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Taşkaya C, Büyükturan B, Büyükturan Ö, Alkan H, Bingölbali Ö, Heybeli C. Comparison of the efficacy of intradialytic core stabilization and aerobic exercises for hemodialysis patients: randomized controlled single-blind study. Disabil Rehabil 2024:1-10. [PMID: 38874310 DOI: 10.1080/09638288.2024.2366438] [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: 11/28/2023] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE This study was performed to investigate and compare the effects of intradialytic core stabilization and aerobic exercises on physical performance, fatigue, quality of life and dialysis adequacy. MATERIALS AND METHODS The study involved 39 individuals on hemodialysis randomized into two groups: aerobic exercise (AE, n = 20) and core stabilization (CSE, n = 19). Over 8 weeks, the AE group performed pedal ergometer exercises, while the CSE group performed 4-phase core stabilization exercises. Physical performance (five times sit to stand test, 2-min step test), quality of life (Kidney Disease Quality of Life-36; KDQOL-36), fatigue levels (Piper Fatigue Scale), and dialysis adequacy (Kt/V and URR) were assessed. RESULTS After training, a significant improvement was observed in the physical performance, fatigue levels, and some parameters of KDQOL-36 of the patients (p < 0.05). However, no significant changes were observed in dialysis adequacy indicators (Kt/V and URR) (p > 0.05). When the amount of development obtained in both treatment groups is compared, kidney disease burden only in the subparameter of KDQOL-36 was statistically significantly improved in the CSE group compared to the AE group (p < 0.05). CONCLUSIONS According to the results of the study, intradialytic core stabilization exercises appear to have similar effects to aerobic exercises and can be performed by HD patients.
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Affiliation(s)
- Cengiz Taşkaya
- Department of Health Care Services, Vocational School of Health Services, Muş Alparslan University, Muş, Turkey
| | - Buket Büyükturan
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Öznur Büyükturan
- School of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Halil Alkan
- Faculty of Health Sciences, Muş Alparslan University, Muş, Turkey
| | - Ömer Bingölbali
- Department of Health Care Services, Vocational School of Health Services, Muş Alparslan University, Muş, Turkey
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Aljawadi MH, Babaeer AA, Alghamdi AS, Alhammad AM, Almuqbil MS, Alonazi KF. Quality of life tools among patients on dialysis: A systematic review. Saudi Pharm J 2024; 32:101958. [PMID: 38322149 PMCID: PMC10845059 DOI: 10.1016/j.jsps.2024.101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction The universal increase in obesity and diabetes has increased the chronic kidney disease (CKD) rate. In 2017, almost 800 million individuals suffered from CKD worldwide. Kidney dialysis becomes necessary as the disease progresses. Dialysis negatively impacts CKD patients' quality of life (QoL). It causes several complications that affect patients' physical, social, psychological, and spiritual aspects of life. This systematic review aims to identify condition-specific tools used to assess CKD patients' quality of life on dialysis. Material and Methods A systematic literature search was conducted to investigate studies using QoL tools among patients on dialysis from February 2000 to June 2023. The search was conducted in several databases and followed the PRISMA guidelines. The focus was to identify tools that capture intrinsic factors, such as spiritual subdomains, rather than extrinsic factors, such as environmental subdomains. Results The review identified five studies and seven dialysis-specific tools for assessing the QoL of CKD patients on dialysis. The physical domain was the most assessed, followed by the psychological and social domains. Fatigue, muscle weakness, sleep disorders, and pain were identified as the most common concerns in the physical domain. Conclusion Dialysis negatively impacts all aspects of QoL in CKD patients. This review can guide clinicians in understanding the disease and treatment burden by identifying the most appropriate tools for assessing the QoL of adult CKD patients undergoing dialysis. There is a need for further studies to explore the detrimental effects of CKD treatment and better understand its impact on patients' QoL.
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Affiliation(s)
- Mohammad H. Aljawadi
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Abdullah M. Alhammad
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mansour S. Almuqbil
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Riyadh, Saudi Arabia
| | - Khalid F Alonazi
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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3
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Komariah A, Rochmawati E. The Effect of Listening to the Holy Qur'an and a Back Massage on Fatigue and Quality of Life for Participants Undergoing Hemodialysis: A Quasi-Experimental Study. JOURNAL OF RELIGION AND HEALTH 2023; 62:4334-4346. [PMID: 36227419 DOI: 10.1007/s10943-022-01664-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
This study examined the effects of combining listening to the Holy Qur'an and back massage on fatigue and the quality of life in participants undergoing hemodialysis in Indonesia. This nonrandomized clinical trial was conducted in 40 patients (n = 20 intervention group, n = 20 control group). The FACIT-fatigue scale was used to measure fatigue, and the KDQOL scale was used to measure quality of life. After the intervention, the mean score on the FACIT-fatigue scale in the intervention group was 36.7 ± 2.1, whereas it was 23.4 ± 5.8 in the control group. Likewise, while the average KDQOL score was 61.2 ± 5.8 in the intervention group, it was 49.5 ± 8.6 in the control group. In the between-group comparisons, fatigue score was significantly lower in the intervention group compared to the control group (p < 0.05), and the between-group comparison also demonstrated a significant difference favoring the intervention group. We conclude that the combination of listening to the Holy Qur'an and back massage improve participant's fatigue and quality of life.
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Affiliation(s)
- Ade Komariah
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Kasman Singodimejo Postgraduate Building, Level 2, Jl Brawijaya, Tamantirto, Bantul, Yogyakarta, Indonesia
| | - Erna Rochmawati
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Kasman Singodimejo Postgraduate Building, Level 2, Jl Brawijaya, Tamantirto, Bantul, Yogyakarta, Indonesia.
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4
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Liu Y, Luo X, Deng S, Chen J, Zhang L, Huang Y, Hu H. Combined aerobic and resistance exercise in maintenance hemodialysis patients: A meta-analysis. Semin Dial 2023; 36:278-293. [PMID: 37313761 DOI: 10.1111/sdi.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023]
Abstract
Exercise brings many benefits to patients undergoing maintenance hemodialysis (MHD), but the effect of combined aerobic and resistance exercise remains unclear. English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wan Fang, and CBM) were searched from inception to January 2023 to retrieve qualified randomized controlled trials. The literature selection, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was performed using RevMan 5.3 software. A total of 23 studies with 1214 participants were included, and 17 of the interventions were conducted during dialysis. Results showed that combined aerobic and resistance exercise (CARE) improved the peak oxygen uptake, six-minute walking test, 60 s sit-to-stand test (STS), 30 s STS, dialysis adequacy, five (out of eight) domains and physical component summary of health-related quality of life (HRQOL) measured by the Medical Outcomes Study Short Form-36, blood pressure, and hemoglobin for MHD patients compared with usual care. No significant changes were found in the mental component summary of HRQOL, C-reactive protein, creatinine, potassium, sodium, calcium, and phosphate. Subgroup analysis showed that intradialytic CARE ameliorated more outcomes, except for handgrip strength and hemoglobin, than non-intradialytic ones. CARE is an effective way to improve physical function, aerobic capacity, dialysis adequacy, and HRQOL for MHD patients. Strategies should be implemented by clinicians and policymakers to motivate patients to do more exercise. Well-designed clinical trials are warranted to explore the effectiveness of non-intradialytic CARE.
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Affiliation(s)
- Yixiu Liu
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xiju Luo
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Siyan Deng
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jing Chen
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Lu Zhang
- Xi'an Medical University, Xi'an, Shan'xi, China
| | - Ying Huang
- Hemodialysis Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huagang Hu
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
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Baião VM, Cunha VA, Duarte MP, Andrade FP, Ferreira AP, Nóbrega OT, Viana JL, Ribeiro HS. Effects of Exercise on Inflammatory Markers in Individuals with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Metabolites 2023; 13:795. [PMID: 37512502 PMCID: PMC10385645 DOI: 10.3390/metabo13070795] [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: 05/23/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Individuals with chronic kidney disease (CKD) have a systemic inflammatory state. We assessed the effects of exercise on inflammatory markers in individuals with CKD. An electronic search was conducted, including MEDLINE. Experimental clinical trials that investigated the effects of exercise on inflammatory markers in individuals with CKD at all stages were included. Meta-analyses were conducted using the random-effects model and standard mean difference (SMD). Subgroup analyses were performed for resistance, aerobic, and combined exercise interventions. Twenty-nine studies were included in the meta-analyses. Exercise interventions showed significant reductions in C-reactive protein (CRP) (SMD: -0.23; 95% CI: -0.39 to -0.06), interleukin (IL)-6 (SMD: -0.35; 95% CI: -0.57, -0.14), and tumor necrosis factor-alpha (TNF-α) (SMD: -0.63, 95% CI: -1.01, -0.25) when compared with the controls. IL-10 levels significantly increased (SMD: 0.66, 95% CI: 0.09, 1.23) with exercise interventions. Resistance interventions significantly decreased CRP (SMD: -0.39, 95% CI: -0.69, -0.09) and TNF-α (SMD: -0.72, 95% CI: -1.20, -0.23) levels, while increasing IL-10 levels (SMD: 0.57, 95% CI: 0.04, 1.09). Aerobic interventions only significantly reduced IL-6 levels (SMD: -0.26, 95% CI: -0.51, -0.01). No significant changes in any inflammatory markers were observed with combined exercise interventions. Exercise interventions are effective as an anti-inflammatory therapy in individuals with CKD compared to usual care control groups. Resistance interventions seem to promote greater anti-inflammatory effects.
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Affiliation(s)
- Victor M Baião
- Faculty of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
| | - Vinícius A Cunha
- Faculty of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
| | - Marvery P Duarte
- Faculty of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
| | - Francini P Andrade
- Graduate Program in Pneumological Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre 91501-970, Brazil
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, 4475-690 Maia, Portugal
| | - Aparecido P Ferreira
- Interdisciplinary Research Department, University Center ICESP, Brasília 71961-540, Brazil
- Post-Graduation Program, Santa Úrsula University, Rio de Janeiro 22231-040, Brazil
| | - Otávio T Nóbrega
- Faculty of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
| | - João L Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, 4475-690 Maia, Portugal
| | - Heitor S Ribeiro
- Faculty of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, 4475-690 Maia, Portugal
- Interdisciplinary Research Department, University Center ICESP, Brasília 71961-540, Brazil
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Parsons RF, Tantisattamo E, Cheungpasitporn W, Basu A, Lu Y, Lentine KL, Woodside KJ, Singh N, Scalea J, Alhamad T, Dunn TB, Rivera FHC, Parajuli S, Pavlakis M, Cooper M. Comprehensive review: Frailty in pancreas transplant candidates and recipients. Clin Transplant 2023; 37:e14899. [PMID: 36591953 DOI: 10.1111/ctr.14899] [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: 09/02/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Well-selected patients with kidney disease and diabetes mellitus who undergo simultaneous kidney-pancreas transplantation often experience dramatic improvements in quality of life and long-term survival compared to those who remain on medical therapy. Over the past several years the importance of frailty in the pancreas transplant candidate and recipient populations has grown. More patients with advanced age have entered the waitlist, and complications from prolonged diabetes, even in younger patients, have created increased evidence of risk for frailty. Given these concerns, and the broad challenges facing pancreas transplantation volumes overall, we generated this review to help establish the impact and implications. We summarize the interplay of immunological factors, aging, environmental factors, diabetes mellitus, and chronic kidney disease that put these patients at risk for frailty. We discuss its measurement and recommend a combination of two instruments (both well-validated and one entirely objective). We describe the outcomes for patients before and after pancreas transplantation who may have frailty, and what interventions can be taken to mitigate its effects. Broader investigation into frailty in the pancreas transplant population is needed to better understand how to select patients for pancreas transplantation and to how manage its consequences thereafter.
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Affiliation(s)
| | | | | | | | - Yee Lu
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Neeraj Singh
- John C. McDonald Regional Transplant Center, Shreveport, Los Angeles, USA
| | - Joseph Scalea
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tarek Alhamad
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ty B Dunn
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Martha Pavlakis
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington DC, USA
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Effects of a Combined Intradialytic Exercise Training Program on Functional Capacity and Body Composition in Kidney Transplant Candidates. J Funct Morphol Kinesiol 2023; 8:jfmk8010009. [PMID: 36648901 PMCID: PMC9844356 DOI: 10.3390/jfmk8010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023] Open
Abstract
Chronic kidney disease (CKD) leads to gradual muscle mass loss, which is strongly associated with lower functional capacity, which limits a patient’s daily activities. The aim of the present study is to examine the effects of a 4-month intradialytic exercise program on the functional capacity and body composition of kidney transplant (KT) candidates. Twenty-nine male patients on hemodialysis (HD) waiting for a kidney transplant, with a mean age of 53.86 ± 9.56 years old and BMI 27.11 ± 5.55 kg/m2, were randomly assigned into the following two groups: A (nA = 15 HD patients), who followed a 4-month intradialytic exercise program combining aerobic and resistance training, with a supervised, progressively increasing workload, and B (nB = 14 HD patients), who continued to receive usual care. At baseline and the end of the study, the KT candidates underwent a 6-min walking distance (6-MWD), and a 10-repetition sit-to-stand test (10-STS) to access physical function, a handgrip strength (HGS) test to evaluate the muscle strength of the non-fistula hand. Moreover, the bioelectrical impedance analysis (BIA) was performed to assess body composition indices, such as body fat (BF), body fat mass index (BFMI), fat-free mass index (FFMI), body cell mass (BCM), basal metabolic rate (BMR), extracellular water (ECW), intracellular water (ICW), total body water (TBW) and phase angle (PhA). Following the exercise program, group A showed favorable improvements in HGS (from 26.59 ± 9.23 to 28.61 ± 9.58 kg, p < 0.05) and 6-MWD (from 427.07 ± 7.66 to 468.16 ± 11.39 m, p < 0.05). Intergroup results from 6-MWD showed a statistically significant difference (Δp = 0.04), at the end of the study. Moreover, group A results from BIA revealed a significant increase of BMR by 2.4% (p < 0.05), ECW by 3.6% (p = 0.01), ICW by 3.8% (p = 0.01), TBW by 4.1% (p = 0.01), lean mass by 2.7% (p = 0.01), and PhA by 13.3% (p = 0.04), while a reduction in BF by 5.0% (p = 0.01) and BFMI by 6.6% (p = 0.03) was also noticed. At the end of the study, group A showed statistical differences in BMR (Δp = 0.01), BMR/BW (Δp = 0.01), dry lean (Δp = 0.01), and PhA (Δp = 0.03), compared to the group B. Linear regression analysis in group A after training showed positive correlations between HGS and both PhA (r = 0.52, p = 0.04) and FFMI (r = 0.64, p = 0.01), and a strong negative correlation between 6-MWT and BF (r = −0.61, p = 0.01). In conclusion, a 4-month intradialytic exercise program can enhance body composition and some physical parameters in HD patients awaiting kidney transplantation.
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8
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Zhou L, Shi D, Zhang L, Wang Q, Chen L, Chen H. Does Intradialytic Group Exercise Programme Influence Patient-Reported Outcomes, Laboratory Parameters, and Anthropometric Parameters in Maintenance Hemodialysis Patients? A Single-Group Repeated-Measures Trial. Patient Prefer Adherence 2023; 17:491-501. [PMID: 36852381 PMCID: PMC9962523 DOI: 10.2147/ppa.s400005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Maintenance hemodialysis(MHD) patients often suffer from fatigue and are recommended to undertake physical activities. The optimal format of exercise rehabilitation for MHD patients remains uncertain despite demonstrated health benefits. This study aimed to evaluate the effectiveness of an intradialytic group exercise programme for MHD patients. METHODS This was a single-centre, single-group repeated-measures design study. The 12-week, three times per-week intradialytic group exercise programme was conducted for around 30 min during the first 2 hours of each dialysis session. Patient-reported outcomes including fatigue, anxiety, depression and health-related quality of life, laboratory parameters including haemoglobin, albumin, pre-albumin and hypersensitive C-reactive protein, and anthropometric parameters including triceps skinfold thickness, mid-upper arm circumference, mid-arm muscle circumference and handgrip strength, were measured at baseline, immediately post-intervention and 12-weeks post-intervention. The repeated-measures analysis of variance and Friedman test were used to compare the parametric and non-parametric data across time points, respectively. RESULTS Ninety patients were enrolled and 75 completed. Participants reported significant improvements across time points in fatigue (F = 10.19, p < 0.01), depression (F = 19.20, p < 0.001), health-related quality of life (F = 5.36, p = 0.006), haemoglobin (F = 3.43, p = 0.047), albumin (F = 4.42, p = 0.032), hypersensitive C-reactive protein (χ 2 = 50.39, p < 0.001), pre-albumin (χ 2 = 11.85, p = 0.003), triceps skinfold thickness (F = 25.03, p < 0.001), mid-upper arm circumference (F = 6.32, p = 0.005), mid-arm muscle circumference (F = 4.89, p = 0.02), and handgrip strength (F = 13.59, p < 0.001). Although the mean anxiety score tended to reduce, the difference across time points was nonsignificant (F = 1.33, p = 0.27). CONCLUSION The findings suggested that the intradialytic group exercise programme could improve MHD patients' fatigue, depression, health-related quality of life, nutritional status, and inflammation. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000034394 (04/07/2020).
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Affiliation(s)
- Lijuan Zhou
- Medical School, Nantong University, Nantong, People’s Republic of China
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Dan Shi
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Liyuan Zhang
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Qian Wang
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Li Chen
- Nursing Department, Taizhou People’s Hospital, Taizhou, People’s Republic of China
| | - Honglin Chen
- School of Public Health, Nantong University, Nantong, People’s Republic of China
- Correspondence: Honglin Chen, Email
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Worboys HM, Cooper NJ, Burton JO, Young HML, Waheed G, Fotheringham J, Gray LJ. Measuring quality of life in trials including patients on haemodialysis: methodological issues surrounding the use of the Kidney Disease Quality of Life Questionnaire. Nephrol Dial Transplant 2022; 37:2538-2554. [PMID: 35689670 PMCID: PMC9681926 DOI: 10.1093/ndt/gfac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Haemodialysis (HD) treatment causes a significant decrease in quality of life (QoL). When enrolled in a clinical trial, some patients are lost prior to follow-up because they die or they receive a kidney transplant. It is unclear how these patients are dealt with in the analysis of QoL data. There are questions surrounding the consistency of how QoL measures are used, reported and analysed. METHODS A systematic search of electronic databases for trials measuring QoL in HD patients using any variation of the Kidney Disease Quality of Life (KDQoL) Questionnaire was conducted. The review was conducted in Covidence version 2. Quantitative analysis was conducted in Stata version 16. RESULTS We included 61 trials in the review, of which 82% reported dropouts. The methods to account for missing data due to dropouts include imputation (7%) and complete case analysis (72%). Few trials (7%) conducted a sensitivity analysis to assess the impact of missing data on the study results. Single imputation techniques were used, but are only valid under strong assumptions regarding the type and pattern of missingness. There was inconsistency in the reporting of the KDQoL, with many articles (70%) amending the validated questionnaires or reporting only statistically significant results. CONCLUSIONS Missing data are not dealt with according to the missing data mechanism, which may lead to biased results. Inconsistency in the use of patient-reported outcome measures raises questions about the validity of these trials. Methodological issues in nephrology trials could be a contributing factor to why there are limited effective interventions to improve QoL in this patient group. PROSPERO REGISTRATION CRD42020223869.
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Affiliation(s)
- Hannah M Worboys
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Hannah M L Young
- Leicester Diabetes Centre, University of Hospitals of Leicester NHS Trust, Leicester, UK
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Ghazala Waheed
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - James Fotheringham
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
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10
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Meléndez Oliva E, Villafañe JH, Alonso Pérez JL, Alonso Sal A, Molinero Carlier G, Quevedo García A, Turroni S, Martínez-Pozas O, Valcárcel Izquierdo N, Sánchez Romero EA. Effect of Exercise on Inflammation in Hemodialysis Patients: A Systematic Review. J Pers Med 2022; 12:jpm12071188. [PMID: 35887685 PMCID: PMC9322638 DOI: 10.3390/jpm12071188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background: In recent years, physical exercise has been investigated for its potential as a therapeutic tool in patients with end-stage renal disease (ESRD) undergoing hemodialysis maintenance treatment (HD). It has been shown that regular practice of moderate-intensity exercise can improve certain aspects of immune function and exert anti-inflammatory effects, having been associated with low levels of pro-inflammatory cytokines and high levels of anti-inflammatory cytokines. Purpose: The aim of this review is to examine the studies carried out in this population that analyzed the effect of intradialytic exercise on the inflammatory state and evaluate which exercise modality is most effective. Methods: The search was carried out in the MEDLINE, CINAHL Web of Science and Cochrane Central Register of Controlled Trials databases from inception to June 2022. The PEDro scale was used to assess methodological quality, and the Cochrane Risk of Bias Tool and MINORS were used to evaluate the risk of bias. The quality of evidence was assessed with GRADE scale. The outcome measures were systemic inflammation biomarkers. Results: Mixed results were found in terms of improving inflammation biomarkers, such as CRP, IL-6 or TNFα, after exercise. Aerobic exercise seems to improve systemic inflammation when performed at medium intensity while resistance training produced better outcomes when performed at high intensity. However, some studies reported no differences after exercise and these results should be taken with caution. Conclusions: The low quality of the evidence suggests that aerobic and resistance exercise during HD treatment improves systemic inflammation biomarkers in patients with ESRD. In any case, interventions that increase physical activity in patients with ESRD are of vital importance as sedentary behaviors are associated with mortality. More studies are needed to affirm solid conclusions and to make intervention parameters, such as modality, dose, intensity or duration, sufficiently clear.
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Affiliation(s)
- Erika Meléndez Oliva
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (E.M.O.); (J.L.A.P.); (A.A.S.); (G.M.C.); (A.Q.G.); (O.M.-P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
| | - Jorge H. Villafañe
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20148 Milan, Italy
- Correspondence: (J.H.V.); (N.V.I.); (E.A.S.R.)
| | - Jose Luis Alonso Pérez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (E.M.O.); (J.L.A.P.); (A.A.S.); (G.M.C.); (A.Q.G.); (O.M.-P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Onelifecenter, Multidisciplinary Pain Treatment Center, 28925 Madrid, Spain
| | - Alexandra Alonso Sal
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (E.M.O.); (J.L.A.P.); (A.A.S.); (G.M.C.); (A.Q.G.); (O.M.-P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Onelifecenter, Multidisciplinary Pain Treatment Center, 28925 Madrid, Spain
| | - Guillermo Molinero Carlier
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (E.M.O.); (J.L.A.P.); (A.A.S.); (G.M.C.); (A.Q.G.); (O.M.-P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Onelifecenter, Multidisciplinary Pain Treatment Center, 28925 Madrid, Spain
| | - Andrés Quevedo García
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (E.M.O.); (J.L.A.P.); (A.A.S.); (G.M.C.); (A.Q.G.); (O.M.-P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Onelifecenter, Multidisciplinary Pain Treatment Center, 28925 Madrid, Spain
| | - Silvia Turroni
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126 Bologna, Italy;
| | - Oliver Martínez-Pozas
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (E.M.O.); (J.L.A.P.); (A.A.S.); (G.M.C.); (A.Q.G.); (O.M.-P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
| | - Norberto Valcárcel Izquierdo
- Higher Institute of Medical Sciences of Havana Victoria de Girón, University of Medical Sciences of Havana, Havana 11600, Cuba
- Correspondence: (J.H.V.); (N.V.I.); (E.A.S.R.)
| | - Eleuterio A. Sánchez Romero
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (E.M.O.); (J.L.A.P.); (A.A.S.); (G.M.C.); (A.Q.G.); (O.M.-P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Correspondence: (J.H.V.); (N.V.I.); (E.A.S.R.)
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11
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The association between MNA and PG-SGA malnutrition assessment and the quality of life among hemodialysis patients. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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March DS, Wilkinson TJ, Burnell T, Billany RE, Jackson K, Baker LA, Thomas A, Robinson KA, Watson EL, Graham-Brown MPM, Jones AW, Burton JO. The Effect of Non-Pharmacological and Pharmacological Interventions on Measures Associated with Sarcopenia in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14091817. [PMID: 35565785 PMCID: PMC9101978 DOI: 10.3390/nu14091817] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis provides a synthesis of the available evidence for the effects of interventions on outcome measures associated with sarcopenia in end-stage kidney disease (ESKD). Thirteen databases were searched, supplemented with internet and hand searching. Randomised controlled trials of non-pharmacological or pharmacological interventions in adults with ESKD were eligible. Trials were restricted to those which had reported measures of sarcopenia. Primary outcome measures were hand grip strength and sit-to-stand tests. Sixty-four trials were eligible (with nineteen being included in meta-analyses). Synthesised data indicated that intradialytic exercise increased hand grip strength (standardised mean difference, 0.58; 0.24 to 0.91; p = 0.0007; I2 = 40%), and sit-to-stand (STS) 60 score (mean difference, 3.74 repetitions; 2.35 to 5.14; p < 0.001; I2 = 0%). Intradialytic exercise alone, and protein supplementation alone, resulted in no statistically significant change in STS5 (−0.78 s; −1.86 to 0.30; p = 0.16; I2 = 0%), and STS30 (MD, 0.97 repetitions; −0.16 to 2.10; p = 0.09; I2 = 0%) performance, respectively. For secondary outcomes, L-carnitine and nandrolone-decanoate resulted in significant increases in muscle quantity in the dialysis population. Intradialytic exercise modifies measures of sarcopenia in the haemodialysis population; however, the majority of trials were low in quality. There is limited evidence for efficacious interventions in the peritoneal dialysis and transplant recipient populations.
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Affiliation(s)
- Daniel S. March
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (R.E.B.); (K.A.R.); (E.L.W.); (M.P.M.G.-B.); (J.O.B.)
- Correspondence:
| | - Thomas J. Wilkinson
- NIHR Applied Research Collaboration, Leicester Diabetes Centre, University of Leicester, Leicester LE5 4PW, UK;
| | - Thomas Burnell
- Leicester Medical School, University of Leicester, Leicester LE1 7HA, UK; (T.B.); (K.J.)
| | - Roseanne E. Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (R.E.B.); (K.A.R.); (E.L.W.); (M.P.M.G.-B.); (J.O.B.)
| | - Katherine Jackson
- Leicester Medical School, University of Leicester, Leicester LE1 7HA, UK; (T.B.); (K.J.)
| | - Luke A. Baker
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK;
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust, University of Leicester, Leicester LE5 4PW, UK
| | - Amal Thomas
- University Hospital of Leicester NHS Trust, Leicester LE1 5WW, UK;
| | - Katherine A. Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (R.E.B.); (K.A.R.); (E.L.W.); (M.P.M.G.-B.); (J.O.B.)
| | - Emma L. Watson
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (R.E.B.); (K.A.R.); (E.L.W.); (M.P.M.G.-B.); (J.O.B.)
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust, University of Leicester, Leicester LE5 4PW, UK
| | - Matthew P. M. Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (R.E.B.); (K.A.R.); (E.L.W.); (M.P.M.G.-B.); (J.O.B.)
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust, University of Leicester, Leicester LE5 4PW, UK
- University Hospital of Leicester NHS Trust, Leicester LE1 5WW, UK;
| | - Arwel W. Jones
- Central Clinical School, Monash University, Melbourne 3004, Australia;
| | - James O. Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK; (R.E.B.); (K.A.R.); (E.L.W.); (M.P.M.G.-B.); (J.O.B.)
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust, University of Leicester, Leicester LE5 4PW, UK
- University Hospital of Leicester NHS Trust, Leicester LE1 5WW, UK;
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
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13
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Effects of Systematic Diet Education Combined with Multidisciplinary Nursing on Nutritional Status and Calcium and Phosphorus Metabolism in Patients with Diabetic Kidney Disease in Uremic Phase after Treatment with Alogliptin. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1120242. [PMID: 35340239 PMCID: PMC8941540 DOI: 10.1155/2022/1120242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
Objective To explore the effects of systematic diet education combined with multidisciplinary nursing on nutritional status and calcium and phosphorus metabolism in patients with diabetic kidney disease (DKD) in uremic phase after treatment with alogliptin. Methods A total of 90 DKD patients with uremia admitted to our hospital from January 2020 to January 2021 were selected as the research objects. The subjects were divided into combined group and routine group by random number table method. All patients received alogliptin medication. The combination group received systematic dietary education combined with multidisciplinary nursing after the medication, and the conventional group received conventional intervention. Serum albumin, blood calcium, and other indexes were detected between both groups after intervention. Results After intervention, compared with the conventional group, all nutritional indexes of the combined group were obviously higher, levels of serum phosphorus and calcium-phosphorus product of the combined group were obviously lower (P < 0.001), the incidence of hypoglycemia and hyperglycemia of the combined group was obviously lower (P < 0.05), the total compliance rate of the combined group was obviously higher (P < 0.05), and the SAS score of the combined group was obviously lower (P < 0.001). Conclusion With conspicuous intervention effect, systematic diet education combined with multidisciplinary nursing is a reliable method that can improve the nutritional status and levels of calcium and phosphorus metabolism, enhance treatment compliance, and reduce anxiety. Further research will help to provide a better solution for patients. This trial is registered with ChiCTR2200057011.
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14
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Bernier-Jean A, Beruni NA, Bondonno NP, Williams G, Teixeira-Pinto A, Craig JC, Wong G. Exercise training for adults undergoing maintenance dialysis. Cochrane Database Syst Rev 2022; 1:CD014653. [PMID: 35018639 PMCID: PMC8752366 DOI: 10.1002/14651858.cd014653] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Dialysis treatments weigh heavily on patients' physical and psychosocial health. Multiple studies have assessed the potential for exercise training to improve outcomes in adults undergoing dialysis. However, uncertainties exist in its relevance and sustainable benefits for patient-important outcomes. This is an update of a review first published in 2011. OBJECTIVES To assess the benefits and safety of regular structured exercise training in adults undergoing dialysis on patient-important outcomes including death, cardiovascular events, fatigue, functional capacity, pain, and depression. We also aimed to define the optimal prescription of exercise in adults undergoing dialysis. SEARCH METHODS In this update, we conducted a systematic search of the Cochrane Kidney and Transplant Register of Studies up to 23 December 2020. The Register includes studies identified from CENTRAL, MEDLINE, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov as well as kidney-related journals and the proceedings of major kidney conferences. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of any structured exercise programs of eight weeks or more in adults undergoing maintenance dialysis compared to no exercise or sham exercise. DATA COLLECTION AND ANALYSIS Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane risk of bias tool. Whenever appropriate, we performed random-effects meta-analyses of the mean difference in outcomes. The primary outcomes were death (any cause), cardiovascular events and fatigue. Secondary outcomes were health-related quality of life (HRQoL), depression, pain, functional capacity, blood pressure, adherence to the exercise program, and intervention-related adverse events. MAIN RESULTS We identified 89 studies involving 4291 randomised participants, of which 77 studies (3846 participants) contributed to the meta-analyses. Seven studies included adults undergoing peritoneal dialysis. Fifty-six studies reported aerobic exercise interventions, 21 resistance exercise interventions and 19 combined aerobic and resistance training within the same study arm. The interventions lasted from eight weeks to two years and most often took place thrice weekly during dialysis treatments. A single study reported death and no study reported long-term cardiovascular events. Five studies directly assessed fatigue, 46 reported HRQoL and 16 reported fatigue or pain through their assessment of HRQoL. Thirty-five studies assessed functional capacity, and 21 reported resting peripheral blood pressure. Twelve studies reported adherence to exercise sessions, and nine reported exercise-related adverse events. Overall, the quality of the included studies was low and blinding of the participants was generally not feasible due to the nature of the intervention. Exercise had uncertain effects on death, cardiovascular events, and the mental component of HRQoL due to the very low certainty of evidence. Compared with sham or no exercise, exercise training for two to 12 months may improve fatigue in adults undergoing dialysis, however, a meta-analysis could not be conducted. Any exercise training for two to 12 months may improve the physical component of HRQoL (17 studies, 656 participants: MD 4.12, 95% CI 1.88 to 6.37 points on 100 points-scale; I² = 49%; low certainty evidence). Any exercise training for two to 12 months probably improves depressive symptoms (10 studies, 441 participants: SMD -0.65, 95% CI -1.07 to -0.22; I² = 77%; moderate certainty evidence) and the magnitude of the effect may be greater when maintaining the exercise beyond four months (6 studies, 311 participants: SMD -0.30, 95% CI 0.14 to -0.74; I² = 71%). Any exercise training for three to 12 months may improve pain (15 studies, 872 participants: MD 5.28 95% CI -0.12 to 10.69 points on 100 points-scale; I² = 63%: low certainty evidence) however, the 95% CI indicates that exercise training may make little or no difference in the level of pain. Any exercise training for two to six months probably improves functional capacity as it increased the distance reached during six minutes of walking (19 studies, 827 participants: MD 49.91 metres, 95% CI 37.22 to 62.59; I² = 34%; moderate certainty evidence) and the number of sit-to-stand cycles performed in 30 seconds (MD 2.33 cycles, 95% CI 1.71 to 2.96; moderate certainty evidence). There was insufficient evidence to assess the safety of exercise training for adults undergoing maintenance dialysis. The results were similar for aerobic exercise, resistance exercise, and a combination of both aerobic and resistance exercise. AUTHORS' CONCLUSIONS It is uncertain whether exercise training improves death, cardiovascular events, or the mental component of HRQoL in adults undergoing maintenance dialysis. Exercise training probably improves depressive symptoms, particularly when the intervention is maintained beyond four months. Exercise training is also likely to improve functional capacity. Low certainty evidence suggested that exercise training may improve fatigue, the physical component of quality of life, and pain. The safety of exercise training for adults undergoing dialysis remains uncertain.
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Affiliation(s)
- Amelie Bernier-Jean
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Nadim A Beruni
- Resident Support Unit, Western Sydney Local Health District, Westmead, Australia
| | - Nicola P Bondonno
- School of Biomedical Sciences, The University of Western Australia, Royal Perth Hospital, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Gabrielle Williams
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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15
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Hu H, Liu X, Chau PH, Choi EPH. Effects of intradialytic exercise on health-related quality of life in patients undergoing maintenance haemodialysis: a systematic review and meta-analysis. Qual Life Res 2021; 31:1915-1932. [PMID: 34731388 DOI: 10.1007/s11136-021-03025-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To summarize the current evidence regarding the effectiveness of intradialytic exercise (IDE) on the health-related quality of life (HRQOL) of patients undergoing maintenance haemodialysis. METHODS Five English databases (PubMed, EMBASE, Cochrane Library, Web of Science, and ScienceDirect) and four Chinese databases (VIP, WAN FANG, CNKI, CBM) were comprehensively searched from their inception to 18 March 2021. This study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two independent reviewers selected the papers and extracted the details of each study therein. Only randomized controlled trials were included. The risk of bias tool version 2.0 was used to evaluate the risk of bias of the included studies. A random-effects meta-analysis was conducted to pool the effect size. RESULTS Thirty-three eligible studies with 1481 participants were included. For the generic HRQOL, assessed by the Medical Outcomes Study Short-Form survey, IDE significantly improved most domains and the physical component summary compared with the control group. Furthermore, aerobic exercise alone significantly improved more domains compared to resistance exercise, combined aerobic and resistance exercise, and other types of exercise. Regarding the kidney-specific HRQOL, IDE improved three of eleven domains, including the symptom/problem list, the effect of kidney disease, and the quality of social interaction. No significant effect was found on other domains of kidney-specific HRQOL. CONCLUSION Intradialytic exercise could benefit patients undergoing haemodialysis in improving most domains of generic HRQOL, but the effect on most domains of kidney-specific HRQOL is insufficient.
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Affiliation(s)
- Huagang Hu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China.,School of Nursing, Medical College, Soochow University, Box 203, 1 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xu Liu
- Department of Infectious Disease; Guangdong Provincial Engineering Research Center of Molecular Imaging; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, No. 52, Meihua East Rd, Xiangzhou District, Zhuhai, 519000, Guangdong Province, China
| | - Pui Hing Chau
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, SAR, China.
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16
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Rochmawati E, Utomo EK, Makiyah SNN. Improving dialysis adequacy and quality of life in patients undergoing hemodialysis with twice a week range of motion exercise. Ther Apher Dial 2021; 26:140-146. [PMID: 34129271 DOI: 10.1111/1744-9987.13701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/03/2021] [Accepted: 06/12/2021] [Indexed: 12/01/2022]
Abstract
The study aimed to determine the effects of giving range of motion (ROM) twice a week as a form intradialytic exercise on patients' dialysis adequacy and quality of life. A total of 48 eligible participants were recruited and completed this study. The intervention group (n = 24) received twice a week ROM exercise over a 4 weeks period. The outcomes were assessed at pretest and at the end of the intervention. The study shows that ROM exercise was effective in improving dialyis adequacy that include ureum retention ratio (p= 0.027) and Kt/V (p= 0.017). Quality of life improved significantly particularly in the domains of symptom and effect of kidney disease. Integrating ROM into dialysis care shows as a potential intervention to improve dialysis adequacy and quality of life for patients undergoing hemodialysis. Future research should evaluate its efficacy using a randomized clinical trial design and larger sample of patients.
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Affiliation(s)
- Erna Rochmawati
- School of Master in Nursing, Universitas of Muhammadiyah Yogyakarta, Jl Brawijaya, Tamantirto, Bantul, Indonesia
| | - Endrat Kartiko Utomo
- School of Master in Nursing, Universitas of Muhammadiyah Yogyakarta, Jl Brawijaya, Tamantirto, Bantul, Indonesia.,School of Nursing, Universitas Duta Bangsa, Surakarta, Indonesia
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17
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Bakaloudi DR, Siargkas A, Poulia KA, Dounousi E, Chourdakis M. The Effect of Exercise on Nutritional Status and Body Composition in Hemodialysis: A Systematic Review. Nutrients 2020; 12:E3071. [PMID: 33050111 PMCID: PMC7601723 DOI: 10.3390/nu12103071] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/27/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) is associated with aggravating factors which can affect both body composition and nutritional status. The purpose of the present systematic review was to investigate the potential effects of any physical activity on body composition or nutritional status among patients with stage 5 CKD undergoing hemodialysis (HD). A literature search on PubMed, Scopus, Web of Science, Google Scholar, and Cochrane was conducted and 14 randomized clinical trials were included. Skeletal muscle index and mid-arm muscular circumference increased after resistance exercise, and the results on body mass index, % body fat, and lean body mass varied. Serum albumin and C-reactive protein, in most cases, showed a slight increase and decrease, respectively. An improvement was also observed in body strength and overall performance status. The results suggest that physical activity can be beneficial for both the body composition and nutritional status of patients undergoing HD and can help in the prevention of sarcopenia. However, further research is needed mainly in the field of nutritional status.
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Affiliation(s)
- Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.R.B.); (A.S.)
| | - Antonios Siargkas
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.R.B.); (A.S.)
| | - Kalliopi Anna Poulia
- Department of Nutrition and Dietetics, Laiko General Hospital, 11527 Athens, Greece;
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.R.B.); (A.S.)
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18
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Ju A, Scholes-Robertson N, Johnson DW, Cho Y, van Zwieten A, Manera K, Howell M, Viecelli AK, Jesudason S, Evangelidis N, Polkinghorne K, Gutman T, Wyburn K, Craig JC, Tong A, Charalambous A, Beach B, Larkin B, Beach C, Clive C, Dingle D, Thomas D, Blake D, Baker D, Underwood D, McLaren D, Demagante F, Jennings G, Jeff H, Mewburn I, Wooldridge J, Ellis J, Widders K, Young K, McLaren K, Yew K, Ellis M, Blake M, Scholes-Robertson N, Scholes-Robertson N, Grant P, Kennedy P, Walter P, Yew P, Jeff R, Wooldridge W. Patient-led identification and prioritization of exercise interventions for fatigue on dialysis: a workshop report. Clin Kidney J 2020; 14:831-839. [PMID: 34840732 PMCID: PMC8612136 DOI: 10.1093/ckj/sfz200] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/19/2019] [Indexed: 12/04/2022] Open
Abstract
Background Fatigue is one of the most important symptoms among patients receiving dialysis and is nominated as a core outcome to be reported in all clinical trials in this setting. However, few trials of interventions targeting fatigue have been conducted. Patients historically have rarely been involved in the design of interventions, which can limit acceptability and uptake. When asked, they have indicated a preference for lifestyle interventions, such as exercise, to improve fatigue. While some research has focussed on intradialytic exercise for patients receiving haemodialysis, patients have also indicated a preference for a convenient method of exercising with guidance, but on their own time outside of dialysis hours. In response to this, a mobile phone application was proposed as the method of delivery for a home-based exercise intervention targeting fatigue. Methods We convened a workshop with five breakout group sessions in Australia, with 24 patients on dialysis (16 haemodialysis and 8 peritoneal dialysis) and 8 caregivers to identify, prioritize and discuss exercise interventions for fatigue in patients receiving dialysis and the delivery of this through a mobile application. Results Of the 21 types of exercise identified, the top-ranked were walking outdoors, walking on a treadmill and cardio and resistance training. Six themes were identified: (i) ‘an expectation of tangible gains from exercise’, including strengthening and protecting against bodily deterioration related to dialysis; (ii) ‘overcoming physical limitations’, meaning that comorbidities, baseline fatigue and fluctuating health needed to be addressed to engage in exercise; (iii) ‘fear of risks’, which reinforced the importance of safety and compatibility of exercise with dialysis; (iv) ‘realistic and achievable’ exercise, which would ensure initial readiness for uptake; (v) ‘enhancing motivation and interest’ , which expected to support sustained use of the exercise intervention and (vi) ‘ensuring usability of the mobile application’ , which would require simplicity, convenience and comprehensibility. Conclusion Exercise interventions that are expected by patients to improve health outcomes and that are safe, realistic and easy to adopt may be more acceptable to patients on dialysis.
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Affiliation(s)
- Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Karine Manera
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Shilpanjali Jesudason
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Kevan Polkinghorne
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Talia Gutman
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Kate Wyburn
- Department of Transplantation, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
- Colleges of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
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Ferrari F, Helal L, Dipp T, Soares D, Soldatelli Â, Mills AL, Paz C, Tenório MCC, Motta MT, Barcellos FC, Stein R. Intradialytic training in patients with end-stage renal disease: a systematic review and meta-analysis of randomized clinical trials assessing the effects of five different training interventions. J Nephrol 2019; 33:251-266. [PMID: 31865607 DOI: 10.1007/s40620-019-00687-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Patients with end-stage renal disease (ESRD) undergoing hemodialysis may have reduced dialysis adequacy (Kt/V), low cardiorespiratory fitness, and worse prognosis. Different types of intradialytic training (IDT) may serve as an adjunct therapy for the management of the ESRD. This systematic review and meta-analysis aimed to assess the impact of different types of IDT on clinical outcomes and functional parameters in ESRD. METHODS PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, SPORTDiscus, and Google Scholar were searched for randomized clinical trials in adult patients with ESRD which compared IDT with usual care (UC), without language restrictions and published up to July 2019; a handsearch of references was also performed. Certainty of evidence was assessed using GRADE, and risk of bias in primary studies with the RoB 1.0 tool. RESULTS Fifty studies were included (n = 1757). Compared to UC, aerobic IDT improved Kt/V (WMD = 0.08), VO2peak (WMD = 2.07 mL/kg/min), 6-minute walk test (6MWT) distance (64.98 m), reduced systolic blood pressure (- 10.07 mmHg) and C-reactive protein (- 3.28 mg/L). Resistance training increased 6MWT distance (68.50 m). Combined training increased VO2peak (5.41 mL/kg/min) and reduced diastolic blood pressure (- 5.76 mmHg). Functional electrostimulation (FES) and inspiratory muscle training (IMT) improved 6MWT distance (54.14 m and 117.62 m, respectively). There was no impact on total cholesterol, interleukin-6, or hemoglobin levels. There was no difference in incidence of adverse events between the IDT and control groups. The certainty of evidence was variable according to the GRADE scale, with most outcomes rated very low certainty. The risk of bias assessment of primary studies showed unclear risk in most. CONCLUSIONS Aerobic, resistance, and combined training during hemodialysis, as well as FES and IMT, demonstrated to be effective for the treatment of the patient with ESRD. Our data should be interpreted in light of the unclear risk of bias of most evaluated articles and the low to very low certainty of evidence for evaluated outcomes. PROSPERO REGISTRATION ID CRD42017081338. DATA SHARING REPOSITORY: https://osf.io/fpj54/.
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Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.,Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Helal
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.,Exercise Pathophysiology Laboratory (LaFiEx), Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thiago Dipp
- School of Physical Therapy, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Douglas Soares
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.,Experimental and Molecular Cardiovascular Laboratory and Heart Failure Unit, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ângela Soldatelli
- Exact Sciences and Engineering, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Andrew Lee Mills
- Center for Workplace Health, American Heart Association, Houston, TX, USA
| | | | | | - Marcelo Trotte Motta
- Department of Biotechnology, Universidade Estadual de Feira de Santana, Feira de Santana, Brazil
| | | | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350-Santa Cecília, Porto Alegre, RS, 90035-003, Brazil. .,Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Vitta Centro de Bem-Estar Físico, Porto Alegre, Brazil. .,Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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