); (P.C.N.); (F.M.S.d.B.); (A.S.d.R.); (L.T.R.); (H.O.S.); (L.S.L.)
| | - Flávia M. S. de Branco
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais 38400-902, Brazil; (J.P.F.); (P.C.N.); (F.M.S.d.B.); (A.S.d.R.); (L.T.R.); (H.O.S.); (L.S.L.)
| | - Aline S. dos Reis
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais 38400-902, Brazil; (J.P.F.); (P.C.N.); (F.M.S.d.B.); (A.S.d.R.); (L.T.R.); (H.O.S.); (L.S.L.)
| | - Luana T. Rossato
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais 38400-902, Brazil; (J.P.F.); (P.C.N.); (F.M.S.d.B.); (A.S.d.R.); (L.T.R.); (H.O.S.); (L.S.L.)
| | - Heitor O. Santos
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais 38400-902, Brazil; (J.P.F.); (P.C.N.); (F.M.S.d.B.); (A.S.d.R.); (L.T.R.); (H.O.S.); (L.S.L.)
| | - Larissa S. Limirio
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais 38400-902, Brazil; (J.P.F.); (P.C.N.); (F.M.S.d.B.); (A.S.d.R.); (L.T.R.); (H.O.S.); (L.S.L.)
| | | | - Erick P. de Oliveira
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais 38400-902, Brazil; (J.P.F.); (P.C.N.); (F.M.S.d.B.); (A.S.d.R.); (L.T.R.); (H.O.S.); (L.S.L.)
- Correspondence: ; Tel.: +55-34-32182084; Fax: +55-34-32328620
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