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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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Rossum K, Hancock E, Thompson S, Brar R, Riehl-Tonn V, Garcia E, Leon SJ, Sharma M, Ford E, Komenda P, Rigatto C, Tangri N, MacRae JM, Bohm C. A Randomized Trial Examining the Impact of Timing of Intradialytic Cycling on Intradialytic Hypotension. Kidney Int Rep 2023; 8:1002-1012. [PMID: 37180520 PMCID: PMC10166740 DOI: 10.1016/j.ekir.2023.02.1074] [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: 08/15/2022] [Revised: 01/15/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Intradialytic cycling is often performed during the first half of hemodialysis because of concerns regarding increased frequency of intradialytic hypotension (IDH) late in hemodialysis. This increases exercise program resource needs and limits utility of intradialytic cycling to treat dialysis-related symptoms. Methods This multicenter, randomized, crossover trial compared IDH rate when cycling during the first half versus the second half of hemodialysis in 98 adults on maintenance hemodialysis. Group A cycled during the first half of hemodialysis for 2 weeks and subsequently during the second half for 2 weeks. In group B, the cycling schedule was reversed. Blood pressure (BP) was measured every 15 minutes throughout hemodialysis. Primary outcome was IDH rate (systolic BP [SBP] decrease of >20 mm Hg or SBP <90 mm Hg). Secondary outcomes included symptomatic IDH rate and time to recover post hemodialysis. Data were analyzed using negative binomial and gamma distribution mixed regression. Results Mean age 64.7 (SD 12.0) and 64.7 (SD 14.2) years in group A (n = 52) and group B (n = 46), respectively. Proportions of females were 33% in group A and 43% in group B. Median time on hemodialysis was 4.1 (interquartile range [IQR] 2.5, 6.1]) years in group A and 3.9 years (IQR 2.5, 6.7) in group B. IDH rate per 100 hemodialysis hours (95% confidence interval [CI]) was 34.2 (26.4, 42.0) and 36.0 (28.9, 43.1) during early and late intradialytic cycling, respectively (P = 0.53). Timing of intradialytic cycling was not associated with symptomatic IDH (relative risk [RR]: 1.07 [0.75-1.53]) or time to recover post hemodialysis (odds ratio: 0.99 [0.79-1.23]). Conclusion We found no association between the rate of overall or symptomatic IDH and the timing of intradialytic cycling in patients enrolled in an intradialytic cycling program. Increased use of cycling late in hemodialysis may optimize intradialytic cycling program resource use and should be studied as a possible treatment for symptoms common in late hemodialysis.
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Affiliation(s)
- Krista Rossum
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Evelyn Hancock
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephanie Thompson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ranveer Brar
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | | | - Eric Garcia
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Renal Program, Winnipeg, Manitoba, Canada
| | - Silvia J. Leon
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | - Monica Sharma
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Emilie Ford
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | - Claudio Rigatto
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | - Jennifer M. MacRae
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Clara Bohm
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | - Global Renal Exercise Network6
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Manitoba Renal Program, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
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3
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Marzougui H, Turki M, Ben Dhia I, Maaloul R, Chaker H, Makhlouf R, Agrebi I, Kammoun K, Jamoussi K, Ayadi F, Ben Hmida M, Hammouda O. Melatonin intake before intradialytic exercise reverses oxidative stress and improves antioxidant status in hemodialysis patients. Int J Artif Organs 2023; 46:264-273. [PMID: 37051719 DOI: 10.1177/03913988231165324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
PURPOSE The present study aimed to investigate for the first time the effects of melatonin (MEL) intake on oxidative stress and cellular damage during intradialytic exercise (IEX). METHODS Thirteen hemodialysis (HD) patients volunteered to participate in the current randomized crossover trial. Participants performed four HD sessions in four different conditions: (Exercise (EX)-MEL), (EX-Placebo (PLA)), (Control (C)-MEL), and (C-PLA). 3 mg of MEL or PLA were taken 60 min before starting exercise, or at the equivalent time in the C conditions. Blood samples were taken before HD (T0), immediately after the end of IEX (T1), 60 min after IEX (T2), or at the corresponding times in the C conditions to measure free radicals damage, antioxidant biomarkers, as well as biomarkers of muscle and liver damage. RESULTS Malondialdehyde and Advanced Oxidation Protein Products decreased in (C-MEL) (p < 0.05, d = 2.19; p < 0.01, d = 0.99, respectively) at T2 compared to T0. Catalase and total thiol levels increased in (C-MEL) (p < 0.01, d = 1.51; p < 0.01, d = 1.56, respectively) and in (EX-MEL) (p = 0.01, d = 1.28; p < 0.01, d = 1.52, respectively) at T1 compared to T0. Total bilirubin levels increased in (EX-MEL) and (C-MEL) at T2 compared to T0 (p < 0.001, d = 2.77; p < 0.001, d = 1.36, respectively), but only at T2 compared to T1 in (EX-MEL) (p < 0.001, d = 1.67). In all conditions, uric acid levels decreased at T1 compared to T0 and at T2 compared to T1, while biomarkers of muscle and liver damage remained unchanged. CONCLUSION This pilot study is the first to show that MEL ingestion, alone or combined with IEX, could improve oxidant-antioxidant balance during HD.
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Affiliation(s)
- Houssem Marzougui
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Mouna Turki
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Biochemistry Department, CHU Habib Bourguiba, University of Sfax, Sfax, Tunisia
| | - Imen Ben Dhia
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
- Research Laboratory: Evaluation and Management of Musculoskeletal System Pathologies, LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Rami Maaloul
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Hanen Chaker
- Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
- Research Laboratory of Renal Pathology, LR19ES11, Faculty of Medicine, University of Sfax, Sfax,Tunisia
| | - Rihab Makhlouf
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Biochemistry Department, CHU Habib Bourguiba, University of Sfax, Sfax, Tunisia
| | - Ikram Agrebi
- Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
- Research Laboratory of Renal Pathology, LR19ES11, Faculty of Medicine, University of Sfax, Sfax,Tunisia
| | - Khawla Kammoun
- Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
- Research Laboratory of Renal Pathology, LR19ES11, Faculty of Medicine, University of Sfax, Sfax,Tunisia
| | - Kamel Jamoussi
- Biochemistry Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
| | - Fatma Ayadi
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Biochemistry Department, CHU Habib Bourguiba, University of Sfax, Sfax, Tunisia
| | - Mohamed Ben Hmida
- Nephrology Department, CHU Hedi Chaker, University of Sfax, Sfax, Tunisia
- Research Laboratory of Renal Pathology, LR19ES11, Faculty of Medicine, University of Sfax, Sfax,Tunisia
| | - Omar Hammouda
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, Nanterre, France
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Yildiz AB, Vehbi S, Covic A, Burlacu A, Covic A, Kanbay M. An update review on hemodynamic instability in renal replacement therapy patients. Int Urol Nephrol 2023; 55:929-942. [PMID: 36308664 DOI: 10.1007/s11255-022-03389-w] [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: 05/24/2022] [Accepted: 10/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemodynamic instability in patients undergoing kidney replacement therapy (KRT) is one of the most common and essential factors influencing mortality, morbidity, and the quality of life in this patient population. METHOD Decreased cardiac preload, reduced systemic vascular resistance, redistribution of fluids, fluid overload, inflammatory factors, and changes in plasma osmolality have all been implicated in the pathophysiology of hemodynamic instability associated with KRT. RESULT A cascade of these detrimental mechanisms may ultimately cause intra-dialytic hypotension, reduced tissue perfusion, and impaired kidney rehabilitation. Multiple parameters, including dialysate composition, temperature, posture during dialysis sessions, physical activity, fluid administrations, dialysis timing, and specific pharmacologic agents, have been studied as possible management modalities. Nevertheless, a clear consensus is not reached. CONCLUSION This review includes a thorough investigation of the literature on hemodynamic instability in KRT patients, providing insight on interventions that may potentially minimize factors leading to hemodynamic instability.
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Affiliation(s)
- Abdullah B Yildiz
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sezan Vehbi
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Andreea Covic
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Alexandru Burlacu
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Adrian Covic
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, 34010, Istanbul, Turkey.
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Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session. Healthcare (Basel) 2022; 11:healthcare11010079. [PMID: 36611539 PMCID: PMC9818851 DOI: 10.3390/healthcare11010079] [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: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.
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6
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Wahida AZ, Rumahorbo H, Murtiningsih. The effectiveness of intradialytic exercise in ameliorating fatigue symptoms in patients with chronic kidney failure undergoing hemodialysis: A systematic literature review and meta-analysis. J Taibah Univ Med Sci 2022; 18:512-525. [PMID: 36818184 PMCID: PMC9906013 DOI: 10.1016/j.jtumed.2022.11.004] [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: 07/16/2022] [Revised: 10/30/2022] [Accepted: 11/19/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Hemodialysis in patients with chronic kidney failure is an intervention serving as an alternative to kidney transplantation. In 2019, chronic kidney failure became the world's 6th leading cause of death. In Indonesia, kidney failure has an increasing number of cases every year and is the 10th highest cause of death. According to basic health research in 2018, the prevalence of chronic kidney failure was 3.4%, and 19.3% of patients 15 years of age and older underwent hemodialysis. This study analyzed the effectiveness of intradialytic exercise in ameliorating fatigue symptoms in patients with chronic kidney failure undergoing hemodialysis, in terms of exercise type, duration, time, and frequency. Methods All appropriate and eligible full-text articles published between January 2010 and October 2021 were screened and extracted from the databases PubMed, Scopus, ProQuest, Science Direct, CrossRef, Google Scholar, and Garuda Database for Research and Technology. The articles were critically reviewed, and two independent authors reviewed the risk of bias by using the JBI form. Data analysis was performed qualitatively to obtain an overview of the characteristics of intradialytic exercise and quantitatively through meta-analysis. Results Intradialytic exercise was found to effectively decrease fatigue by 81% in the intervention group. The most significant effect sizes were as follows: type of intradialytic exercise: aerobic exercise (146%); duration of intradialytic exercise: >20 min (100%); time of intradialytic exercise: first 2 h (127%); and exercise frequency: <12 sessions (120%). Conclusion The characteristics of intradialytic exercise that are considered effective in ameliorating fatigue are aerobic exercise lasting >20 min and performed in the first 2 h of hemodialysis, with a frequency of <12 sessions.
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Affiliation(s)
| | - Hotma Rumahorbo
- Politeknik Kesehatan Bandung, Indonesia,Corresponding address: Politeknik Kesehatan Bandung, Jl. Pajajaran No.56, Pasir Kaliki, Kec. Cicendo, Bandung, 40171, West Java, Indonesia.
| | - Murtiningsih
- Universitas Jenderal Achmad Yani Cimahi, Indonesia
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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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8
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The effect of a 6-month intradialytic exercise program on hemodialysis adequacy and body composition: a randomized controlled trial. Int Urol Nephrol 2022; 54:2983-2993. [DOI: 10.1007/s11255-022-03238-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/04/2022] [Indexed: 12/25/2022]
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9
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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: 53] [Impact Index Per Article: 26.5] [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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10
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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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11
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Highton PJ, March DS, Churchward DR, Grantham CE, Young HML, Graham-Brown MPM, Estruel S, Martin N, Brunskill NJ, Smith AC, Burton JO, Bishop NC. Intradialytic cycling does not exacerbate microparticles or circulating markers of systemic inflammation in haemodialysis patients. Eur J Appl Physiol 2021; 122:599-609. [PMID: 34854982 PMCID: PMC8854296 DOI: 10.1007/s00421-021-04846-7] [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: 09/08/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022]
Abstract
Purpose Patients receiving haemodialysis (HD) display elevated circulating microparticle (MP) concentration, tissue factor (TF) expression and markers of systemic inflammation, though regular intradialytic cycling (IDC) may have a therapeutic effect. This study investigated the impact of regular, moderate-intensity IDC on circulating MPs and inflammatory markers in unit-based HD patients. Methods Patients were cluster-randomised to intervention (n = 20, age: 51.4 ± 18.1 years, body mass: 77.6 ± 18.3 kg, mean ± SD) or no-exercise control (n = 20, 56.8 ± 14.0 years, 80.5 ± 26.5 kg). Intervention participants completed 30 min of moderate intensity (rating of perceived exertion [RPE] of 12–14) IDC, thrice weekly for 6 months. Pre-dialysis venous blood samples were obtained at 0, 3 and 6 months. Circulating MP phenotypes, cytokines, chemokine and MP TF expression were quantified using flow cytometry and cytometric bead array assays. Results Despite high exercise compliance (82%), no IDC-dependent effects were observed for any MP, cytokine or chemokine measure (p ≥ 0.051, ηρ2 ≤ 0.399) other than TNF-α (p = 0.001, ηρ2 = 0.186), though no significance was revealed upon post hoc analysis. Conclusion Six months of regular, moderate-intensity IDC had no effect on MPs, cytokines or chemokines. This suggests that the exercise did not exacerbate thrombotic or inflammatory status, though further functional assays are required to confirm this. Trial registration ISRCTN1129707, prospectively registered on 05/03/2015.
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Affiliation(s)
- Patrick J Highton
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,NIHR Applied Research Collaboration East Midlands, Leicester Diabetes Centre of Research, University of Leicester, Leicester, UK
| | - Daniel S March
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Darren R Churchward
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Hannah M L Young
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Seila Estruel
- Department of Physiological Sciences, University of Barcelona, Barcelona, Spain
| | - Naomi Martin
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Alice C Smith
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK.,Department of Health Sciences, University of Leicester, Leicester, UK
| | - James O Burton
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Nicolette C Bishop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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12
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Graham-Brown MPM, Herrington WG, Burton JO. Spinning the legs and blood: should intradialytic exercise be routinely offered during maintenance haemodialysis? Clin Kidney J 2021; 14:1297-1300. [PMID: 34221366 PMCID: PMC8247751 DOI: 10.1093/ckj/sfab018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with end-stage kidney disease on haemodialysis (HD) have an elevated risk of cardiovascular disease (CVD). These patients also experience high levels of physical deconditioning and programmes of rehabilitation have been tested in a variety of forms with variable success. It has been suggested that programmes of exercise rehabilitation have a role to play in improving the physical condition of patients on HD and in addressing the traditional and non-traditional risk factors that drive CVD for this population. Intradialytic exercise has often been suggested as a convenient way of delivering rehabilitation for patients on HD, as it makes use of otherwise dead time, but there are legitimate concerns about this group of at-risk patients undertaking exercise at a time when their myocardium is already vulnerable to the insults of demand ischaemia from the processes of dialysis and ultrafiltration. A study in this issue of Clinical Kidney Journal provides reassuring data, showing that cycling during dialysis potentially reduces evidence of demand ischaemia (episodes of myocardial stunning). Together with the safety and quality of life data, we expect from the multicentre PrEscription of Intra-Dialytic Exercise to Improve quAlity of Life in Patients With Chronic Kidney Disease study (the protocol for which is published concurrently), rehabilitation programmes that include intradialytic exercise are perhaps closer than ever for patients on HD.
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Affiliation(s)
- Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - William G Herrington
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Oxford Kidney Unit, Churchill Hospital, Oxford, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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13
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McGuire S, Horton EJ, Renshaw D, Chan K, Krishnan N, McGregor G. Cardiopulmonary and metabolic physiology during hemodialysis and inter/intradialytic exercise. J Appl Physiol (1985) 2021; 130:1033-1042. [PMID: 33507853 DOI: 10.1152/japplphysiol.00888.2020] [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] [Indexed: 11/22/2022] Open
Abstract
Hemodialysis is associated with numerous symptoms and side effects that, in part, may be due to subclinical hypoxia. However, acute cardiopulmonary and metabolic physiology during hemodialysis is not well defined. Intradialytic and interdialytic exercise appear to be beneficial and may alleviate these side effects. To better understand these potential benefits, the acute physiological response to exercise should be evaluated. The aim of this study was to compare and characterize the acute physiological response during hemodialysis, intradialytic exercise, and interdialytic exercise. Cardiopulmonary physiology was evaluated during three conditions: 1) hemodialysis without exercise (HD), 2) intradialytic exercise (IDEx), and 3) interdialytic exercise (Ex). Exercise consisted of 30-min constant load cycle ergometry at 90% V̇O2AT (anaerobic threshold). Central hemodynamics (via noninvasive bioreactance) and ventilatory gas exchange were recorded during each experimental condition. Twenty participants (59 ± 12 yr, 16/20 male) completed the protocol. Cardiac output (Δ = -0.7 L/min), O2 uptake (Δ = -1.4 mL/kg/min), and arterial-venous O2 difference (Δ = -2.0 mL/O2/100 mL) decreased significantly during HD. Respiratory exchange ratio exceeded 1.0 throughout HD and IDEx. Minute ventilation was lower (P = 0.001) during IDEx (16.5 ± 1.1 L/min) compared with Ex (19.8 ± 1.0 L/min). Arterial-venous O2 difference was partially restored further to IDEx (4.6 ± 1.9 mL/O2/100 mL) compared with HD (3.5 ± 1.2 mL/O2/100 mL). Hemodialysis altered cardiopulmonary and metabolic physiology, suggestive of hypoxia. This dysregulated physiology contributed to a greater physiological demand during intradialytic exercise compared with interdialytic exercise. Despite this, intradialytic exercise partly normalized cardiopulmonary physiology during treatment, which may translate to a reduction in the symptoms and side effects of hemodialysis.NEW & NOTEWORTHY This study is the first, to our knowledge, to directly compare cardiopulmonary and metabolic physiology during hemodialysis, intradialytic exercise, and interdialytic exercise. Hemodialysis was associated with increased respiratory exchange ratio, blunted minute ventilation, and impaired O2 uptake and extraction. We also identified a reduced ventilatory response during intradialytic exercise compared with interdialytic exercise. Impaired arterial-venous O2 difference during hemodialysis was partly restored by intradialytic exercise. Despite dysregulated cardiopulmonary and metabolic physiology during hemodialysis, intradialytic exercise was well tolerated.
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Affiliation(s)
- S McGuire
- Faculty of Health and Life Sciences, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, United Kingdom
| | - E J Horton
- Faculty of Health and Life Sciences, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, United Kingdom
| | - D Renshaw
- Faculty of Health and Life Sciences, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, United Kingdom
| | - K Chan
- Faculty of Health and Life Sciences, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, United Kingdom
| | - N Krishnan
- Faculty of Health and Life Sciences, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, United Kingdom.,Department of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - G McGregor
- Faculty of Health and Life Sciences, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, United Kingdom.,Department of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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14
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Ribeiro HS, Cunha VA, Baiao VM, Almeida LS, Dourado GÍ, Carvalho HL, Duarte MP, Inda‐Filho A, Viana JL, Nóbrega OT, Ferreira AP. Intradialytic isometric handgrip exercise does not cause hemodynamic instability: A randomized,
cross‐over
, pilot study. Ther Apher Dial 2020; 25:282-289. [DOI: 10.1111/1744-9987.13581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Heitor S. Ribeiro
- Faculty of Physical Education University of Brasília Brasília Brazil
- Interdisciplinary Research Department University Center ICESP Brasília Brazil
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD) University Institute of Maia (ISMAI) Porto Portugal
| | | | - Victor M. Baiao
- Interdisciplinary Research Department University Center ICESP Brasília Brazil
| | - Lucas S. Almeida
- Faculty of Physical Education University of Brasília Brasília Brazil
| | | | - Helton L. Carvalho
- Interdisciplinary Research Department University Center ICESP Brasília Brazil
| | - Marvery P. Duarte
- Faculty of Physical Education University of Brasília Brasília Brazil
| | - Antônio Inda‐Filho
- Interdisciplinary Research Department University Center ICESP Brasília Brazil
| | - João L. Viana
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD) University Institute of Maia (ISMAI) Porto Portugal
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15
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Melatonin ingestion before intradialytic exercise improves immune responses in hemodialysis patients. Int Urol Nephrol 2020; 53:553-562. [PMID: 32965623 DOI: 10.1007/s11255-020-02643-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The present study aimed to investigate the effects of melatonin (MEL) intake on systemic inflammation and immune responses during intradialytic exercise. METHODS Thirteen hemodialysis (HD) patients volunteered to participate in the current randomized-crossover study. Immunological responses were monitored in four HD sessions at different conditions: [Exercise (EX) + MEL], [EX + Placebo (PLA)], [Control (CON) + MEL] and [CON + PLA]. MEL (3 mg) or PLA was ingested 1 h before starting exercise or the equivalent time in CON condition. During all sessions, peripheral blood samples were collected to assess c-reactive protein, complete blood count, and immune cells phenotypes before HD (T0), immediately after exercise (T1) and 1 h after exercise (T2) or at corresponding times in the CON condition. RESULTS HD therapy induced a significant decrease in natural killer (NK) (p = 0.001, d = 0.85; p < 0.001, d = 1.19, respectively) and CD8+ T-lymphocytes rates (p = 0.001, d = 0.57; p < 0.001, d = 0.75, respectively) at T1 and T2 compared to T0. MEL intake prevented the decrease in NK and CD8+ T-lymphocytes, increased the proportion of CD4+ T-lymphocytes at T1 and T2 compared to T0 (p = 0.002, d = 1.18; p = 0.001, d = 1.04, respectively) and decreased the proportion of CD14++CD16+ Monocytes at T2 compared to T0 (p = 0.02, d = 1.57) in peripheral blood during HD therapy. Similar results were found in [EX + MEL] and [EX + PLA] conditions. CONCLUSION This pilot study provides the first evidence that MEL intake alone or associated with intradialytic exercise displays potential immunoregulatory and anti-inflammatory effects. The combination of MEL with intradialytic exercise may be an appropriate anti-inflammatory therapy for HD patients.
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16
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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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17
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McGuire S, Horton EJ, Renshaw D, Chan K, Jimenez A, Maddock H, Krishnan N, McGregor G. Cardiac stunning during haemodialysis: the therapeutic effect of intra-dialytic exercise. Clin Kidney J 2019; 14:1335-1344. [PMID: 33959263 PMCID: PMC8087145 DOI: 10.1093/ckj/sfz159] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular risk is elevated in end-stage renal disease. Left ventricular (LV) dysfunction is linked to repetitive transient ischaemia occurring during haemodialysis (HD). Cardiomyocyte ischaemia results in ‘cardiac stunning’, evidenced by regional wall motion abnormalities (RWMAs). Ischaemic RWMA have been documented during HD resulting in maladaptive cardiac remodelling and increased risk of heart failure. Intra-dialytic exercise is well tolerated and can improve quality of life and functional capacity. It may also attenuate HD-induced cardiac stunning. Methods This exploratory study aimed to assess the effect of intra-dialytic cycle ergometry on cardiac stunning. Twenty exercise-naïve participants on maintenance HD (mean ± SD, 59 ± 11 years) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain-derived RWMAs at four time points during (i) standard HD and (ii) HD with 30 min of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90% oxygen uptake at the anaerobic threshold (VO2AT). Central haemodynamics and cardiac troponin I were also assessed. Results Compared with HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5 h of HD (total 110 ± 4, mean 7 ± 4 segments versus total 77 ± 3, mean 5 ± 3, respectively; P = 0.008). Global cardiac function, intra-dialytic haemodynamics and LV volumetric parameters were not significantly altered with exercise. Conclusions Intra-dialytic exercise reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90% VO2AT was sufficient to elicit acute cardio-protection. These data potentially demonstrate a novel therapeutic effect of intra-dialytic exercise.
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Affiliation(s)
- Scott McGuire
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Elizabeth J Horton
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Derek Renshaw
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Klaris Chan
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Alfonso Jimenez
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Helen Maddock
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Nithya Krishnan
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK.,Department of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Gordon McGregor
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK.,Department of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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18
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Young HML, March DS, Graham-Brown MPM, Jones AW, Curtis F, Grantham CS, Churchward DR, Highton P, Smith AC, Singh SJ, Bridle C, Burton JO. Effects of intradialytic cycling exercise on exercise capacity, quality of life, physical function and cardiovascular measures in adult haemodialysis patients: a systematic review and meta-analysis. Nephrol Dial Transplant 2019; 33:1436-1445. [PMID: 29608708 DOI: 10.1093/ndt/gfy045] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background Intradialytic cycling (IDC), delivered during haemodialysis (HD), has the potential to improve many health issues. This systematic review and meta-analysis examine the evidence on the effects of IDC on exercise capacity, quality of life (QoL), physical function and cardiovascular health. Methods Twenty-four databases were searched alongside Internet and hand searching, and consultation with experts. Eligibility criteria were cluster randomized, randomized and quasi-randomized controlled trials (RCTs) of IDC versus usual care in prevalent adult HD patients. Primary outcome measures were exercise capacity (VO2 peak and field tests) and QoL. Secondary measures were cardiac and physical function. Results Thirteen RCTs were eligible. Eight provided data for use in meta-analyses, which indicated no significant change in VO2 peak (mean difference, MD 1.19 mL/kg/min, 95% confidence interval -1.15 to 3.52, P = 0.3), physical (mean change, MC 1.97, -8.27 to 12.22, P = 0.7) or mental component (MC 3.37, -7.94 to 14.68, P = 0.6) summary scores of the Medical Outcomes Short Form 36, pulse wave velocity (MD -0.57 m/s, -1.55 to 0.41, P = 0.4), systolic (MD -2.28 mmHg, -14.46 to 9.90, P = 0.7) or diastolic blood pressure (MD 2.25 mmHg, -3.01 to 7.50, P = 0.4) following IDC. IDC, however, leads to an improvement in performance on the 6-min walk test (MD 87.84 m, 39.60-136.09, P = 0.0004). All included studies were considered to have high risk of bias. Conclusions There is insufficient evidence demonstrating whether cycling exercise during HD improves patient outcomes. High-quality, adequately powered RCTs of IDC are required.
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Affiliation(s)
- Hannah M L Young
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel S March
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matthew P M Graham-Brown
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Arwel W Jones
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - Ffion Curtis
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - Charlotte S Grantham
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Darren R Churchward
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Patrick Highton
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Alice C Smith
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Chris Bridle
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | - James O Burton
- Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
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Yamagata K, Hoshino J, Sugiyama H, Hanafusa N, Shibagaki Y, Komatsu Y, Konta T, Fujii N, Kanda E, Sofue T, Ishizuka K, Kitagawa M, Kono K, Hinamoto N, Miyai T, Koike K, Toda S, Hasegawa J, Yamanouchi M, Yoshimura R, Ishii R, Goto S, Kawarazaki H, Takase K, Taki F, Matsumura M, Raita Y, Sakurai S, Shimizu T, Yamanoto S, Kawaguchi T, Oguchi H, Tsujita M, Yazawa M, Uchida A, Ando Y, Kaneko S, Matsunaga A, Harada T, Ito O, Kohzuki M. Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0209-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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20
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Michou V, Kouidi E, Liakopoulos V, Dounousi E, Deligiannis A. Attitudes of hemodialysis patients, medical and nursing staff towards patients' physical activity. Int Urol Nephrol 2019; 51:1249-1260. [PMID: 31161521 DOI: 10.1007/s11255-019-02179-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 05/21/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Patients with end-stage renal disease (ESRD) seem to have a negative attitude towards physical activity, which is mainly favored by the lack of counseling provided by the medical and nursing staff. The aim of this study was to investigate the attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity and identify the obstacles that discourage patients' involvement in intervention programs. STUDY DESIGN Subjective assessment questionnaires and the International Physical Activity Questionnaire were administrated to hemodialysis patients and medical staff, to investigate the association between patient's barriers to physical activity, the total intensity level of physical activity, and attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity. RESULTS A total of 103 ESRD patients (61 men, 59.2%), 20 nephrologists (12 men, 60.0%), and 72 nurses (61 women, 84.7%) participated in the study. Most commonly reported patient's barriers were fatigue on dialysis (97.4%) and non-dialysis days (55.1%). Healthcare staff showed positive attitude towards renal rehabilitation exercise programs. However, most of physicians (85.0%) and nurses (83.3%) did not have previous experience with interventional exercise rehabilitation programs. Binary logistic regression revealed significant association between patients' inactivity, demographic data, and barriers towards physical activity, such as fatigue and pain in dialysis and non-dialysis days (p < 0.05), family's and physician's concern (p < 0.05), too many medical problems (p < 0.05), the fear of getting hurt (p = 0.01), and unwillingness for exercise (p < 0.05). Interestingly, healthcare staff's negative attitudes toward patient's physical activity seem to be strongly associated with patient's inactivity status. CONCLUSION Healthcare staff negative attitudes and multiple related barriers especially fatigue on dialysis and non-dialysis days, towards ESRD patient's physical activity, suppress desire for exercise and active patients' status, leading them to abstain from it.
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Affiliation(s)
- Vassiliki Michou
- Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, Thessaloniki, Greece.
| | - Evangelia Kouidi
- Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, Thessaloniki, Greece
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - Evangelia Dounousi
- Department of Nephrology, Medical School University of Ioannina, Ioannina, Greece
| | - Asterios Deligiannis
- Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, Thessaloniki, Greece
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21
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Wilund KR, Jeong JH, Greenwood SA. Addressing myths about exercise in hemodialysis patients. Semin Dial 2019; 32:297-302. [DOI: 10.1111/sdi.12815] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kenneth R. Wilund
- Department of Kinesiology and Community Health University of Illinois at Urbana‐Champaign Urbana Illinois
| | - Jin Hee Jeong
- Department of Population Health Sciences, Medical College of Georgia Augusta University Augusta Georgia
| | - Sharlene A. Greenwood
- Department of Therapies and Renal Medicine King's College Hospital NHS Trust London UK
- Department of Renal Medicine Faculty of Life Sciences and Medicine, King's College London London UK
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Abstract
Clinical manifestations of functional and morphological muscular abnormalities in dialysis patients are muscle weakness and low exercise capacity, possibly leading to a sedentary life style with low physical activity. Low cardiorespiratory fitness and muscle atrophy and weakness contribute to the development of frailty and affect patients' ability to physically navigate their environment. While many dialysis patients may appear too frail to participate in moderate-to-vigorous aerobic exercise training, those who can complete such programs appear to derive substantial benefit. Less vigorous aerobic exercise, resistance training, and alternative forms of exercise can also be beneficial. Most patients on dialysis are not too frail to perform resistance exercise of adequate intensity to achieve increases in muscle size and strength, therefore, frailty should not be considered a contraindication to exercise.
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Affiliation(s)
- Connie J Wang
- Division of Nephrology, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota.,Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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Graham‐Brown MP, Jardine MJ, Burton JO. Cardiovascular adaptations associated with exercise in patients on hemodialysis. Semin Dial 2019; 32:361-367. [DOI: 10.1111/sdi.12789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Matthew P.M. Graham‐Brown
- John Walls Renal Unit University Hospitals Leicester NHS Trust Leicester UK
- Department of Cardiovascular Sciences University of Leicester Leicester UK
| | - Meg J. Jardine
- Renal and Metabolic Division The George Institute for Global Health Newtown NSW Australia
| | - James O. Burton
- John Walls Renal Unit University Hospitals Leicester NHS Trust Leicester UK
- Department of Cardiovascular Sciences University of Leicester Leicester UK
- School of Sport, Exercise and Health University of Loughborough Loughborough UK
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The Effect of Mechanically-Generated Vibrations on the Efficacy of Hemodialysis; Assessment of Patients' Safety: Preliminary Reports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040594. [PMID: 30781708 PMCID: PMC6406417 DOI: 10.3390/ijerph16040594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 11/24/2022]
Abstract
Muscle activity during a hemodialysis procedure improves its efficacy. We have formulated a hypothesis that vibrations generated by a specially-designed dialysis chair can, the same as physical exercise, affect the filtering of various fluids between fluid spaces during the hemodialysis procedure. This prospective and interventional study included 21 dialyzed patients. During a single dialysis session, each patient used a prototype device with the working name “vibrating chair”. The chair’s drive used a low-power cage induction motor, which, along with the worm gear motor, was a part of the low-frequency (3.14 Hz) vibration-generating assembly with an amplitude of 4 mm. Tests and measurements were performed before and after the vibration dialysis. After a single hemodialysis session including five 3-min cycles of vibrations, an increase in Kt/V in relation to non-vibration Kt/V (1.53±0.26 vs. 1.62±0.23) was seen. Urea reduction ratio increased significantly (0.73±0.03 vs. 0.75±0.03). A significant increase in systolic blood pressure was observed between the first and the third measurement (146±18 vs. 156±24). The use of a chair generating low-frequency vibrations increased dialysis adequacy; furthermore, it seems an acceptable and safe alternative to intradialytic exercise.
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25
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Sponder M, Lichtenauer M, Wernly B, Paar V, Hoppe U, Emich M, Fritzer-Szekeres M, Litschauer B, Strametz-Juranek J. Serum heart-type fatty acid-binding protein decreases and soluble isoform of suppression of tumorigenicity 2 increases significantly by long-term physical activity. J Investig Med 2018; 67:833-840. [PMID: 30593542 DOI: 10.1136/jim-2018-000913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2018] [Indexed: 01/21/2023]
Abstract
The aim of this prospective study was to investigate the influence of long-term physical activity on biomarkers for myocyte ischemia (heart-type fatty acid-binding protein, H-FABP), matrix remodelling/vascular stress (soluble isoform of suppression of tumorigenicity 2, sST2) and inflammation (soluble urokinase-type plasminogen activator receptor, suPAR). In this prospective observational study 109 subjects were recruited, 98 completed the study. Subjects were asked to perform exercise within the calculated training pulse for 8 months. The performance gain was measured/quantified by bicycle stress tests at the beginning and end of the observation period. Twenty-seven subjects with a performance gain <2.9% were excluded. suPAR, H-FABP and sST2 were measured in serum at baseline and after 2, 4 and 8 months by ELISA. We found a significant decrease in H-FABP (1.86 (0.86) to 1.29 (0.98) ng/mL; p<0.01) and a significant increase in sST2 levels (6126 (2759) to 6919 (3720) pg/mL; p=0.045) during the observation period of 8 months while there was no remarkable change in suPAR levels. We interpret the activity-induced decrease in H-FABP as sign of lower subclinical myocardial ischemia and better perfusion, probably due to a more economic metabolization and electrolyte balance. The increase in sST2 might reflect physiological sports-induced vascular stress. As H-FABP and sST2 play an important role in the pathomechanism of ischemic cardiomyopathy (iCMP) further studies should investigate the influence of regular physical activity on these biomarkers in a population of patients with iCMP. TRIAL REGISTRATION NUMBER: NCT02097199.
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Affiliation(s)
- Michael Sponder
- Department of Cardiology, Medical University of Vienna, Vienna, Vienna, Austria
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Vera Paar
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Uta Hoppe
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Emich
- Austrian Federal Ministry of Defence and Sports, Austrian Armed Forces, Vienna, Austria
| | - Monika Fritzer-Szekeres
- Department of Medical-Chemical Laboratory Analysis, Medical University of Vienna, Vienna, Austria
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Martin N, Smith AC, Dungey MR, Young HML, Burton JO, Bishop NC. Exercise during hemodialysis does not affect the phenotype or prothrombotic nature of microparticles but alters their proinflammatory function. Physiol Rep 2018; 6:e13825. [PMID: 30294974 PMCID: PMC6174123 DOI: 10.14814/phy2.13825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Abstract
Hemodialysis patients have dysfunctional immune systems, chronic inflammation and comorbidity-associated risks of cardiovascular disease (CVD) and infection. Microparticles are biologically active nanovesicles shed from activated endothelial cells, immune cells, and platelets; they are elevated in hemodialysis patients and are associated with chronic inflammation and predictive of CVD mortality in this group. Exercise is advocated in hemodialysis to improve cardiovascular health yet acute exercise induces an increase in circulating microparticles in healthy populations. Therefore, this study aimed to assess acute effect of intradialytic exercise (IDE) on microparticle number and phenotype, and their ability to induce endothelial cell reactive oxygen species (ROS) in vitro. Eleven patients were studied during a routine hemodialysis session and one where they exercised in a randomized cross-over design. Microparticle number increased during hemodialysis (2064-7071 microparticles/μL, P < 0.001) as did phosphatidylserine+ (P < 0.05), platelet-derived (P < 0.01) and percentage procoagulant neutrophil-derived microparticles (P < 0.05), but this was not affected by IDE. However, microparticles collected immediately and 60 min after IDE (but not later) induced greater ROS generation from cultured endothelial cells (P < 0.05), suggesting a transient proinflammatory event. In summary IDE does not further increase prothrombotic microparticle numbers that occurs during hemodialysis. However, given acute proinflammatory responses to exercise stimulate an adaptation toward a circulating anti-inflammatory environment, microparticle-induced transient increases of endothelial cell ROS in vitro with IDE may indicate the potential for a longer-term anti-inflammatory adaptive effect. These findings provide a crucial evidence base for future studies of microparticles responses to IDE in view of the exceptionally high risk of CVD in these patients.
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Affiliation(s)
- Naomi Martin
- National Centre for Sport and Exercise MedicineSchool of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUnited Kingdom
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - Alice C. Smith
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - Maurice R. Dungey
- National Centre for Sport and Exercise MedicineSchool of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUnited Kingdom
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - Hannah M. L. Young
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - James O. Burton
- Leicester Kidney Lifestyle TeamDepartment of Infection, Immunity & InflammationUniversity of Leicester and John Walls Renal UnitUniversity Hospitals of Leicester NHS TrustLeicestershireUnited Kingdom
| | - Nicolette C. Bishop
- National Centre for Sport and Exercise MedicineSchool of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUnited Kingdom
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Pochmann D, Peccin PK, da Silva IRV, Dorneles GP, Peres A, Nique S, Striebel V, Elsner VR. Cytokine modulation in response to acute and chronic aquatic therapy intervention in Parkinson disease individuals: A pilot study. Neurosci Lett 2018. [DOI: 10.1016/j.neulet.2018.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8276912. [PMID: 29682559 PMCID: PMC5848102 DOI: 10.1155/2018/8276912] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/24/2018] [Indexed: 12/11/2022]
Abstract
Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intradialytic hypotension (IDH) can be as high as 20–30%, contributing to subclinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodeling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are suboptimal. Whilst a programme of intradialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intradialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intradialytic exercise with a view to determining the potential for this nonmedical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion, and reduce cardiovascular morbidity and mortality in ESRD.
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Gomes Neto M, de Lacerda FFR, Lopes AA, Martinez BP, Saquetto MB. Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis: systematic review and meta-analysis. Clin Rehabil 2018; 32:1189-1202. [PMID: 29480025 DOI: 10.1177/0269215518760380] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the effects of different intradialytic exercise training modalities on physical functioning and health-related quality of life of maintenance hemodialysis patients. METHODS We searched MEDLINE, Cochrane Trials Register and CINAHL for controlled trials that evaluated the effects of intradialytic exercise training for maintenance hemodialysis patients and published from the earliest available date to December 2017. Weighted mean difference and 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I2 test. RESULTS Fifty-six studies met the study criteria, comprising a total of 2586 patients. Compared with no exercise, combined aerobic and resistance exercise resulted in significant improvement in peak VO2 weighted mean difference (5.1 mL kg-1 min-1; 95% CI: 3.4, 6.8 mL kg-1 min-1), depression symptoms (-7.32; 95% CI -9.31, -5.33) and both physical function (10.67 points; 95% CI 1.08, 20.25 points) and vitality (10.01 points; 95% CI 4.30, 15.72 points) domains of health-related quality of life. Resistance exercise alone was significantly associated with improvement in the 6-minute walk test distance (30.2 m; 95% CI 24.6, 35.9 m), knee extensor strength (0.6 N; 95% CI 0.1, 1.0 N) and Physical Component Score of health-related quality of life (9.53 points; 95% CI -3.09, 22.15 points) when compared with control group. Aerobic exercise alone was not significantly associated with aerobic capacity and quality of life improvement. CONCLUSION The results provide support to interventions that combine intradialytic aerobic and resistance exercises to improve physical functioning and quality of life in end-stage renal disease patients undergoing hemodialysis.
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Affiliation(s)
- Mansueto Gomes Neto
- 1 Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, Brazil.,2 Programa de Pós Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil.,3 Physiotherapy Research Group, Federal University of Bahia (UFBA), Salvador, Brazil
| | | | - Antonio Alberto Lopes
- 4 Departamento de Medicina Interna e Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Bruno Prata Martinez
- 1 Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, Brazil.,3 Physiotherapy Research Group, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Micheli Bernardone Saquetto
- 1 Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, Brazil.,2 Programa de Pós Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil.,3 Physiotherapy Research Group, Federal University of Bahia (UFBA), Salvador, Brazil
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Afsar B, Siriopol D, Aslan G, Eren OC, Dagel T, Kilic U, Kanbay A, Burlacu A, Covic A, Kanbay M. The impact of exercise on physical function, cardiovascular outcomes and quality of life in chronic kidney disease patients: a systematic review. Int Urol Nephrol 2018; 50:885-904. [DOI: 10.1007/s11255-018-1790-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/07/2018] [Indexed: 12/18/2022]
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Kang SH, Lee HS, Lee S, Cho JH, Kim JC. Comparison of Muscle Mass Indices Using Computed Tomography or Dual X-Ray Absorptiometry for Predicting Physical Performance in Hemodialysis Patients. Kidney Blood Press Res 2017; 42:1119-1127. [PMID: 29224021 DOI: 10.1159/000485779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Our study aims to evaluate the association between thigh muscle cross-sectional area (TMA) using computed tomography (CT), or appendicular skeletal muscle mass (ASM) using dual energy X-ray absorptiometry (DEXA), and physical performance levels in hemodialysis (HD) patients. METHODS Patients were included if they were on HD for ≥6 months (n = 84). ASM and TMA were adjusted to body weight (BW, kg) or height2 (Ht2, m2). Each participant performed a short physical performance battery test (SPPB), a sit-to-stand for 30 second test (STS30), a 6-minute walk test (6-MWT), a timed up and go test (TUG), and hand grip strength (HGS) test. RESULTS Correlation coefficients for SPPB, GS, 5STS, STS30, 6-MWT, and TUG were highest in TMA/BW. Results from partial correlation or linear regression analyses displayed similar trends to those derived from Pearson's correlation analyses. An increase in TMA/BW or TMA/Ht2 was associated with a decreased odds ratio of low SPPB, GS, or HGS in multivariate analyses. Indices using DEXA were associated with a decreased odds ratio of a low HGS only in multivariate analysis. CONCLUSION TMA indices using CT may be more valuable in predicting physical performance or strength in HD patients.
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Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Hyun Seok Lee
- Department of Radiology, CHA Gumi Medical Center, CHA University, Gumi-si, Republic of Korea
| | - Sukyung Lee
- Division of Nephrology, Department of Internal Medicine, Semyung Christianity Hospital, Pohang-si, Republic of Korea
| | - Ji-Hyung Cho
- Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi-si, Republic of Korea
| | - Jun Chul Kim
- Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi-si, Republic of Korea
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Acute exercise during hemodialysis prevents the decrease in natural killer cells in patients with chronic kidney disease: a pilot study. Int Urol Nephrol 2017; 50:527-534. [DOI: 10.1007/s11255-017-1747-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022]
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Kang S, Do J, Jeong H, Lee SY, Kim J. The Clinical Significance of Physical Activity in Maintenance Dialysis Patients. Kidney Blood Press Res 2017; 42:575-586. [DOI: 10.1159/000480674] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/19/2017] [Indexed: 11/19/2022] Open
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March DS, Graham-Brown MPM, Young HML, Greenwood SA, Burton JO. ‘There is nothing more deceptive than an obvious fact’: more evidence for the prescription of exercise during haemodialysis (intradialytic exercise) is still required. Br J Sports Med 2017; 51:1379. [DOI: 10.1136/bjsports-2017-097542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 11/04/2022]
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Wong J, Davis P, Patidar A, Zhang Y, Vilar E, Finkelman M, Farrington K. The Effect of Intra-Dialytic Exercise on Inflammation and Blood Endotoxin Levels. Blood Purif 2017; 44:51-59. [DOI: 10.1159/000455059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022]
Abstract
Background: In healthy individuals, an acute inflammatory response occurs after intense exercise due to gut ischaemia and intestinal bacterial endotoxin translocation into the bloodstream. This process maybe exacerbated in patients who exercise during dialysis due to large volume shifts experienced by many during haemodialysis (HD). The acute effect of intra-dialytic exercise on blood endotoxins and inflammation is not known. Method: The effect of intra-dialytic exercise on blood endotoxin and inflammation was investigated in 10 patients and compared with resting haemodialysis. Blood was measured for endotoxin and inflammatory biomarkers before and after dialysis. Result: With the exception of one sample, all samples tested negative for endotoxin. Intra-dialytic exercise attenuated the rise of interleukin-6, tumour necrosis factor-α and high-sensitivity C-reactive protein after the HD procedure. Conclusion: Intra-dialytic exercise was not associated with an observable rise in blood endotoxin, although it may ameliorate the inflammatory effects of the HD procedure. Larger studies are needed to confirm this finding.
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Intestinal Barrier Disturbances in Haemodialysis Patients: Mechanisms, Consequences, and Therapeutic Options. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5765417. [PMID: 28194419 PMCID: PMC5282437 DOI: 10.1155/2017/5765417] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/20/2016] [Indexed: 01/01/2023]
Abstract
There is accumulating evidence that the intestinal barrier and the microbiota may play a role in the systemic inflammation present in HD patients. HD patients are subject to a number of unique factors, some related to the HD process and others simply to the uraemic milieu but with common characteristic that they can both alter the intestinal barrier and the microbiota. This review is intended to provide an overview of the current methods for measuring such changes in HD patients, the mechanisms behind these changes, and potential strategies that may mitigate these modifications. Lastly, intradialytic exercise is an increasingly employed intervention in HD patients; however the potential implications that this may have for the intestinal barrier are not known; therefore future research directions are also covered.
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Wilkinson TJ, Shur NF, Smith AC. “Exercise as medicine” in chronic kidney disease. Scand J Med Sci Sports 2016; 26:985-8. [DOI: 10.1111/sms.12714] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 12/19/2022]
Affiliation(s)
- T. J. Wilkinson
- Leicester Exercise Kidney Team; John Wells Renal Unit; University Hospitals of Leicester NHS Trust and Department of Infection, Immunity and Inflammation; University of Leicester; Leicester UK
| | - N. F. Shur
- Leicester Exercise Kidney Team; John Wells Renal Unit; University Hospitals of Leicester NHS Trust and Department of Infection, Immunity and Inflammation; University of Leicester; Leicester UK
| | - A. C. Smith
- Leicester Exercise Kidney Team; John Wells Renal Unit; University Hospitals of Leicester NHS Trust and Department of Infection, Immunity and Inflammation; University of Leicester; Leicester UK
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Hompesch C, Ma TW, Neyra JA, Ripley L, Xiao G, Inrig J, Toto R, Van Buren PN. Comparison of Ambulatory Blood Pressure Patterns in Patients With Intradialytic Hypertension and Hemodialysis Controls. Kidney Blood Press Res 2016; 41:240-9. [PMID: 27100207 PMCID: PMC4919278 DOI: 10.1159/000443427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 01/22/2023] Open
Abstract
Background/Aims Intradialytic hypertension (IH) patients have higher mortality risk than other hemodialysis patients and have been shown to have higher ambulatory blood pressure (BP). We hypothesized that interdialytic BP patterns would differ in IH patients and hypertensive hemodialysis controls. Methods We consecutively screened hemodialysis patients at our university-affliated units. Based on pre and post-HD BP measurements during the prior 2 week period, we identified IH patients and demographically matched hemodialysis controls. We measured ambulatory interdialytic BP, fow-mediated vasodilation, and intradialytic endothelin-1 (ET-1). Using linear mixed-models, we compared BP slopes during the following intervals: 1–24 hours post-dialysis, 25–44 hours post-dialysis, and 1–44 hours post-dialysis. Results There were 25 case subjects with IH and 24 controls. Systolic BP during hours 1–44, 1–24, and 25–44 were 143.1 (16.5), 138.0 (21.2), and 150.8 (22.3) mmHg in controls. For IH subjects, they were 155.4 (14.2), 152.7 (22.8), and 156.5 (20.8) mmHg (p=0.008, 0.02, 0.4). In controls, the slopes were +0.6, +0.6, and +0.4 mmHg/hr. In IH subjects, they were +0.1, −0.3, and +0.3 mmHg/hr. The IH 1–24 hour slope differed from the IH 25–44 hour slope (p=0.001) and the control 1–24 hour slope (p=0.002). The change in ET-1 from pre to post dialysis was 0.5 (1.5) pg/mL in controls and 1.0 (2.3) pg/mL in IH patients (p=0.4). In a univariate model, there was an association with screening BP and BP slope (p=0.002 for controls and p=0.1 for IH patients). Conclusions Interdialytic BP patterns differ in IH patients and hemodialysis controls. The elevated post dialysis blood pressure persists for many hours in IH patients contributing to the overall increased BP burden.
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Affiliation(s)
- Catherine Hompesch
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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