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Michou V, Nikodimopoulou M, Liakopoulos V, Anifanti M, Tsamos G, Vasdeki D, Panayiotou G, Mameletzi D, Deligiannis A, Kouidi E. Home-based tele-exercise training and physical activity during the COVID-19 pandemic in chronic kidney disease patients. J Nephrol 2024; 37:1893-1901. [PMID: 38809360 DOI: 10.1007/s40620-024-01976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/26/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic and lockdown reduced physical activity levels in hemodialysis (HD) patients and kidney transplant recipients (KTRs). This study aimed to describe physical activity levels during lockdown and assess the effects of an online home-based exercise training program on physical activity levels in HD patients and KTRs. METHODS Forty-five HD patients and thirty-five KTRs were divided into four groups: exercise groups 1 (ΕΧ-HD) and 2 (EX-KTR) followed a 4-month tele-exercise training program, while control groups received usual care. All participants at baseline and at the end of the study completed the International Physical Activity Questionnaire (IPAQ), while their daily physical activity levels were recorded via a step counting application. RESULTS At the end of the study, the repeated measures analysis revealed a significant effect of time, group, and time-by-group interaction in the average steps per day, walking, and moderate activity for the exercise-HD group (p < 0.05). Similarly, the analysis revealed a notable effect of time, group, and time-by-group interaction in the exercise-KTR group in average daily steps, vigorous and walking activity (p < 0.05). Multiple regression analysis showed that the level of physical activity at the end of the study was related to the urban place of residence and the participation in the 4-month exercise program of both HD patients and KTRs. CONCLUSIONS Participation in a tele-exercise training program led to favorable effects on physical activity levels both in HD patients and KTRs during lockdown.
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Affiliation(s)
- Vassiliki Michou
- Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, 57001, Thessaloniki, Greece.
| | - Maria Nikodimopoulou
- Transplant Surgery Clinic of Aristotle University of Thessaloniki, Hippokration General Hospital, 54642, Thessaloniki, Greece
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University, 57001, Thessaloniki, Greece
| | - Maria Anifanti
- Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, 57001, Thessaloniki, Greece
| | - Georgios Tsamos
- Laboratory of Hygiene, Department of Internal Medicine, Agios Dimitrios Hospital, Aristotle University, 57001, Thessaloniki, Greece
| | - Dimitra Vasdeki
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - George Panayiotou
- S Laboratory of Exercise, Health and Human Performance, Applied Sport Science Postgraduate Program, Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Dimitra Mameletzi
- Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, 57001, Thessaloniki, Greece
| | - Asterios Deligiannis
- Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, 57001, Thessaloniki, Greece
| | - Evangelia Kouidi
- Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, 57001, Thessaloniki, Greece
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Dawson J, Lambert K, Campbell KL, Kelly JT. Incorporating digital platforms into nutritional care in chronic kidney disease. Semin Dial 2024; 37:350-359. [PMID: 34235785 DOI: 10.1111/sdi.12998] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
Digital health is increasingly recognized for its value to enhance patient care and clinical care processes. People with chronic kidney disease often find dietary self-management challenging. There is promising evidence that digital health interventions can support people with chronic kidney disease to self-manage their diet, by providing more frequent access to nutritional information and dietitians and by facilitating regular monitoring and feedback. There is some emerging evidence of the impact of digital interventions in chronic kidney disease; however, more research is needed to provide meaningful interpretation of how digital interventions can enhance current practice. Importantly, a number of factors need to be considered when designing, developing, implementing, and evaluating the impact of digital interventions. Consideration of the nutrition service and patients' needs, motivation and digital literacy, type of digital intervention, and the ability to embed the digital intervention into current care processes are critical. This paper overviews the current literature on digital health and self-management, factors to consider when embedding digital interventions and platforms into nutrition care and practical considerations for designing and implementing digital health interventions to enhance the nutritional care of people with chronic kidney disease.
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Affiliation(s)
- Jessica Dawson
- Nutrition and Dietetics Department, St George Hospital, Sydney, New South Wales, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
- Centre of Applied Health Economics, School of Medicine, Griffith University, Nathan Campus, Nathan, Queensland, Australia
| | - Jaimon T Kelly
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
- Centre of Applied Health Economics, School of Medicine, Griffith University, Nathan Campus, Nathan, Queensland, Australia
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Malhotra R, Rahimi S, Agarwal U, Katz R, Kumar U, Garimella PS, Gupta V, Chopra T, Kotanko P, Ikizler TA, Larsen B, Cadmus-Bertram L, Ix JH. The Impact of a Wearable Activity Tracker and Structured Feedback Program on Physical Activity in Hemodialysis Patients: The Step4Life Pilot Randomized Controlled Trial. Am J Kidney Dis 2023; 82:75-83. [PMID: 36801430 PMCID: PMC10962931 DOI: 10.1053/j.ajkd.2022.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 12/18/2022] [Indexed: 02/19/2023]
Abstract
RATIONALE & OBJECTIVE People with end-stage kidney disease (ESKD) have very low physical activity, and the degree of inactivity is strongly associated with morbidity and mortality. We assessed the feasibility and effectiveness of a 12-week intervention coupling a wearable activity tracker (FitBit) and structured feedback coaching versus wearable activity tracker alone on changes in physical activity in hemodialysis patients. STUDY DESIGN Randomized controlled trial. SETTING & PARTICIPANTS 55 participants with ESKD receiving hemodialysis who were able to walk with or without assistive devices recruited from a single academic hemodialysis unit between January 2019 and April 2020. INTERVENTIONS All participants wore a Fitbit Charge 2 tracker for a minimum of 12 weeks. Participants were randomly assigned 1:1 to a wearable activity tracker plus a structured feedback intervention versus the wearable activity tracker alone. The structured feedback group was counseled weekly on steps achieved after randomization. OUTCOME The outcome was step count, and the main parameter of interest was the absolute change in daily step count, averaged per week, from baseline to completion of 12 weeks intervention. In the intention-to-treat analysis, mixed-effect linear regression analysis was used to evaluate change in daily step count from baseline to 12-weeks in both arms. RESULTS Out of 55 participants, 46 participants completed the 12-week intervention (23 per arm). The mean age was 62 (± 14 SD) years; 44% were Black, and 36% were Hispanic. At baseline, step count (structured feedback intervention: 3,704 [1,594] vs wearable activity tracker alone: 3,808 [1,890]) and other participant characteristics were balanced between the arms. We observed a larger change in daily step count in the structured feedback arm at 12 weeks relative to use of the wearable activity tracker alone arm (Δ 920 [±580 SD] versus Δ 281 [±186 SD] steps; between-group difference Δ 639 [±538 SD] steps; P<0.05). LIMITATIONS Single-center study and small sample size. CONCLUSION This pilot randomized controlled trial demonstrated that structured feedback coupled with a wearable activity tracker led to a greater daily step count that was sustained over 12 weeks relative to a wearable activity tracker alone. Future studies are required to determine longer-term sustainability of the intervention and potential health benefits in hemodialysis patients. FUNDING Grants from industry (Satellite Healthcare) and government (National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK). TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT05241171.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California.
| | - Sina Rahimi
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California
| | - Ushma Agarwal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Ujjala Kumar
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California
| | - Pranav S Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California
| | - Vineet Gupta
- Division of Hospital Medicine, Department of Medicine, University of California-San Diego, San Diego, California
| | - Tushar Chopra
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Peter Kotanko
- Renal Research Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - T Alp Ikizler
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Britta Larsen
- Herbert Wertheim School of Public Health, University of California-San Diego, San Diego, California
| | | | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego, San Diego, California; Nephrology Section, Veteran Affairs San Diego Healthcare System, La Jolla, California
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Cohen B, Munugoti S, Kotwani S, Randhawa LS, Dalezman S, Elters AC, Nam K, Ibarra JS, Venkataraman S, Paredes W, Ohri N, Abramowitz MK. Continuous Long-Term Physical Activity Monitoring in Hemodialysis Patients. KIDNEY360 2022; 3:1545-1555. [PMID: 36245649 PMCID: PMC9528381 DOI: 10.34067/kid.0002082022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022]
Abstract
BackgroundPhysical inactivity is common in patients receiving hemodialysis, but activity patterns throughout the day and in relation to dialysis are largely unknown. This knowledge gap can be addressed by long-term continuous activity monitoring, but this has not been attempted and may not be acceptable to patients receiving dialysis.MethodsAmbulatory patients with end-stage kidney disease receiving thrice-weekly hemodialysis wore commercially available wrist-worn activity monitors for 6 months. Step counts were collected every 15 minutes and were linked to dialysis treatments. Physical function was assessed using the Short Physical Performance Battery (SPPB). Fast time to recovery from dialysis was defined as ≤2 hours. Mixed effects models were created to estimate step counts over time.ResultsOf 52 patients enrolled, 48 were included in the final cohort. The mean age was 60 years, and 75% were Black or Hispanic. Comorbidity burden was high, 38% were transported to and from dialysis by paratransit, and 79% had SPPB <10. Median accelerometer use (199 days) and adherence (95%) were high. Forty-two patients (of 43 responders) reported wearing the accelerometer every day, and few barriers to adherence were noted. Step counts were lower on dialysis days (3991 [95% CI, 3187 to 4796] versus 4561 [95% CI, 3757 to 5365]), but step-count intensity was significantly higher during the hour immediately after dialysis than during the corresponding time on nondialysis days (188 steps per hour increase [95% CI, 171 to 205]); these levels were the highest noted at any time. Postdialysis increases were more pronounced among patients with fast recovery time (225 [95% CI, 203 to 248] versus 134 [95% CI, 107 to 161] steps per hour) or those with SPPB ≥7. Estimates were unchanged after adjustment for demographics, diabetes status, and ultrafiltration rate.ConclusionsLong-term continuous monitoring of physical activity is feasible in patients receiving hemodialysis. Highly granular data collection and analysis yielded new insights into patterns of activity after dialysis treatments.
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Zhang F, Ren Y, Wang H, Bai Y, Huang L. Daily Step Counts in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Observational Studies. Front Med (Lausanne) 2022; 9:842423. [PMID: 35252275 PMCID: PMC8891233 DOI: 10.3389/fmed.2022.842423] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
BackgroundPhysical inactivity is an essential factor in the prognosis of patients with chronic kidney disease (CKD). Daily step count is a straightforward measure to assess physical activity levels. Understanding the step counts among different CKD stages is essential to change sedentary behavior.ObjectivesThis systematic review and meta-analysis aimed to investigate the daily step counts in patients with CKD at a different stage.DesignA systematic review and meta-analysis.Data SourcesThe literature search was performed in PubMed, Embase, and Web of Science from inception to November 3rd, 2021.Review MethodsObservational studies (cross-sectional, case-control, or cohort studies) reported specific values of step counts in CKD patients by the wearable device were included. A random-effects model was used to pool the data. Subgroup analysis explored differences in outcomes by stage of CKD. Heterogeneity between studies was assessed using the χ2 test of Cochrane's Q statistic. A contour-enhanced funnel plot was conducted to investigate publication bias. Univariate and multivariate meta-regression was conducted to examine possible sources of heterogeneity.ResultsTwenty-eight articles were identified and used for quantitative analysis. The result showed that the daily step count in patients with CKD was 4642.47 (95% CI: 4274.18–5010.76), and significantly lower than the healthy population. Subgroup analysis revealed that the step counts decreased before dialysis, dropped to a freezing point at the hemodialysis phase, and increased after kidney transplantation. Meta-regression analysis showed that daily step counts were relatively higher in the Americas or younger than 60 or kidney transplant recipients.ConclusionThe status of daily step counts in patients with CKD decreases with CKD severity and increases after kidney transplantation. Although studies have begun to focus on strategies to improve step counts in patients with CKD, future studies should focus more on step counts in pre-dialysis patients and changing their physically inactive lifestyle early to alleviate deteriorating renal function.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291551, identifier: CRD42021291551.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yibo Ren
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectal, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Cardiology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liuyan Huang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Liuyan Huang
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Zemp DD, Giannini O, Quadri P, Rabuffetti M, Tettamanti M, de Bruin ED. Signatures of Gait Movement Variability in CKD Patients Scheduled for Hemodialysis Indicate Pathological Performance Before and After Hemodialysis: A Prospective, Observational Study. Front Med (Lausanne) 2021; 8:702029. [PMID: 34395481 PMCID: PMC8355421 DOI: 10.3389/fmed.2021.702029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The frailty status of hemodialysis patients is well-known, but the role of the therapy in the frailty process is not yet clear. Nowadays gait analysis in nephrology is neglected, although gait performance is known to be related to frailty and kidney function. We hypothesized that gait quality and physical activity level is already affected before, and does not change because of the start of hemodialysis. Methods: Fourteen patients (72.3 ± 5.7 years old) in a pre-dialysis program underwent an instrumental gait analysis and their physical activity was monitored for a week. This protocol was repeated 3, 6, 12, and 24 months after the first hemodialysis session. Results: At baseline, our sample showed a conservative gait with pathologic gait variability, high dual-task cost, and a sedentary lifestyle. No statistically significant change was found in any parameter in the analyzed period, but there was a tendency toward an improvement of gait quality and physical activity in the first year of treatment, and a decline in the second year. Conclusion: Elderly patients in the pre-dialysis stage show a conservative gait, however variability was in a pathological range and did not change post-hemodialysis. This hints toward changes in the central nervous system due to the kidney disease. This finding suggests the importance of gait analysis in the early stages of renal disease in the diagnosis of changes in the nervous system due to kidney failure that affect gait. Early detection of these changes would potentially allow a prevention program tailored to this population to be developed.
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Affiliation(s)
- Damiano D Zemp
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Geriatric Service, Ente Ospedaliero Cantonale, Ospedale Regionale della Beata Vergine, Mendrisio, Switzerland
| | - Olivier Giannini
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland.,Service of Nephrology, Ente Ospedaliero Cantonale, Ospedale Regionale della Beata Vergine, Mendrisio, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pierluigi Quadri
- Geriatric Service, Ente Ospedaliero Cantonale, Ospedale Regionale della Beata Vergine, Mendrisio, Switzerland.,Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland
| | | | - Mauro Tettamanti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCSS, Milan, Italy
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,OST - Eastern Swiss University of Applied Sciences, Department of Health, St. Gallen, Switzerland
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Pecoits-Filho R, Larkin J, Poli-de-Figueiredo CE, Cuvello-Neto AL, Barra ABL, Gonçalves PB, Sheth S, Guedes M, Han M, Calice-Silva V, de Castro MCM, Kotanko P, de Moraes TP, Raimann JG, Canziani MEF. Effect of hemodiafiltration on measured physical activity: primary results of the HDFIT randomized controlled trial. Nephrol Dial Transplant 2021; 36:1057-1070. [PMID: 33160281 PMCID: PMC8160948 DOI: 10.1093/ndt/gfaa173] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Dialysis patients are typically inactive and their physical activity (PA) decreases over time. Uremic toxicity has been suggested as a potential causal factor of low PA in dialysis patients. Post-dilution high-volume online hemodiafiltration (HDF) provides greater higher molecular weight removal and studies suggest better clinical/patient-reported outcomes compared with hemodialysis (HD). Methods HDFIT was a randomized controlled trial at 13 clinics in Brazil that aimed to investigate the effects of HDF on measured PA (step counts) as a primary outcome. Stable HD patients (vintage 3–24 months) were randomized to receive HDF or high-flux HD. Treatment effect of HDF on the primary outcome from baseline to 3 and 6 months was estimated using a linear mixed-effects model. Results We randomized 195 patients (HDF 97; HD 98) between August 2016 and October 2017. Despite the achievement of a high convective volume in the majority of sessions and a positive impact on solute removal, the treatment effect HDF on the primary outcome was +538 [95% confidence interval (CI) −330 to 1407] steps/24 h after dialysis compared with HD, and was not statistically significant. Despite a lack of statistical significance, the observed size of the treatment effect was modest and driven by steps taken between 1.5 and 24.0 h after dialysis, in particular between 20 and 24 h (+197 steps; 95% CI −95 to 488). Conclusions HDF did not have a statistically significant treatment effect on PA 24 h following dialysis, albeit effect sizes may be clinically meaningful and deserve further investigation.
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Affiliation(s)
| | - John Larkin
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.,Fresenius Medical Care, Global Medical Office, Waltham, MA, USA
| | | | | | | | | | | | - Murilo Guedes
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Maggie Han
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.,Renal Research Institute, New York, NY, USA
| | | | | | - Peter Kotanko
- Renal Research Institute, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Han M, Preciado P, Thwin O, Tao X, Tapia-Silva LM, Fuentes LR, Hakim M, Patel A, Tisdale L, Zhang H, Kotanko P. Effect of Statewide Lockdown in Response to COVID-19 Pandemic on Physical Activity Levels of Hemodialysis Patients. Blood Purif 2021; 50:602-609. [PMID: 33789266 PMCID: PMC8089462 DOI: 10.1159/000514935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND/OBJECTIVES On March 22, 2020, a statewide stay-at-home order for nonessential tasks was implemented in New York State. We aimed to determine the impact of the lockdown on physical activity levels (PAL) in hemodialysis patients. METHODS Starting in May 2018, we are conducting an observational study with a 1-year follow-up on PAL in patients from 4 hemodialysis clinics in New York City. Patients active in the study as of March 22, 2020, were included. PAL was defined by steps taken per day measured by a wrist-based monitoring device (Fitbit Charge 2). Average steps/day were calculated for January 1 to February 13, 2020, and then weekly from February 14 to June 30. RESULTS 42 patients were included. Their mean age was 55 years, 79% were males, and 69% were African Americans. Between January 1 and February 13, 2020, patients took on average 5,963 (95% CI 4,909-7,017) steps/day. In the week prior to the mandated lockdown, when a national emergency was declared, and in the week of the shutdown, the average number of daily steps had decreased by 868 steps/day (95% CI 213-1,722) and 1,222 steps/day (95% CI 668-2300), respectively. Six patients were diagnosed with COVID-19 during the study period. Five of them exhibited significantly higher PAL in the 2 weeks prior to showing COVID-19 symptoms compared to COVID-19 negative patients. CONCLUSION Lockdown measures were associated with a significant decrease in PAL in hemodialysis patients. Patients who contracted COVID-19 had higher PAL during the incubation period. Methods to increase PAL while allowing for social distancing should be explored and implemented.
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Affiliation(s)
- Maggie Han
- Research Department, Renal Research Institute, New York City, New York, USA
| | - Priscila Preciado
- Research Department, Renal Research Institute, New York City, New York, USA
| | - Ohnmar Thwin
- Research Department, Renal Research Institute, New York City, New York, USA
| | - Xia Tao
- Research Department, Renal Research Institute, New York City, New York, USA
| | | | | | - Mohamad Hakim
- Research Department, Renal Research Institute, New York City, New York, USA
| | - Amrish Patel
- Research Department, Renal Research Institute, New York City, New York, USA
| | - Lela Tisdale
- Research Department, Renal Research Institute, New York City, New York, USA
| | - Hanjie Zhang
- Research Department, Renal Research Institute, New York City, New York, USA
| | - Peter Kotanko
- Research Department, Renal Research Institute, New York City, New York, USA
- Icahn School of Medicine at Mount Sinai, Division of Nephrology, New York City, New York, USA
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9
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Malhotra R, Kumar U, Virgen P, Magallon B, Garimella PS, Chopra T, Kotanko P, Ikizler TA, Trzebinska D, Cadmus-Bertram L, Ix JH. Physical activity in hemodialysis patients on nondialysis and dialysis days: Prospective observational study. Hemodial Int 2021; 25:240-248. [PMID: 33650200 DOI: 10.1111/hdi.12913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The physical decline in patients with end-stage kidney disease (ESKD) is associated with morbidity and mortality. Prior studies have attempted to promote physical activity at the time of dialysis; however, physical activity patterns on the nondialysis days are unknown. This study aimed to quantify physical activity on dialysis and nondialysis days in hemodialysis patients using a wearable actigraph. METHODS In this prospective study, subjects receiving hemodialysis were recruited from two outpatient dialysis units in urban San Diego and rural Imperial County, CA, between March 2018 and April 2019. Key inclusion criteria included: (1) receiving thrice weekly hemodialysis for ≥3 months, (2) age ≥ 18 years, and (3) able to walk with or without assistive devices. All participants wore a Fitbit Charge 2 tracker for a minimum of 4 weeks. The primary outcome was the number of steps per day. Each participant completed the Physical Activity Questionnaire, the Patient Health Questionnaire (PHQ)-9, the PROMIS Short form Fatigue Questionnaire at baseline, and the Participant Technology Experience Questionnaire at day 7 after study enrolment. FINDINGS Of the 52 recruited, 45 participants (urban = 25; rural = 20) completed the study. The mean age was 61 ± 15 years, 42% were women, 64% were Hispanic, and the mean dialysis vintage was 4.4 ± 3.0 years. For those with valid Fitbit data (defined as ≥10 hours of wear per day) for 28 days (n = 45), participants walked an average of 3688 steps per day, and 73% of participants were sedentary (<5000 steps/day). Participants aged >80 years were less active than younger (age < 65 years) participants (1232 vs. 4529 steps, P = 0.01). There were no statistical differences between the groups when stratified by gender (women vs. men [2817 vs. 4324 steps, respectively]), urbanicity (rural vs. urban dialysis unit [3141 vs. 4123 steps, respectively]), and dialysis/nondialysis day (3177 vs. 4133 steps, respectively). Due to the small sample size, we also calculated effect sizes. The effect size was medium for the gender differences (cohen's d = 0.57) and small to medium for urbanicity and dialysis/nondialysis day (d = 0.37 and d = 0.33, respectively). We found no association between physical activity and self-reported depression and fatigue scale. The majority of participants (62%, 28/45) found the Fitbit tracker easy to wear and comfortable. DISCUSSION ESKD participants receiving hemodialysis are frequently sedentary, and differences appear more pronounced in older patients. These findings may assist in designing patient-centered interventions to increase physical activity among hemodialysis patients.
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Affiliation(s)
- Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Ujjala Kumar
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | | | | | - Pranav S Garimella
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Tushar Chopra
- Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - T Alp Ikizler
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danuta Trzebinska
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Lisa Cadmus-Bertram
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA.,Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA.,Nephrology Section, Veteran Affairs San Diego Healthcare System, La Jolla, California, USA
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Del Brutto OH, Mera RM, Del Brutto VJ, Recalde BY, Castillo PR. The association between physical activity and sleep quality in stroke-free adults living in rural settings. The Three Villages Study. Sleep Med 2020; 70:2-5. [DOI: 10.1016/j.sleep.2020.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/19/2020] [Accepted: 01/29/2020] [Indexed: 12/31/2022]
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11
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Larkin JW, Han M, Han H, Guedes MH, Gonçalves PB, Poli-de-Figueiredo CE, Cuvello-Neto AL, Barra ABL, de Moraes TP, Usvyat LA, Kotanko P, Canziani MEF, Raimann JG, Pecoits-Filho R. Impact of hemodialysis and post-dialysis period on granular activity levels. BMC Nephrol 2020; 21:197. [PMID: 32450793 PMCID: PMC7249440 DOI: 10.1186/s12882-020-01853-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing. Methods We used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over 1 week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 h after start HD), first non-HD days (> 24 to ≤48 h after start HD) and second non-HD day (> 48 to ≤72 h after start HD). PA was recorded in blocks/slices: 4 h during HD, 0 to ≤2 h post-HD (30 min slices), and > 2 to ≤20 h post-HD (4.5 h slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days. Results Among 195 patients (mean age 53 ± 15 years, 71% male), step counts per 24-h were 3919 ± 2899 on HD days, 5308 ± 3131 on first non-HD days (p < 0.001), and 4926 ± 3413 on second non-HD days (p = 0.032). During concurrent/parallel times to HD on first and second non-HD days, patients took 1308 and 1128 more steps (both p < 0.001). Patients took 276 more steps and had highest rates of steps/hour 2-h post-HD versus same times on first non-HD days (all p < 0.05). Consistent findings were observed on second non-HD days. Conclusions PA was higher within 2-h of HD versus same times on non-HD days. Lower PA on HD days was attributable to intradialytic inactivity. The established PA profiles are of importance to the design and development of exercise programs that aim to increase activity during and between HD treatments. Trial registration HDFIT was prospectively registered 20 April 2016 on ClinicalTrials.gov (NCT02787161)
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Affiliation(s)
- John W Larkin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil. .,Global Medical Office, Fresenius Medical Care, Waltham, MA, USA.
| | - Maggie Han
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.,Research Division, Renal Research Institute, New York, NY, USA
| | - Hao Han
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Murilo H Guedes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | | | | | | | | | - Thyago Proença de Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Len A Usvyat
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
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12
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Heshmati Far N, Salari M, Rakhshani MH, Borzoee F, Sahebkar M. The effects of Benson relaxation technique on activities of daily living in hemodialysis patients; A single-blind, randomized, parallel-group, controlled trial study. Complement Ther Clin Pract 2020; 39:101133. [PMID: 32379668 DOI: 10.1016/j.ctcp.2020.101133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Many patients with renal failure due to the chronic nature of the disease and prolonged dialysis treatment experience dramatically reduced ability to perform daily living activities (ADLs). This study was aimed at evaluating the effects of Benson relaxation technique (BRT) on ADLs in hemodialysis (HD) patients. MATERIALS AND METHODS This single-blind, randomized, parallel-group, controlled trial study was conducted among 65 hemodialysis patients. They were randomly divided into intervention (n = 33) and control (n = 32) groups. In the intervention group, BRT was performed twice daily for 20 min in a month. The control group received no intervention except for usual care. Data were assessed using the Nottingham Extended Activitıes of Daily Living (NEADL) scale. RESULTS The mean age of the subjects was 50.32 ± 7.23 years and 78.4% (n = 51) were male. The odds of higher degree of independence regarding NEADLS was about 25% greater in the intervention group as compared to the control one (OR: 1.24; 95% CI: 1.07, 1.44; P = 0.001). CONCLUSION Findings suggest that using BRT as a non-pharmacological intervention may effectively enhance the ADLs of HD patients.
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Affiliation(s)
- Narjes Heshmati Far
- Department of Nursing, School of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran.
| | - Maryam Salari
- Member of Student Research Committee, School of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Hasan Rakhshani
- Biostatistics Department, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
| | - Fateme Borzoee
- Department of Operating Room, School of Paramedics, Sabzevar University of Medical Sciences, Sabzevar, Iran.
| | - Mohammad Sahebkar
- Department of Social Medicine, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
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13
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Weller RB, Wang Y, He J, Maddux FW, Usvyat L, Zhang H, Feelisch M, Kotanko P. Does Incident Solar Ultraviolet Radiation Lower Blood Pressure? J Am Heart Assoc 2020; 9:e013837. [PMID: 32106744 PMCID: PMC7335547 DOI: 10.1161/jaha.119.013837] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
Background Hypertension remains a leading global cause for premature death and disease. Most treatment guidelines emphasize the importance of risk factors, but not all are known, modifiable, or easily avoided. Population blood pressure correlates with latitude and is lower in summer than winter. Seasonal variations in sunlight exposure account for these differences, with temperature believed to be the main contributor. Recent research indicates that UV light enhances nitric oxide availability by mobilizing storage forms in the skin, suggesting incident solar UV radiation may lower blood pressure. We tested this hypothesis by exploring the association between environmental UV exposure and systolic blood pressure (SBP) in a large cohort of chronic hemodialysis patients in whom SBP is determined regularly. Methods and Results We studied 342 457 patients (36% black, 64% white) at 2178 US dialysis centers over 3 years. Incident UV radiation and temperature data for each clinic location were retrieved from the National Oceanic and Atmospheric Administration database. Linear mixed effects models with adjustment for ambient temperature, sex/age, body mass index, serum Na+/K+ and other covariates were fitted to each location and combined estimates of associations calculated using the DerSimonian and Laird procedure. Pre-dialysis SBP varied by season and was ≈4 mm Hg higher in black patients. Temperature, UVA and UVB were all linearly and inversely associated with SBP. This relationship remained statistically significant after correcting for temperature. Conclusions In hemodialysis patients, in addition to environmental temperature, incident solar UV radiation is associated with lower SBP. This raises the possibility that insufficient sunlight is a new risk factor for hypertension, perhaps even in the general population.
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Affiliation(s)
- Richard B. Weller
- Center for Inflammation ResearchUniversity of EdinburghUnited Kingdom
| | - Yuedong Wang
- Department of Statistics & Applied ProbabilityUniversity of California ‐ Santa BarbaraSanta BarbaraCA
| | - Jingyi He
- Department of Statistics & Applied ProbabilityUniversity of California ‐ Santa BarbaraSanta BarbaraCA
| | | | - Len Usvyat
- Integrated Care AnalyticsFresenius Medical Care North AmericaWalthamMA
| | | | - Martin Feelisch
- Clinical & Experimental SciencesFaculty of Medicine, and Institute for Life SciencesSouthampton General HospitalUniversity of SouthamptonUnited Kingdom
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14
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Young HML, Orme MW, Song Y, Dungey M, Burton JO, Smith AC, Singh SJ. Standardising the measurement of physical activity in people receiving haemodialysis: considerations for research and practice. BMC Nephrol 2019; 20:450. [PMID: 31801480 PMCID: PMC6894215 DOI: 10.1186/s12882-019-1634-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/20/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical activity (PA) is exceptionally low amongst the haemodialysis (HD) population, and physical inactivity is a powerful predictor of mortality, making it a prime focus for intervention. Objective measurement of PA using accelerometers is increasing, but standard reporting guidelines essential to effectively evaluate, compare and synthesise the effects of PA interventions are lacking. This study aims to (i) determine the measurement and processing guidance required to ensure representative PA data amongst a diverse HD population, and; (ii) to assess adherence to PA monitor wear amongst HD patients. METHODS Clinically stable HD patients from the UK and China wore a SenseWear Armband accelerometer for 7 days. Step count between days (HD, Weekday, Weekend) were compared using repeated measures ANCOVA. Intraclass correlation coefficients (ICCs) determined reliability (≥0.80 acceptable). Spearman-Brown prophecy formula, in conjunction with a priori ≥ 80% sample size retention, identified the minimum number of days required for representative PA data. RESULTS Seventy-seven patients (64% men, mean ± SD age 56 ± 14 years, median (interquartile range) time on HD 40 (19-72) months, 40% Chinese, 60% British) participated. Participants took fewer steps on HD days compared with non-HD weekdays and weekend days (3402 [95% CI 2665-4140], 4914 [95% CI 3940-5887], 4633 [95% CI 3558-5707] steps/day, respectively, p < 0.001). PA on HD days were less variable than non-HD days, (ICC 0.723-0.839 versus 0.559-0.611) with ≥ 1 HD day and ≥ 3 non-HD days required to provide representative data. Using these criteria, the most stringent wear-time retaining ≥ 80% of the sample was ≥7 h. CONCLUSIONS At group level, a wear-time of ≥7 h on ≥1HD day and ≥ 3 non-HD days is required to provide reliable PA data whilst retaining an acceptable sample size. PA is low across both HD and non- HD days and future research should focus on interventions designed to increase physical activity in both the intra and interdialytic period.
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Affiliation(s)
- Hannah M L Young
- Department of Respiratory Science, University of Leicester, Leicester Kidney Lifestyle Team, Academic Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK.
| | - Mark W Orme
- Department of Respiratory Science, University of Leicester, Leicester Kidney Lifestyle Team, Academic Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yan Song
- Department of Health Sciences, University of Leicester, Leicester, UK
- Nantong University, Nantong, China
| | - Maurice Dungey
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester Kidney Lifestyle Team, Academic Unit, Leicester General Hospital, Gwendolen Road, Leicester, LE4 5PW, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
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Serrano Navarro I, Mesa Abad P, Tovar Muñoz L, Crespo Montero R. Trastornos del sueño en el paciente con enfermedad renal crónica avanzada. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000400003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Conocer las alteraciones y/o trastornos del sueño en los pacientes con Enfermedad Renal Crónica Avanzada. Método: Se realizó una búsqueda en las bases de datos Google Académico, Scielo, Science Direct, PubMed y Scopus. Se incluyeron artículos científicos en español e inglés y texto completo disponible. Se analizaron aquellos artículos que trataban sobre alteraciones del sueño en los pacientes en prediálisis, y en tratamiento renal sustitutivo: Hemodiálisis, Diálisis Peritoneal y Trasplante Renal. Resultados: Se han incluido 30 artículos publicados entre los años 2013 y 2018. Los pacientes con Enfermedad Renal Crónica Avanzada presentan una alta prevalencia de alteraciones del sueño, llegando a alcanzar una prevalencia de casi el 90% en pacientes en hemodiálisis y diálisis peritoneal, y 62% en pacientes con trasplante renal; y entre el 44% y el 77% en la etapa prediálisis. Las alteraciones del sueño más frecuentes encontradas, fueron: insomnio, síndrome de piernas inquietas, apnea del sueño y somnolencia diurna excesiva. Como principales medidas y tratamientos utilizados para las alteraciones del sueño en estos pacientes se han encontrado terapias tanto farmacológicas, como no farmacológicas y la combinación de ambas. Conclusiones: Las alteraciones del sueño tienen una alta prevalencia en los pacientes con Enfermedad Renal Crónica Avanzada, tanto en prediálisis como en tratamiento renal sustitutivo; siendo las más frecuentes el insomnio, el síndrome de piernas inquietas, la apnea obstructiva del sueño y la somnolencia diurna excesiva. Entre los factores de riesgo más influyentes destacan: ansiedad y depresión, Diabetes Mellitus, hipertensión arterial, problemas respiratorios y tiempo en diálisis.
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16
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Stevenson JK, Campbell ZC, Webster AC, Chow CK, Tong A, Craig JC, Campbell KL, Lee VWS. eHealth interventions for people with chronic kidney disease. Cochrane Database Syst Rev 2019; 8:CD012379. [PMID: 31425608 PMCID: PMC6699665 DOI: 10.1002/14651858.cd012379.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with high morbidity and death, which increases as CKD progresses to end-stage kidney disease (ESKD). There has been increasing interest in developing innovative, effective and cost-efficient methods to engage with patient populations and improve health behaviours and outcomes. Worldwide there has been a tremendous increase in the use of technologies, with increasing interest in using eHealth interventions to improve patient access to relevant health information, enhance the quality of healthcare and encourage the adoption of healthy behaviours. OBJECTIVES This review aims to evaluate the benefits and harms of using eHealth interventions to change health behaviours in people with CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 14 January 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs using an eHealth intervention to promote behaviour change in people with CKD were included. There were no restrictions on outcomes, language or publication type. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility, extracted data and assessed the risk of bias. The certainty of the evidence was assessed using GRADE. MAIN RESULTS We included 43 studies with 6617 participants that evaluated the impact of an eHealth intervention in people with CKD. Included studies were heterogeneous in terms of eHealth modalities employed, type of intervention, CKD population studied and outcomes assessed. The majority of studies (39 studies) were conducted in an adult population, with 16 studies (37%) conducted in those on dialysis, 11 studies (26%) in the pre-dialysis population, 15 studies (35%) in transplant recipients and 1 studies (2%) in transplant candidates We identified six different eHealth modalities including: Telehealth; mobile or tablet application; text or email messages; electronic monitors; internet/websites; and video or DVD. Three studies used a combination of eHealth interventions. Interventions were categorised into six types: educational; reminder systems; self-monitoring; behavioural counselling; clinical decision-aid; and mixed intervention types. We identified 98 outcomes, which were categorised into nine domains: blood pressure (9 studies); biochemical parameters (6 studies); clinical end-points (16 studies); dietary intake (3 studies); quality of life (9 studies); medication adherence (10 studies); behaviour (7 studies); physical activity (1 study); and cost-effectiveness (7 studies).Only three outcomes could be meta-analysed as there was substantial heterogeneity with respect to study population and eHealth modalities utilised. There was found to be a reduction in interdialytic weight gain of 0.13kg (4 studies, 335 participants: MD -0.13, 95% CI -0.28 to 0.01; I2 = 0%) and a reduction in dietary sodium intake of 197 mg/day (2 studies, 181 participants: MD -197, 95% CI -540.7 to 146.8; I2 = 0%). Both dietary sodium and fluid management outcomes were graded as being of low evidence due to high or unclear risk of bias and indirectness (interdialytic weight gain) and high or unclear risk of bias and imprecision (dietary sodium intake). Three studies reported death (2799 participants, 146 events), with 45 deaths/1000 cases compared to standard care of 61 deaths/1000 cases (RR 0.74, CI 0.53 to 1.03; P = 0.08). We are uncertain whether using eHealth interventions, in addition to usual care, impact on the number of deaths as the certainty of this evidence was graded as low due to high or unclear risk of bias, indirectness and imprecision. AUTHORS' CONCLUSIONS eHealth interventions may improve the management of dietary sodium intake and fluid management. However, overall these data suggest that current evidence for the use of eHealth interventions in the CKD population is of low quality, with uncertain effects due to methodological limitations and heterogeneity of eHealth modalities and intervention types. Our review has highlighted the need for robust, high quality research that reports a core (minimum) data set to enable meaningful evaluation of the literature.
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Affiliation(s)
- Jessica K Stevenson
- The University of SydneyWestmead Clinical SchoolCentre for Kidney ResearchCnr Darcy Rd and Hawksbury RdWestmead, SydneyNSWAustralia2145
| | - Zoe C Campbell
- The University of SydneyDepartment of MedicineSydneyNSWAustralia2006
| | - Angela C Webster
- The University of Sydney at WestmeadCentre for Transplant and Renal Research, Westmead Millennium InstituteWestmeadNSWAustralia2145
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
| | - Clara K Chow
- The George Institute for Global HealthCardiovascular DepartmentLevel 10, 83‐117 Missenden RoadCamperdownNSWAustralia2050
| | - Allison Tong
- The Children's Hospital at WestmeadCentre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
| | - Jonathan C Craig
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- Flinders UniversityCollege of Medicine and Public HealthAdelaideSAAustralia5001
| | - Katrina L Campbell
- Bond UniversityFaculty of Health Science and Medicine2 Promenthean WayRobinaQueenslandAustralia4226
| | - Vincent WS Lee
- Westmead & Blacktown HospitalsDepartment of Renal MedicineDarcy RdWestmeadNSWAustralia2145
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Natale P, Ruospo M, Saglimbene VM, Palmer SC, Strippoli GFM. Interventions for improving sleep quality in people with chronic kidney disease. Cochrane Database Syst Rev 2019; 5:CD012625. [PMID: 31129916 PMCID: PMC6535156 DOI: 10.1002/14651858.cd012625.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Sleep disorders are commonly experienced by people with chronic kidney disease (CKD). Several approaches for improving sleep quality are used in clinical practice including relaxation techniques, exercise, acupressure, and medication. OBJECTIVES To assess the effectiveness and associated adverse events of interventions designed to improve sleep quality among adults and children with CKD including people with end-stage kidney disease (ESKD) treated with dialysis or kidney transplantation. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 8 October 2018 with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-randomised RCTs of any intervention in which investigators reported effects on sleep quality. Two authors independently screened titles and abstracts of identified records. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias for included studies. The primary outcomes were sleep quality, sleep onset latency, sleep duration, sleep interruption, and sleep efficiency. Risks of bias were assessed using the Cochrane tool. Evidence certainty was assessed using the GRADE approach. We calculated treatment estimates as risk ratios (RR) for dichotomous outcomes or mean difference (MD) or standardised MD (SMD) for continuous outcomes to account for heterogeneity in measures of sleep quality. MAIN RESULTS Sixty-seven studies involving 3427 participants met the eligibility criteria. Thirty-six studies involving 2239 participants were included in meta-analyses. Follow-up for clinical outcomes ranged between 0.3 and 52.8 weeks (median 5 weeks). Interventions included relaxation techniques, exercise, acupressure, cognitive-behavioural therapy (CBT), educational interventions, benzodiazepine treatment, dopaminergic agonists, telephone support, melatonin, reflexology, light therapy, different forms of peritoneal dialysis, music, aromatherapy, and massage. Incomplete reporting of key methodological details resulted in uncertain risk of bias in many studies.In very low certainty evidence relaxation techniques had uncertain effects on sleep quality and duration, health-related quality of life (HRQoL), depression, anxiety, and fatigue. Studies were not designed to evaluate the effects of relaxation on sleep latency or hospitalisation. Exercise had uncertain effects on sleep quality (SMD -1.10, 95% CI -2.26 to 0.05; I2 = 90%; 5 studies, 165 participants; very low certainty evidence). Exercise probably decreased depression (MD -9.05, 95% CI -13.72 to -4.39; I2 = 0%; 2 studies, 46 participants; moderate certainty evidence) and fatigue (SMD -0.68, 95% CI -1.07 to -0.29; I2 = 0%; 2 studies, 107 participants; moderate certainty evidence). Compared with no acupressure, acupressure had uncertain effects on sleep quality (Pittsburgh Sleep Quality Index (PSQI) scale 0 - 21) (MD -1.27, 95% CI -2.13 to -0.40; I2 = 89%; 6 studies, 367 participants: very low certainty evidence). Acupressure probably slightly improved sleep latency (scale 0 - 3) (MD -0.59, 95% CI -0.92 to -0.27; I2 = 0%; 3 studies, 173 participants; moderate certainty evidence) and sleep time (scale 0 - 3) (MD -0.60, 95% CI -1.12 to -0.09; I2 = 68%; 3 studies, 173 participants; moderate certainty evidence), although effects on sleep disturbance were uncertain as the evidence certainty was very low (scale 0 - 3) (MD -0.49, 95% CI -1.16 to 0.19; I2 = 97%). In moderate certainty evidence, acupressure probably decrease fatigue (MD -1.07, 95% CI -1.67 to -0.48; I2 = 0%; 2 studies, 137 participants). Acupressure had uncertain effects on depression (MD -3.65, 95% CI -7.63 to 0.33; I2 = 27%; 2 studies, 137 participants; very low certainty evidence) while studies were not designed to evaluate the effect of acupressure on HRQoL, anxiety, or hospitalisation. It was uncertain whether acupressure compared with sham acupressure improved sleep quality (PSQI scale 0 to 21) because the certainty of the evidence was very low (MD -2.25, 95% CI -6.33 to 1.82; I2 = 96%; 2 studies, 129 participants), but total sleep time may have been improved (SMD -0.34, 95% CI -0.73 to 0.04; I2 = 0%; 2 studies, 107 participants; low certainty evidence). 2 =2 =There were no studies designed to directly examine and/or correlate efficacy of any interventions aimed at improving sleep that may have been attempted for the spectrum of sleep disordered breathing. No studies reported treatment effects for children. Adverse effects of therapies were very uncertain. AUTHORS' CONCLUSIONS The evidence base for improving sleep quality and related outcomes for adults and children with CKD is sparse. Relaxation techniques and exercise had uncertain effects on sleep outcomes. Acupressure may improve sleep latency and duration, although these findings are based on few studies. The effects of acupressure were not confirmed in studies in which sham acupressure was used as the control. Given the very low certainly evidence, future research will very likely change the evidence base. Based on the importance of symptom management to patients, caregivers and clinicians, future studies of sleep interventions among people with CKD should be a priority.
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Affiliation(s)
- Patrizia Natale
- DiaverumMedical Scientific OfficeLundSweden
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | | | - Valeria M Saglimbene
- DiaverumMedical Scientific OfficeLundSweden
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Suetonia C Palmer
- University of Otago ChristchurchDepartment of Medicine2 Riccarton AvePO Box 4345ChristchurchNew Zealand8140
| | - Giovanni FM Strippoli
- DiaverumMedical Scientific OfficeLundSweden
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
- Diaverum AcademyBariItaly
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
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Gu YH, Yang XH, Pan LH, Zhan XL, Guo LL, Jin HM. Additional hemoperfusion is associated with improved overall survival and self-reported sleep disturbance in patients on hemodialysis. Int J Artif Organs 2019; 42:347-353. [PMID: 30917741 DOI: 10.1177/0391398819837546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Patients with maintenance hemodialysis have experienced long-standing sleep disturbance. In this study, we attempted to explore whether long-term hemoperfusion could improve sleep and increase the overall survival in hemodialysis patients. Methods: A total of 158 patients, who underwent routine hemodialysis, were assessed in this study. These patients were computer-matched into two groups, with one group including 80 patients with absolute hemodialysis and the other consisting of 78 cases with hemodialysis in combination with hemoperfusion. Hemoperfusion was performed 1–2 times biweekly, with each session lasting 2 h. Self-reported sleep disturbance was evaluated before and after the observational time (2-year period); sleep quality was measured using the Pittsburgh Sleep Quality Index. Findings: Using multivariate regression analyses, we found sleep duration was associated with age, diabetes, low income, pruritus, hyperphosphatemia, hypercalcemia, high parathyroid hormone, and hemoglobin ( P < 0.001). The overall survival rate of the hemodialysis in combination with hemoperfusion group was significantly higher than that of the absolute hemodialysis group ( P < 0.05) after adjusting for sex, age, and diabetes. A 2-year hemoperfusion therapy was associated with improved sleep disturbance and sleep efficiency; this was accompanied by an increase in nocturnal melatonin levels. Furthermore, there was a significant difference in the first hospitalization between the hemodialysis and hemodialysis in combination with hemoperfusion groups ( P < 0.01). Discussion: Our results indicated that hemoperfusion in combination with hemodialysis is associated with an increase in the overall survival and improved sleep disorders in hemodialysis patients.
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Affiliation(s)
- Yan Hong Gu
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Xiu Hong Yang
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Li Hua Pan
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Xiao Li Zhan
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Li Li Guo
- Hemodialysis Center, Bao Shan Branch of No.1 People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Min Jin
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
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19
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Pecoits-Filho R, Larkin JW, Poli-de-Figueiredo CE, Cuvello Neto AL, Barra AB, Canhada S, de Campos LG, Woehl J, Gonçalves PB, Han H, de Moraes TP, Raimann JG, Canziani MEF. Design and methodology of the impact of HemoDiaFIlTration on physical activity and self-reported outcomes: a randomized controlled trial (HDFIT trial) in Brazil. BMC Nephrol 2019; 20:98. [PMID: 30894141 PMCID: PMC6425582 DOI: 10.1186/s12882-019-1247-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/01/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND End stage renal disease (ESRD) patients require a renal replacement therapy (RRT) to filter accumulated toxins and remove excess water, which are associated with impaired physical function. Hemodialysis (HD) removes middle-molecular weight (MMW) toxins less efficiently compared to hemodiafiltration (HDF); we hypothesized HDF may improve physical function. We detailed the design and methodology of the HDFIT protocol that is testing whether changing from HD to HDF effects physical activity levels and various outcomes. METHODS HDFIT is a prospective, multi-center, unblinded, randomized control trial (RCT) investigating the impact of dialysis modality (HDF verses HD) on objectively measured physical activity levels, self-reported quality of life, and clinical/non-clinical outcomes. Clinically stable patients with HD vintage of 3 to 24 months without any severe limitation ambulation were recruited from sites throughout southern Brazil. Eligible patients were randomized in a 1:1 ratio to either: 1) be treated with high volume online HDF for 6 months, or 2) continue being treated with high-flux HD. This study includes run-in and randomization visits (baseline), 3- and 6-month study visits during the interventional period, and a 12-month observational follow up. The primary outcome is the difference in the change in steps per 24 h on dialysis days from baseline to the 6-month follow up in patients treated with HDF versus HD. Physical activity is being measured over one week at study visits with the ActiGraph ( www.actigraphcorp.com ). For assessment of peridialytic differences during the dialysis recovery period, we will analyze granular physical activity levels based on the initiation time of HD on dialysis days, or concurrent times on non-dialysis days and the long interdialytic day. DISCUSSION In this manuscript, we provide detailed information about the HDFIT study design and methodology. This trial will provide novel insights into peridialytic profiles of physical activity and various self-reported, clinical and laboratory outcomes in ESRD patients treated by high volume online HDF versus high-flux HD. Ultimately, this investigation will elucidate whether HDF is associated with patients having better vitality and quality of life, and less negative outcomes as compared to HD. TRIAL REGISTRATION Registered on ClinicalTrials.gov on 20 April 2016 ( NCT02787161 ).
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Affiliation(s)
- Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil.
| | - John W Larkin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil.,Fresenius Medical Care North America, 920 Winter Street, Waltham, MA, 02451, USA
| | | | | | - Ana Beatriz Barra
- Fresenius Medical Care Brazil, R. Amoreira 891, Jaguariúna, São Paulo, 13820-000, Brazil
| | - Sinaia Canhada
- Fresenius Medical Care Brazil, R. Amoreira 891, Jaguariúna, São Paulo, 13820-000, Brazil
| | - Ludimila Guedim de Campos
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Juliane Woehl
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Priscila Bezerra Gonçalves
- Health Technology Graduate Program, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Hao Han
- Fresenius Medical Care North America, 920 Winter Street, Waltham, MA, 02451, USA
| | - Thyago Proença de Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Jochen G Raimann
- Research Division, Renal Research Institute, 315 East 62nd Street, 4th Floor, New York, NY, 10065, USA
| | - Maria Eugenia F Canziani
- Universidade Federal de São Paulo, R. Sena Madureira 1500, São Paulo, São Paulo, 04021-001, Brazil
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20
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Castner J, Mammen MJ, Jungquist CR, Licata O, Pender JJ, Wilding GE, Sethi S. Validation of fitness tracker for sleep measures in women with asthma. J Asthma 2018; 56:719-730. [PMID: 29972657 DOI: 10.1080/02770903.2018.1490753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Nighttime wakening with asthma symptoms is a key to assessment and therapy decisions, with no gold standard objective measure. The study aims were to (1) determine the feasibility, (2) explore equivalence, and (3) test concordance of a consumer-based accelerometer with standard actigraphy for measurement of sleep patterns in women with asthma as an adjunct to self-report. METHODS Panel study design of women with poorly controlled asthma from a university-affiliated primary care clinic system was used. We assessed sensitivity and specificity, equivalence and concordance of sleep time, sleep efficiency, and wake counts between the consumer-based accelerometer Fitbit Charge™ and Actigraph wGT3X+. We linked data between devices for comparison both automatically by 24-hour period and manually by sleep segment. RESULTS Analysis included 424 938 minutes, 738 nights, and 833 unique sleep segments from 47 women. The fitness tracker demonstrated 97% sensitivity and 40% specificity to identify sleep. Between device equivalence for total sleep time (15 and 42-minute threshold) was demonstrated by sleep segment. Concordance improved for wake counts and sleep efficiency when adjusting for a linear trend. CONCLUSIONS There were important differences in total sleep time, efficiency, and wake count measures when comparing individual sleep segments versus 24-hour measures of sleep. Fitbit overestimates sleep efficiency and underestimates wake counts in this population compared to actigraphy. Low levels of systematic bias indicate the potential for raw measurements from the devices to achieve equivalence and concordance with additional processing, algorithm modification, and modeling. Fitness trackers offer an accessible and inexpensive method to quantify sleep patterns in the home environment as an adjunct to subjective reports, and require further informatics development.
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Affiliation(s)
- Jessica Castner
- a The Rockefeller University Heilbrunn Family Center for Research Nursing , New York , NY , USA.,b University at Buffalo , Buffalo , NY , USA.,c Castner Incorporated , Grand Island , New York , NY , USA
| | - Manoj J Mammen
- d Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo , Buffalo , NY , USA.,e Department of Medicine, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo , Buffalo , NY , USA
| | | | - Olivia Licata
- g Department of Materials Design and Innovation, School of Engineering and Applied Sciences , University at Buffalo , Buffalo , NY , USA.,h Department of Biomedical Engineering, School of Engineering and Applied Sciences , University at Buffalo , Buffalo , NY , USA
| | - John J Pender
- f School of Nursing , University at Buffalo , Buffalo , NY , USA
| | - Gregory E Wilding
- i Department of Biostatistics, School of Public Health and Health Professions , University at Buffalo , Buffalo , NY , USA
| | - Sanjay Sethi
- e Department of Medicine, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo , Buffalo , NY , USA
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21
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Han M, Ye X, Preciado P, Williams S, Campos I, Bonner M, Young C, Marsh D, Larkin JW, Usvyat LA, Maddux FW, Pecoits-Filho R, Kotanko P. Relationships between Neighborhood Walkability and Objectively Measured Physical Activity Levels in Hemodialysis Patients. Blood Purif 2018; 45:236-244. [PMID: 29478044 DOI: 10.1159/000485161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Neighborhood walkability is associated with indicators of health in the general population. We explored the association between neighborhood walkability and daily steps in hemodialysis (HD) patients. METHODS We measured daily steps over 5 weeks using Fitbit Flex (Fitbit, San Francisco, CA, USA) and retrieved Walk Score® (WS) data by patient's home ZIP code (www.walkscore.com; 0 = poorest walkability; 100 = greatest walkability). RESULTS HD patients took a mean of 6,393 ± 3,550 steps/day (n = 46). Median WS of the neighborhood where they resided was 28. Patients in an above-median WS (n = 27) neighborhood took significantly more daily steps compared to those (n = 19) in a below-median WS neighborhood (7,514 ± 3,900 vs. 4,800 ± 2,228 steps/day; p < 0.001, t test). Daily steps and WS were directly correlated (R = 0.425; p = 0.0032, parametric test; R = 0.359, p = 0.0143, non-parametric test). CONCLUSION This is the first study conducted among HD patients to indicate a direct relationship between neighborhood walkability and the actual steps taken. These results should be considered when designing initiatives to increase and improvise exercise routines in HD populations.
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Affiliation(s)
- Maggie Han
- Renal Research Institute, New York, New York, USA
| | - Xiaoling Ye
- Renal Research Institute, New York, New York, USA
| | | | | | | | | | | | | | - John W Larkin
- Pontificia Universidade Catolica do Parana, Curitiba, Brazil.,Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | - Len A Usvyat
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | | | | | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine, New York, New York, USA
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22
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Baron KG, Duffecy J, Berendsen MA, Cheung Mason I, Lattie EG, Manalo NC. Feeling validated yet? A scoping review of the use of consumer-targeted wearable and mobile technology to measure and improve sleep. Sleep Med Rev 2017; 40:151-159. [PMID: 29395985 DOI: 10.1016/j.smrv.2017.12.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
Abstract
The objectives of this review were to evaluate the use of consumer-targeted wearable and mobile sleep monitoring technology, identify gaps in the literature and determine the potential for use in behavioral interventions. We undertook a scoping review of studies conducted in adult populations using consumer-targeted wearable technology or mobile devices designed to measure and/or improve sleep. After screening for inclusion/exclusion criteria, data were extracted from the articles by two co-authors. Articles included in the search were using wearable or mobile technology to estimate or evaluate sleep, published in English and conducted in adult populations. Our search returned 3897 articles and 43 met our inclusion criteria. Results indicated that the majority of studies focused on validating technology to measure sleep (n = 23) or were observational studies (n = 10). Few studies were used to identify sleep disorders (n = 2), evaluate response to interventions (n = 3) or deliver interventions (n = 5). In conclusion, the use of consumer-targeted wearable and mobile sleep monitoring technology has largely focused on validation of devices and applications compared with polysomnography (PSG) but opportunities exist for observational research and for delivery of behavioral interventions. Multidisciplinary research is needed to determine the uses of these technologies in interventions as well as the use in more diverse populations including sleep disorders and other patient populations.
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Affiliation(s)
- Kelly Glazer Baron
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois, Chicago, Chicago, IL, USA
| | - Mark A Berendsen
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, USA
| | - Ivy Cheung Mason
- Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, USA
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Natalie C Manalo
- Department of Neurology, Massachusetts General Hospital, Harvard University, USA
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