1
|
Li WY, Yeh JC, Cheng CC, Huang SH, Yeh HC, Cheng BW, Lin JW, Yang FJ. Digital health interventions to promote healthy lifestyle in hemodialysis patients: an interventional pilot study. Sci Rep 2024; 14:2849. [PMID: 38310128 PMCID: PMC10838291 DOI: 10.1038/s41598-024-53259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
Low physical activity has been associated with poor prognosis in hemodialysis (HD) patients. Interventions to maintain healthy lifestyle in this population are important to reduce mortality. This study aimed to evaluate the effectiveness of digital health interventions (DHIs) for improving the physical activity and health-related quality of life (HRQoL) in HD patients. The 24-week prospective study enrolled 31 clinically stable HD patients. All participants were assigned home exercises and provided with wearable devices. Dietary and exercise information was uploaded to a health management platform. Suggestions about diet and exercise were provided, and a social media group was created. Physical performance testing was performed at baseline and during weeks 4, 8, 12, 16 and 24. HRQoL and nutritional status were evaluated. A total of 25 participants completed the study. After the interventions, the daily step count increased 1658 steps. The 10-time-repeated sit-to-stand test reduced by 4.4 s, the sit-to-stand transfers in 60 s increased 12 repetitions, the distance of six-minute walk test (6MWT) increased by 55.4 m. The mental health components and burden of kidney disease of the Kidney Disease Quality of Life survey, and subjective global assessment (SGA) scores improved. By Spearman correlation, the monthly step count correlated positively with 6MWT and SGA. DHIs that combined wearable devices, a health management platform, and social media could strengthen physical activity and improve the HRQoL and nutrition of maintenance HD patients. The results outline a new model to promote healthy lifestyle behaviors in HD patients.
Collapse
Affiliation(s)
- Wen-Yi Li
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, No. 579, Sec. 2, Yunlin Rd., Douliu, Yunlin County, 640, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiang-Chou Yeh
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Cheng-Chih Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Su-Hua Huang
- Department of Dietetics, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Hui-Chin Yeh
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
- Department of Applied Foreign Languages, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Bor-Wen Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Jou-Wei Lin
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Feng-Jung Yang
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, No. 579, Sec. 2, Yunlin Rd., Douliu, Yunlin County, 640, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
2
|
Yin R, Wang Y, Li Y, Lynn HS, Zhang Y, Jin X, Yan LL. Changes in physical activity and all-cause mortality in the oldest old population: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Prev Med 2023; 175:107721. [PMID: 37802195 DOI: 10.1016/j.ypmed.2023.107721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Insufficient or decreasing physical activity is common in older adults. Most studies on physical activity changes and mortality were conducted in adults younger than 80 years old in developed countries. We aimed to investigate the relationship between changes in physical activity and longevity in the oldest old (80 years or older) population using the Chinese Longitudinal Healthy Longevity Survey. METHODS Participants aged 80 or older at baseline were categorized into four groups: 1) remaining physically inactive (n = 14,287), 2) remaining physically active (n = 5411), 3) shifting from being inactive to active (n = 1364), and 4) shifting from being active to inactive (n = 1401). We fitted accelerated failure time Weibull survival regression models, adjusting for baseline sociodemographics, lifestyle factors and disease status. We further examined whether the associations differed by subgroups. RESULTS A total of 15,707 participants died during follow-up (median duration of follow-up = 3.0 years). Compared with participants who remained physically inactive, those who remained active (fully adjusted event time ratio (ETR): 1.14, 95%CI: 1.11-1.17) or shifted from being inactive to active (fully adjusted ETR: 1.14, 95%CI: 1.08-1.20) had statistically significant longer survival time. No significant association was observed between remaining physically inactive and shifting from being active to inactive. Subgroup analyses showed consistent associations in nearly all strata. CONCLUSION Maintaining frequent physical activity or shifting from being physically inactive to active was consistently associated with longer survival time in the oldest old population. Our findings provide evidence for encouraging older adults to regularly engage in physical activity to gain longevity benefits.
Collapse
Affiliation(s)
- Ruoyu Yin
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Yinsu Wang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China.
| | - Yaxi Li
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Henry S Lynn
- School of Public Health, Fudan University, Shanghai, China; School of Public Health, Xinjiang Medical University, Xinjiang, China.
| | - Yueqian Zhang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China.
| | - Xurui Jin
- MindRank AI Ltd., Hangzhou, Zhejiang 310000, China..
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China; School of Public Health, Wuhan University, Wuhan, China; Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; The George Institute for Global Health, China.
| |
Collapse
|
3
|
Mishra RK, Najafi B, Hamad A, Bara R, Lee M, Ibrahim R, Mathew M, Talal T, Al-Ali F. Intradialytic plantar electrical nerve stimulation to improve mobility and plantar sensation among adults with diabetes undergoing hemodialysis: a randomized double-blind trial. J Nephrol 2023:10.1007/s40620-023-01625-9. [PMID: 37326952 DOI: 10.1007/s40620-023-01625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Impaired mobility is a debilitating consequence of hemodialysis. We examined the efficacy of intradialytic-plantar-electrical-nerve-stimulation (iPENS) to promote mobility among diabetes patients undergoing hemodialysis.. METHODS Adults with diabetes undergoing hemodialysis received either 1-h active iPENS, (Intervention-Group) or non-functional iPENS (Control-Group) during routine hemodialysis for 12 weeks (3 sessions/week). Participants and care-providers were blinded. Mobility (assessed using a validated pendant-sensor) and neuropathy (quantified by vibration-perception-threshold test) outcomes were assessed at baseline and 12 weeks. RESULTS Among 77 enrolled subjects (56.2 ± 2.6 years old), 39 were randomly assigned to the intervention group, while 38 were assigned to the control group. No study-related adverse events and dropouts were reported in the intervention group. Compared to the control group, significant improvements with medium to large effect sizes were observed in the intervention group at 12 weeks for mobility-performance metrics, including active-behavior, sedentary-behavior, daily step counts, and sit-to-stand duration variability (p < 0.05), Cohen's d effect size (d = 0.63-0.84). The magnitude of improvement in active-behavior was correlated with improvement in the vibration-perception-threshold test in the intervention group (r = - 0.33, p = 0.048). A subgroup with severe-neuropathy (vibration-perception-threshold > 25 V) showed a significant reduction in plantar numbness at 12 weeks compared to baseline (p = 0.03, d = 1.1). CONCLUSIONS This study supports feasibility, acceptability, and effectiveness of iPENS to improve mobility and potentially reduce plantar numbness in people with diabetes undergoing hemodialysis. Considering that exercise programs are not widely used in hemodialysis clinical practice, iPENS may serve as a practical, alternative solution to reduce hemodialysis-acquired weakness and promote mobility.
Collapse
Affiliation(s)
- Ram Kinker Mishra
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX, 77030, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX, 77030, USA.
| | - Abdullah Hamad
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Rasha Bara
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX, 77030, USA
| | - Myeounggon Lee
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX, 77030, USA
| | - Rania Ibrahim
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Mincy Mathew
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Talal Talal
- Diabetic Foot and Wound Clinic, Hamad Medical Co, Doha, Qatar
| | - Fadwa Al-Ali
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| |
Collapse
|
4
|
Tabibi MA, Cheema B, Salimian N, Corrêa HDL, Ahmadi S. The effect of intradialytic exercise on dialysis patient survival: a randomized controlled trial. BMC Nephrol 2023; 24:100. [PMID: 37069527 PMCID: PMC10108498 DOI: 10.1186/s12882-023-03158-6] [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: 12/09/2022] [Accepted: 04/07/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Patients with kidney failure have a high mortality rate. This study aimed to evaluate the effect of intradialytic exercise on survival in patients receiving hemodialysis (HD). METHODS In this randomized controlled trial conducted in a HD center in Iran, adult patients receiving chronic HD were randomized to intradialytic exercise (60 min) in the second hour of thrice weekly dialysis for 6 months (intervention) or no intradialytic exercise (control). The primary outcome was survival rate at 12 months. Secondary outcomes were serum albumin, hemoglobin, hematocrit, red blood cell count, serum calcium, serum phosphorous, parathyroid hormone, physical function (6-min walk test) and nutritional status (Geriatric Nutritional Risk Index) during the first 6 months. The trial follow-up period was 12 months. RESULTS The study included 74 participants (44 males) with an age average of 64 ± 12 years old and a dialysis history of 27 ± 12 months, randomized to intervention (n = 37) or control (n = 37). Compared with controls, 1-year survival was higher in the intervention group (94% vs 73%, P = 0.01). The hazard ratio in univariate analysis in intervention group was 0.17 (95% CI 0.04-0.8; P = 0.02) compared to that in control group. During the 6-month intervention period, significant between-group changes were observed in all secondary outcomes between the intervention and control groups. CONCLUSION Intradialytic exercise performed for at least 60 min during thrice weekly dialysis sessions improves survival in adult patients receiving HD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04898608. Retrospectively registered on 24/05/2021. Registered trial name: The Effect of Intradialytic Exercise on Dialysis Patients Survival.
Collapse
Affiliation(s)
- Mohammad Ali Tabibi
- Department of Exercise Physiology, Pardis Specialized Wellness Institute, Isfahan, Iran.
| | - Bobby Cheema
- School of Health Sciences, Western Sydney University, Campbelltow, NSW, 2560, Australia
- National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Nasrin Salimian
- Department of Research and Development, Pardis Specialized Wellness Institute, Isfahan, Iran
| | - Hugo de Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, Distrito Federal, Brazil
| | - Saghar Ahmadi
- Department of Health and Palliative Care, Pardis Specialized Wellness Institute, Isfahan, Iran
| |
Collapse
|
5
|
A multicomponent exercise program improves functional capacity and respiratory muscle strength in hemodialysis patients: a randomized clinical trial. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-023-01053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
|
6
|
Teixeira MDS, Ferrari F, Dipp T, Carvalho G, Bitencourt EDS, Saffi M, Stein R. Effects of intradialytic inspiratory muscle training at different intensities on diaphragm thickness and functional capacity: clinical trial protocol in patients undergoing haemodialysis. BMJ Open 2023; 13:e066778. [PMID: 36707111 PMCID: PMC9884932 DOI: 10.1136/bmjopen-2022-066778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) commonly present with a sedentary behaviour and reduced functional capacity, factors that can compromise their prognosis. Intradialytic inspiratory muscle training (IMT) can increase respiratory muscle strength and, consequently, improve functional capacity, besides being easy to apply, cheap and performed in a supervised setting. However, few studies show the effects of this type of training applied at different intensities in this population. This study aims to compare the effects of IMT at different intensities in adults with ESRD undergoing HD. METHODS AND ANALYSIS A randomised, double-blind, sham-controlled trial will be conducted on 36 subjects randomly allocated into three groups: IMT at intensities of 30% or 50% of maximal inspiratory pressure (intervention groups), or 10% of maximal inspiratory pressure (sham-IMT). All the interventions will be supervised and performed three times per week, for 12 weeks, totalling 36 sessions. The primary outcomes are the 6-minute walk test, diaphragm thickness and the response of VO2peak post-intervention. Respiratory muscle strength, 24-hour ambulatory blood pressure measurement and the Kidney Disease Quality of Life 36-item short form survey will be evaluated as secondary outcomes. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (ID: 2020-0458). The results of this study will be disseminated by conference presentations and peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04660383.
Collapse
Affiliation(s)
- Marcelo de S Teixeira
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Thiago Dipp
- Graduate Program in Collective Health, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Gabriel Carvalho
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduarda da S Bitencourt
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marco Saffi
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Exercise Research Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| |
Collapse
|
7
|
Mrcp HH, Sridharan S, Farrington K, Davenport A. Determinants of active energy expenditure in haemodialysis patients. Clin Physiol Funct Imaging 2022; 42:303-307. [PMID: 35522167 DOI: 10.1111/cpf.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/04/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Less active haemodialysis patients have an increased risk of mortality. We wished to determine which factors were associated with active energy expenditure (AEE), METHODS: We used the validated recent physical activity questionnaire to determine AEE, and estimated dietary protein intake and creatinine generation rates. We measured extracellular and total body water ratio (ECW/TBW) and appendicular lean muscle with bioimpedance, and arm strength by hand grip strength (HGS). Patients were graded using the Charlson co-morbidity, and the Clinical Frailty Score (CFS). RESULTS AEE was calculated in 98 patients (64 male), mean age 62.1±15.5 years, and AEE was negatively associated with CFS (r=-0.48), ECW/TBW (r=-0.47), and age (r=-0.4), all p<0.001, Charlson co-morbidity score (-0.27, p=0.007), and positively with serum creatinine (r=0.38, p<0.010), and HGS (r=0.25, p=0.016). Although protein nitrogen accumulation and creatinine generation were associated with resting energy expenditure (r=0.7 and r=0.44 respectively, both p<.0001), neither were associated with AEE. On multivariable analysis only CFS remained independently associated with AEE (β-0.031, 95% limits -0.057 to -0.004, p=0.024), although both age (negative p=0.07), and ALM (positive p=0.081) were retained in the model. CONCLUSIONS We found that AEE was lower with increasing frailty, age, loss of cell mass, co-morbidity and inflammation, and greater AEE in patients with higher serum creatinine and albumin, and greater muscle strength on univariate analysis, but only frailty remained independently associated on multivariable analysis. Whether exercise programmes designed to increase AEE in haemodialysis patients can improve frailty scores, and so reduce mortality risk reman to be determined. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Heidy Hendry Mrcp
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, NW3 2PF, UK
| | | | - Ken Farrington
- Renal Unit, Lister Hospital, Corey's Mill Lane, Stevenage, UK.,University of Hertfordshire, Hatfield, UK
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, NW3 2PF, UK
| |
Collapse
|
8
|
Santos LMM, Figueiredo PHS, Silva ACR, Campos PC, Gonçalves GT, de Paula C Freitas J, da Silva Junior FA, Santos JM, Alves FL, Rodrigues VGB, Maciel EHB, Prates MCSM, Sañudo B, Taiar R, Bernardo-Filho M, Lima VP, Costa HS, Mendonça VA, Lacerda ACR. Determining factors of functioning in hemodialysis patients using the international classification of functioning, disability and health. BMC Nephrol 2022; 23:119. [PMID: 35331148 PMCID: PMC8944099 DOI: 10.1186/s12882-022-02719-5] [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: 08/26/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hemodialysis (HD) treatment affects functioning, physical activity level, clinical biomarkers, and body composition. However, the association between these variables with functioning, considering International Classification of Functioning, Disability and Health (ICF) domains remains unclear. Thus, the aim of this study was to investigate the possible association between physical activity, biomarkers, and body composition with functioning in HD patients in reference to the ICF. Methods Eighty HD patients performed different tests grouped according to ICF domain: Body structure and function – handgrip strength (HS), 5-repetition sit-to-stand test, and 60-s sit-to-stand test (5-STS, 60-STS, respectively); Activity – short physical performance battery (SPPB); and Participation – participation scale questionnaire. Physical activity [Human Activity Profile questionnaire (HAP)], body composition (Dual-energy X-ray absorptiometry), Parathormone (PTH), and alkaline phosphatase were analyzed as possible variables associated with ICF domains. Data analyses were performed using simple and multiple regression models adjusted for age, duration of HD, and diuresis volume. Results In the body structure and function domain, appendicular lean mass, PTH level, and age were associated with HS (R2 = 0.558); HAP and PTH were associated with 5-STS (R2 = 0.263); and HAP, PTH, duration of HD, and age were associated with 60-STS (R2 = 0.337). In the activity domain, HAP, PTH, alkaline phosphatase, duration of HD, age, and body fat were associated with SPPB (R2 = 0.689). Finally, only HAP was associated with the participation scale (R2 = 0.067). Conclusion Physical activity and PTH levels are determinant protagonists of functioning in all ICF domains in hemodialysis patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02719-5.
Collapse
Affiliation(s)
- Luciana M M Santos
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Pedro Henrique S Figueiredo
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Ana C R Silva
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Patrícia C Campos
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Gabriele T Gonçalves
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil
| | - Jaqueline de Paula C Freitas
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Laboratório de Inflamação e Metabolismo - LIM - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Fidelis Antônio da Silva Junior
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil
| | - Jousielle Márcia Santos
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil
| | - Frederico L Alves
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Unidade de Hemodiálise do Hospital Santa Casa de Caridade de Diamantina, Diamantina, Brazil
| | - Vanessa G B Rodrigues
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Unidade de Hemodiálise do Hospital Santa Casa de Caridade de Diamantina, Diamantina, Brazil
| | - Emílio Henrique B Maciel
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Unidade de Hemodiálise do Hospital Santa Casa de Caridade de Diamantina, Diamantina, Brazil
| | - Maria Cecília S M Prates
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Unidade de Hemodiálise do Hospital Santa Casa de Caridade de Diamantina, Diamantina, Brazil
| | - Borja Sañudo
- Department of Physical Education and Sports, Universidad de Sevilla, Seville, Spain
| | - Redha Taiar
- MATériaux et Ingénierie Mécanique (MATIM), Université de Reims Champagne-Ardenne, Reims, France
| | - Mario Bernardo-Filho
- Mechanical Vibration Laboratory and Integrative Practices (LAVIMPI), Biophysics and Biometrics Department, Institute of Biology Roberto Alcântara Gomes and Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vanessa P Lima
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Henrique S Costa
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Inflamação e Metabolismo - LIM - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Vanessa A Mendonça
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil.,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Laboratório de Inflamação e Metabolismo - LIM - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Ana Cristina R Lacerda
- Centro Integrado de Pós-Graduação e Pesquisa em Saúde (CIPq-Saúde), Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil. .,Laboratório de Fisiologia do Exercício - LAFIEX - CIPq/Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil. .,Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rodovia MGT 367 - Km 583, n 5000, Alto da Jacuba, Diamantina, Minas Gerais, 39100-000, Brazil. .,Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| |
Collapse
|
9
|
Zhang F, Wang H, Wang W, Zhang H. The Role of Physical Activity and Mortality in Hemodialysis Patients: A Review. Front Public Health 2022; 10:818921. [PMID: 35252096 PMCID: PMC8891147 DOI: 10.3389/fpubh.2022.818921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/26/2022] [Indexed: 12/20/2022] Open
Abstract
Available data indicated that physical activity was related to improved outcomes in hemodialysis patients. Multiple observational studies involving different cohorts have reported that increased physical activity level was associated with decreased mortality among hemodialysis patients. Therefore, promoting physical activity has become an increasingly critical and promising approach to improving cardiovascular health and clinical outcomes in hemodialysis patients. This review summarizes the published articles regarding physical activity and hemodialysis patients, focusing on mortality and strategy to promote physical activity.
Collapse
Affiliation(s)
- Fan Zhang
- 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
| | - Weiqiong Wang
- Blood Purification Centre, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huachun Zhang
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Huachun Zhang
| |
Collapse
|
10
|
Suzuki Y, Matsuzawa R, Hoshi K, Koh YM, Harada M, Yamamoto S, Imamura K, Kamiya K, Matsunaga A. Physical activity and its trajectory over time and clinical outcomes in hemodialysis patients. Int Urol Nephrol 2022; 54:2065-2074. [PMID: 35038083 DOI: 10.1007/s11255-021-03098-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: 05/15/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We examined whether physical activity measured at starting point and its trajectory over time were simultaneously associated with vital prognosis. METHODS This retrospective cohort study included 295 ambulatory maintenance hemodialysis patients (mean age 63.9 years; 54.6% male). We measured physical activity at index date (starting point) and its change over 1 year as predictors, and all-cause death and cardiovascular events were assessed as the outcomes. Two groups each of high versus low physical activity at starting point (based on 4000 steps per day) and no decline versus decline (based on a predicted mean slope) were created. Cox proportional-hazards regression and Fine-Gray proportional sub-distribution hazards model were used to examine associations between physical activity and its trajectory and clinical outcomes. RESULTS Decline in physical activity over 1 year was associated with a higher risk of all-cause death and cardiovascular events, irrespective of the physical activity at starting point. Furthermore, both lower physical activity at starting point and decrease in physical activity over time were independently associated with a higher risk of all-cause death and cardiovascular events in models in which each exposure was mutually adjusted. Compared to other groups that worsened in either exposure, the lowest risk for death/cardiovascular events was observed in the high at starting point/no decline over time group. CONCLUSIONS Both physical activity at starting point and its change over time were independently associated with vital prognosis. The assessment of both exposures provides additional prognostic information for the assessment of each exposure.
Collapse
Affiliation(s)
- Yuta Suzuki
- Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.,Department of Rehabilitation, Sagami Circulatory Organ Clinic, Kanagawa, Japan.,Advanced Research Course, National Institute of Public Health, Saitama, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Hyogo, Japan
| | - Keika Hoshi
- Center for Public Health Informatics, National Institute of Public Health, Saitama, Japan.,Department of Hygiene, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yong Mo Koh
- LightStone Corp, Tokyo, Japan.,Department of Economics, School of Economic, Senshu University, Tokyo, Japan
| | - Manae Harada
- Department of Rehabilitation, Sagami Circulatory Organ Clinic, Kanagawa, Japan
| | - Shohei Yamamoto
- Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.,Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Keigo Imamura
- Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Science, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
| |
Collapse
|
11
|
Matsuzawa R. Renal rehabilitation as a management strategy for physical frailty in CKD. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00393-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AbstractAn aging population and the increasing prevalence of lifestyle-related diseases have led to a worldwide increase in the rate of chronic kidney disease requiring renal replacement therapy. The mean age of individuals requiring dialysis therapy has been increasing, and Japanese patients are aging more rapidly than those in the USA and Europe. Patients undergoing renal replacement therapy are at increased risk of sarcopenia/frailty compared with people with normal kidney function due to comorbid burden, long-standing malnutrition, chronic inflammation, metabolic acidosis, anabolic resistance, hormonal changes, physical inactivity and amino acid loss via dialysis treatment in addition to aging. Sarcopenia and frailty are serious global health problems that can decrease access to kidney transplantation and lead to various adverse health outcomes, including functional dependence, hospitalizations and deaths in patients on dialysis treatment. However, sarcopenia/frailty fortunately is potentially modifiable by early identification of poor physical functioning, sustainment and enhancement of daily physical activity, and participation in exercise treatments. The Japanese Society of Renal Rehabilitation was established in 2011 and published a clinical practice guideline for “Renal Rehabilitation” targeting nondialysis-dependent and dialysis-dependent patients and renal transplant recipients, in 2019. The guideline emphasized the importance of physical management for patients with kidney diseases in addition to nutritional supports and anemia management. Kidney health professionals should manage sarcopenia and physical frailty as a part of routine clinical care for patients undergoing hemodialysis to improve poor physical functioning, functional dependence, decreased quality of life and poor prognosis.
Collapse
|
12
|
Wu YH, Hsu YJ, Tzeng WC. Physical Activity and Health-Related Quality of Life of Patients on Hemodialysis with Comorbidities: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020811. [PMID: 35055633 PMCID: PMC8775483 DOI: 10.3390/ijerph19020811] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 01/27/2023]
Abstract
Patients on hemodialysis with multiple comorbidities have limited physical activity, resulting in poor health, low activity participation, and low quality of life. Accordingly, the nursing care provided to such patients should include regular physical activity training programs. Therefore, this cross-sectional descriptive study investigated whether patients on hemodialysis with and without comorbidities have different levels of physical activity and health-related quality of life (HRQoL); the correlations among the comorbidities, physical activity, and HRQoL of the two cohorts were also assessed. The 36-Item Short-Form Health Survey version 2 and International Physical Activity Questionnaire were employed to collect data from 120 patients on hemodialysis. An independent samples t-test and univariate and multivariate linear regression analyses were conducted. The overall HRQoL of patients with comorbidities was lower than that of patients without comorbidities (p = 0.008). Compared with patients who participated in low-intensity physical activity, the overall HRQoL of patients who participated in moderate-intensity physical activity was higher (p < 0.001). The overall HRQoL of patients with comorbidities who participated in low-intensity physical activity was lower than that of those who participated in moderate-intensity physical activity (p < 0.001). Moderate-intensity physical activity was correlated with higher HRQoL for patients with comorbidities. This finding supports the implementation of effective physical activity intervention measures. Furthermore, it supports the promotion of patient self-management and the implementation of regular exercise programs and lifestyle changes, and patients on hemodialysis can benefit from the future management of physical activities.
Collapse
Affiliation(s)
- Yu-Hui Wu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
- Nursing Department, Tri-Service General Hospital, Taipei 11490, Taiwan
| | - Yu-Juei Hsu
- Nephrology Division, Tri-Service General Hospital, Taipei 11490, Taiwan;
- School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence:
| |
Collapse
|
13
|
Li Y, Zhang D, Ma Q, Diao Z, Liu S, Shi X. The Impact of Frailty on Prognosis in Elderly Hemodialysis Patients: A Prospective Cohort Study. Clin Interv Aging 2021; 16:1659-1667. [PMID: 34552324 PMCID: PMC8450604 DOI: 10.2147/cia.s329665] [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: 07/16/2021] [Accepted: 09/08/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose To explore the impact of frailty on adverse outcomes in elderly hemodialysis (HD) patients. Patients and Methods An observational and prospective cohort study was conducted in elderly patients (≥60) with HD, with an average 12-month follow-up. Fried frailty phenotype (FFP) was used to define frailty. Negative binomial regression was used to estimate the impact of frailty on the incidence of emergency visits, hospitalizations, acute cardiovascular events, and falls within a year. Cox regression analysis was used to assess the influence of frailty on all-cause mortality in elderly HD patients. Results Our study enrolled 150 elderly HD patients, and the prevalence of frailty was 34.7%. After adjustment, frailty was independently associated with increased all-cause mortality [hazard ratio (HR)=4.10, 95% CI: 1.09-15.43, p=0.037] and emergency visits [incidence rate ratio (IRR)=2.78 95% CI: 1.70-4.60, p<0.001]. Gait speed was an independent risk factor for all-cause deaths (HR=5.56 95% CI: 1.41-22.00, p=0.014), emergency visits (IRR=2.52 95% CI: 1.48-4.33, p<0.001), and hospitalizations (IRR=2.24, 95% CI: 1.19-4.21, p=0.010) in elderly HD patients. Conclusion Frailty was an independent indicator of all-cause mortality and emergency visits in elderly patients with HD.
Collapse
Affiliation(s)
- Yuanyuan Li
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dai Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qing Ma
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zongli Diao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Sha Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaotian Shi
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
14
|
Su G, Saglimbene V, Wong G, Natale P, Ruospo M, Craig JC, Hegbrant J, Carrero JJ, Strippoli GFM. Healthy Lifestyle and Mortality Among Adults Receiving Hemodialysis: The DIET-HD Study. Am J Kidney Dis 2021; 79:688-698.e1. [PMID: 34547395 DOI: 10.1053/j.ajkd.2021.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023]
Abstract
RATIONALE & OBJECTIVE A healthy lifestyle promotes cardiovascular health and reduces cardiac-related mortality in the general population but its benefits for people receiving maintenance hemodialysis are uncertain. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 5,483 of 9,757 consecutive adults receiving maintenance hemodialysis (January 2014 to June 2017, median dialysis vintage: 3.6 yrs) in a multinational private dialysis network and with complete lifestyle data. EXPOSURES Based on the American Heart Association's recommendations for cardiovascular prevention, a modified healthy lifestyle score was the sum of four components addressing use of smoking tobacco, physical activity, diet, and control of systolic blood pressure. OUTCOMES Cardiovascular and all-cause mortality. ANALYTICAL APPROACH Adjusted proportional hazards (aHRs) regression analyses with country as a random effect to estimate the associations between lifestyle score (low [0-2 points] as the referent, medium [3-5], and high [6-8]) and mortality. Associations were expressed as aHRs with 95% confidence intervals (CIs). RESULTS During a median of 3.8 years (17,451 person-years in total), there were 2,163 deaths, of which 826 were related to cardiovascular disease. Compared to patients with a low lifestyle score, the aHRs (95% CIs) for all-cause mortality among those with medium and high lifestyle scores were 0.75 (0.65-0.85) and 0.64 (0.54-0.76), respectively. Compared to patients with a low lifestyle score, the aHRs (95% CIs) for cardiovascular mortality among those with medium and high lifestyle scores were 0.73 (0.59-0.91) and 0.65 (0.49-0.85), respectively. LIMITATIONS Self-reported lifestyle, data-driven approach. CONCLUSIONS A healthier lifestyle is associated with lower all-cause and cardiovascular mortality among patients receiving maintenance hemodialysis.
Collapse
Affiliation(s)
- Guobin Su
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou city, Guangdong Province, China; Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;; European Renal Nutrition Working Group of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA)
| | - Valeria Saglimbene
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Piazza Giulio Cesare, 70124 Bari, Italy
| | - Germaine Wong
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Patrizia Natale
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Piazza Giulio Cesare, 70124 Bari, Italy
| | - Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Piazza Giulio Cesare, 70124 Bari, Italy
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jorgen Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;; European Renal Nutrition Working Group of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA)
| | - Giovanni F M Strippoli
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Piazza Giulio Cesare, 70124 Bari, Italy.
| |
Collapse
|
15
|
Chen JB, Li LC, Lee WC, Moi SH, Yang CH. Effect of clinical factors on trajectory of functional performance in patients undergoing hemodialysis. Ren Fail 2021; 43:90-96. [PMID: 33349082 PMCID: PMC7758042 DOI: 10.1080/0886022x.2020.1852090] [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] [Indexed: 11/16/2022] Open
Abstract
Purpose This study aimed to investigate the association between clinical factors and temporary changes in functional performance in patients undergoing hemodialysis. Methods This was a retrospective, longitudinal observational study conducted from 2015 to 2017. Eight-two patients undergoing hemodialysis in the outpatient clinic were enrolled. Functional performance was measured using the Karnofsky Performance Status (KPS) scale. Collected data for analysis included demographics, laboratory parameters, and KPS scale scores. All participants were grouped into a high KPS cluster and a low KPS cluster based on dynamic changes in KPS scales from 2015 to 2017. Results Participants in the high KPS cluster demonstrated an approximate trend, and those in the low KPS cluster demonstrated a low pattern. By stepwise selection model analysis, age (OR 1.12, 95% CI 1.03–1.23, p = 0.011), serum BUN (OR 1.08, 95% CI 1.02–1.16, p = 0.015), calcium levels (OR 3.24, 95% CI 1.2–8.73, p = 0.02), and beta-2-microglobulin (OR > 1.0, CI >1.00-<1.01, p = 0.031) showed risk for the low KPS cluster. Male sex (OR 0.20, 95% CI 0.04–0.96, p = 0.045) and albumin level (OR 0.02, 95% CI 0–0.4, p = 0.009) showed a low risk for the low KPS cluster. Conclusions A different trajectory pattern was observed between the high and low KPS clusters in a 3-year period. Risk factors for the low KPS cluster were age, serum BUN, calcium, and beta-2-microglobulin levels. Male sex and serum albumin levels reduced the risk for the low KPS cluster.
Collapse
Affiliation(s)
- Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lung-Chih Li
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sin-Hua Moi
- Center of Cancer Program Development, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| |
Collapse
|
16
|
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.
Collapse
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
| | | | | | | | | |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Ghafourifard M, Mehrizade B, Hassankhani H, Heidari M. Hemodialysis patients perceived exercise benefits and barriers: the association with health-related quality of life. BMC Nephrol 2021; 22:94. [PMID: 33726689 PMCID: PMC7962390 DOI: 10.1186/s12882-021-02292-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients on hemodialysis have less exercise capacity and lower health-related quality of life than healthy individuals without chronic kidney disease (CKD). One of the factors that may influence exercise behavior among these patients is their perception of exercise benefits and barriers. The present study aimed to assess the perception of hemodialysis patients about exercise benefits and barriers and its association with patients' health-related quality of life. METHODS In this cross-sectional study, 227 patients undergoing hemodialysis were randomly selected from two dialysis centers. Data collection was carried out using dialysis patient-perceived exercise benefits and barriers scale (DPEBBS) and kidney disease quality of life short form (KDQOL-SF). Data were analyzed using SPSS software ver. 21. RESULTS The mean score of DPEBBS was 68.2 ± 7.4 (range: 24 to 96) and the mean KDQOL score was 48.9 ± 23.3 (range: 0 to 100). Data analysis by Pearson correlation coefficient showed a positive and significant relationship between the mean scores of DPEBBS and the total score of KDQOL (r = 0.55, p < 0.001). Moreover, there was a positive relationship between the mean scores of DPEBBS and the mean score of all domains of KDQOL. CONCLUSION Although most of the patients undergoing hemodialysis had a positive perception of the exercise, the majority of them do not engage in exercise; it could be contributed to the barriers of exercise such as tiredness, muscle fatigue, and fear of arteriovenous fistula injury. Providing exercise facilities, encouraging the patients by the health care provider to engage in exercise programs, and incorporation of exercise professionals into hemodialysis centers could help the patients to engage in regular exercise.
Collapse
Affiliation(s)
- Mansour Ghafourifard
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati-jonubi St., Tabriz, 4515789589, Iran
| | - Banafshe Mehrizade
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati-jonubi St., Tabriz, 4515789589, Iran.
| | - Hadi Hassankhani
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati-jonubi St., Tabriz, 4515789589, Iran
| | - Mohammad Heidari
- Community-Oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| |
Collapse
|
19
|
Sato Y, Iino N. Snow removal maintained a high level of physical activity in patients undergoing hemodialysis in heavy snowfall areas. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Physical activity is an essential parameter associated with the prognosis of hemodialysis patients. Physical activity has regional characteristics; for example, snow removal is imperative in snowbelts during the winter. This study investigated the effects of removing snow on the physical activity levels of hemodialysis patients living in a snowbelt.
Methods
This study retrospectively examined 28 patients who underwent hemodialysis (age 69.6 ± 15.4 years, 19 males) in Uonuma Kikan Hospital between December 2019 and March 2020. Physical activity was assessed using the International Physical Activity Questionnaire. Patients were divided into a snow remover group and a non-snow remover group. We examined whether there were differences in physical or mental functioning and physical activity between the two groups. We also investigated the factors that influence high levels of physical activity among hemodialysis patients using multivariate linear regression analysis.
Results
The snow remover group had significantly greater grip strength, higher sit-to-stand test scores and gait speed, and a lower prevalence of frailty than the non-snow remover group. The level of physical activity was also significantly higher in the snow remover group. One of the patients in the snow remover group was frail. The univariate linear regression analysis showed that physical activity was related to age, grip strength, sit-to-stand test score, gait speed, and snow removal. In the multivariate linear regression analysis, snow removal and grip strength were significantly associated with a high level of physical activity.
Conclusions
Among hemodialysis patients living in a snowbelt, the snow remover group had significantly better physical functioning and a higher level of physical activity.
Collapse
|
20
|
Rampersad C, Brar R, Connelly K, Komenda P, Rigatto C, Prasad B, Bohm C, Tangri N. Association of Physical Activity and Poor Health Outcomes in Patients With Advanced CKD. Am J Kidney Dis 2021; 78:391-398. [PMID: 33581165 DOI: 10.1053/j.ajkd.2020.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
RATIONALE & OBJECTIVE Chronic kidney disease (CKD) is associated with declining physical function and activity. In the general population, lower physical activity is associated with poorer quality of life and greater all-cause mortality. The aim of this study was to assess if lower physical activity levels are associated with adverse health outcomes in patients with advanced CKD. STUDY DESIGN A multicenter prospective cohort study. SETTING & PARTICIPANTS 579 adult patients with CKD glomerular filtration rate categories 4 and 5 (G4-G5) treated at 4 Canadian multidisciplinary kidney health clinics between 2012 and 2018. EXPOSURE Patient-reported measures of physical activity using the Physical Activity Scale for the Elderly (PASE) questionnaire and subsequently stratified PASE scores into tertiles. OUTCOME All-cause mortality, progression to kidney failure, and future falls. ANALYTICAL APPROACH Outcomes were analyzed using time-dependent proportional hazards models and logistic regression models. RESULTS In 1,193 days of follow-up observation, 118 patients died, 204 progressed to dialysis, and 129 reported a fall. When compared with low physical activity, higher levels of physical activity were associated with a 52% lower all-cause mortality (adjusted HR, 0.48; 95% CI, 0.27-0.85) in models adjusted for age, sex, and comorbidity. No associations were detected between higher levels of physical activity and either slower progression to kidney failure or a lower rate of future falls. LIMITATIONS Physical activity and falls were self-reported. Our population was of limited racial/ethnic diversity, which may affect generalizability. Findings were observational and do not indicate whether interventions targeting physical activity may affect adverse health outcomes. CONCLUSIONS Higher levels of physical activity were associated with about 50% lower all-cause mortality in the advanced CKD population. These findings are consistent with a potential benefit from maintained physical activity as patients approach kidney failure.
Collapse
Affiliation(s)
- Christie Rampersad
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ranveer Brar
- Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Kelsey Connelly
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Paul Komenda
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Claudio Rigatto
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Bhanu Prasad
- Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Clara Bohm
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| |
Collapse
|
21
|
Deligiannis A, D'Alessandro C, Cupisti A. Exercise training in dialysis patients: impact on cardiovascular and skeletal muscle health. Clin Kidney J 2021; 14:ii25-ii33. [PMID: 33981417 PMCID: PMC8101623 DOI: 10.1093/ckj/sfaa273] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022] Open
Abstract
Dialysis patients show a high rate of reduced functional capacity, morbidity and mortality. Cardiovascular disorders, muscle atrophy and malnutrition play an essential role among the aetiological factors. Sedentary lifestyle characterizes them and contributes to the aggravation of the disorders. On the contrary, exercise training is an important preventive and therapeutic tool both for cardiovascular problems and for the appearance of muscle atrophy in dialysis patients. Regular exercise causes both central (cardiac) and peripheral (muscular) adaptations, improving functional capacity. In particular, circulatory system clinical trials in haemodialysis (HD) patients documented that exercise has favourable effects on heart function, promotes balance on the cardiac autonomic nervous system and contributes to the management of arterial hypertension. In the muscular system, it prevents muscle atrophy or contributes significantly to its treatment. The main preventive mechanisms of the beneficial effect of exercise on the muscles constitute the inhibition of the apoptotic processes and protein degradation. Exercise training in HD patients leads to an increase of muscle fibers, mitochondria and capillaries, and the combination of regular exercise and dietary strategies is even more effective in preventing or treating muscle atrophy. Finally, an improvement in functional capacity and quality of life was found also in peritoneal dialysis patients following exercise training.
Collapse
Affiliation(s)
- Asterios Deligiannis
- Sports Medicine Laboratory, School of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thermi, Greece
| | - Claudia D'Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
22
|
Yamamoto S, Matsuzawa R, Hoshi K, Harada M, Watanabe T, Suzuki Y, Isobe Y, Imamura K, Osada S, Yoshida A, Kamiya K, Matsunaga A. Impact of Physical Activity on Dialysis and Nondialysis Days and Clinical Outcomes Among Patients on Hemodialysis. J Ren Nutr 2020; 31:380-388. [PMID: 33257227 DOI: 10.1053/j.jrn.2020.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Patients undergoing hemodialysis (HD) have different physical activity (PA) patterns on HD and non-HD days. Nonetheless, whether these differences are associated with clinical outcomes remains unclear. We examined the association of PA levels on HD and non-HD days with cardiovascular (CV) hospitalizations and mortality. METHODS Outpatients undergoing HD from 2002 to 2019 were retrospectively enrolled. The number of steps performed over 3 HD days and 4 non-HD days was recorded via accelerometry. Outcomes were all-cause mortality and a composite of CV hospitalizations and mortality. Patients were divided into two groups, each according to the median number of steps performed on HD (2371 steps/day) and non-HD days (3752 steps/day). Further, we categorized them into 4 groups according to each median values: "more active on HD/more active on non-HD (MM)," "more active on HD/less active on non-HD (ML)," "less active on HD/more active on non-HD (LM)," and "less active on HD/less active on non-HD (LL)." Cox and mixed-effects Poisson regression models were used for these outcomes. RESULTS We analyzed 512 patients (median follow-up, 3.4 years). Higher PA on HD (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.54-0.65), and non-HD (HR, 0.84; 95% CI, 0.80-0.88) was associated with lower mortality risk, respectively. Further, the ML group (HR, 1.20; 95% CI, 1.13-1.28), LM group (HR, 1.82; 95% CI, 1.53-2.17), and LL group (HR, 1.83; 95% CI, 1.65-2.02) had higher mortality risks than the MM group. Associations of PA with multiple CV hospitalizations and mortality were similar to those between PA and mortality. CONCLUSIONS Higher PA on HD and non-HD days was associated with lower risks of CV hospitalizations and mortality. However, higher PA levels on either HD or non-HD days alone did not improve clinical outcomes.
Collapse
Affiliation(s)
- Shohei Yamamoto
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan; Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Hyogo, Japan
| | - Keika Hoshi
- Center for Public Health Informatics, National Institute of Public Health, Saitama, Japan; Department of Hygiene, Kitasato University School of Medicine, Kanagawa, Japan
| | - Manae Harada
- Department of Rehabilitation, Sagami Circulatory Organ Clinic, Kanagawa, Japan
| | - Takaaki Watanabe
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Yuta Suzuki
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Yusuke Isobe
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Keigo Imamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Shiwori Osada
- Department of Nephrology, Tokyo Ayase Kidney Center, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Kanagawa, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| |
Collapse
|
23
|
Differences in Physical Activity between Patients with Peripheral Artery Disease and Healthy Subjects. J Aging Res 2020; 2020:5093528. [PMID: 33145111 PMCID: PMC7596450 DOI: 10.1155/2020/5093528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Peripheral artery disease (PAD) is a significant prognostic marker of poor long-term survival due to limited physical activity associated with various functional problems, such as intermittent claudication. A physically active lifestyle has the potential to modify peripheral artery risk factors and promote general health. While low daily physical activity levels have been recognized in the population of PAD, the exact level has yet to be quantified due to lack of research. The aim of the present study was to compare physical activity level (PAL) and time spent at activities of different intensity levels between patients with PAD and healthy individuals. The study subjects were 10 patients with PAD and 10 age-matched healthy control subjects. We measured the time spent at light, moderate, or vigorous physical activity using triaxial accelerometer and calculated PAL. Intermittent claudication onset distance and maximum walking distance were defined as the distance walked at which the subject first reported leg pain and the distance at which the subject was unable to continue walking because of leg pain, respectively. Results Our results showed (i) lower PAL in patients with PAD compared with the controls; (ii) while there was no significant difference in the high-intensity activity between the two groups, the light- and moderate-intensity activities of the PAD group were significantly lower than the controls, the time spent at moderate-intensity activity was approximately 50% less; and (iii) among patients with PAD, low PAL did not correlate directly with intermittent claudication. Conclusions PAD patients limit the amount of their physical activity, especially light and moderate intensities. Our study highlights the importance of spending more time walking in daily life.
Collapse
|
24
|
Perceived difficulty in activities of daily living and survival in patients receiving maintenance hemodialysis. Int Urol Nephrol 2020; 53:177-184. [PMID: 32797384 DOI: 10.1007/s11255-020-02600-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Most patients receiving hemodialysis have perceived difficulty in mobility tasks, such as basic activities of daily living (ADL), ambulation, and walking up or down stairs, even if they can ambulate independently. Perceived difficulty in performing ADL (ADL difficulty) is reportedly a useful predictor of mortality in older community-dwelling people. However, very few studies have examined the association of ADL difficulty with clinical outcomes in patients receiving hemodialysis. This study aimed to identify the association between ADL difficulty related to mobility tasks of lower limbs and all-cause mortality in patients receiving hemodialysis who are able to ambulate independently. METHODS This retrospective study analyzed 300 clinically stable outpatients (median age, 65.0 years) receiving hemodialysis. ADL difficulty was evaluated at baseline with a novel questionnaire developed for patients receiving hemodialysis. Lower scores indicated lower ADL, i.e., greater ADL difficulty. The patients were divided into two groups by the median ADL score: a higher ADL group and a lower ADL group. The association between ADL difficulty and all-cause mortality was estimated by Cox regression analyses. RESULTS Median follow-up duration was 58 months. The incident rates were 0.02 per person-year in the higher ADL group and 0.06 per person-year in the lower ADL group (P < 0.001). After adjusting for the effects of clinical characteristics, the hazard ratio for all-cause mortality in the lower ADL group was 2.70 (95% confidence interval 1.57-4.64) compared with that in the higher ADL group. CONCLUSIONS Perceived difficulty in mobility tasks was independently associated with all-cause mortality among ambulatory patients receiving hemodialysis.
Collapse
|
25
|
Bellizzi V, Regolisti G. What is the role of exercise in chronic kidney disease? Nephrol Dial Transplant 2020; 37:258-261. [PMID: 32785698 DOI: 10.1093/ndt/gfaa161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 01/31/2023] Open
Affiliation(s)
- Vincenzo Bellizzi
- Nephrology, Dialysis and Renal Transplantation Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona" of Salerno, Salerno, Italy.,Italian Society of Nephrology (SIN), Physical Exercise in Chronic Kidney Disease Working Group, Rome, Italy
| | - Giuseppe Regolisti
- Italian Society of Nephrology (SIN), Physical Exercise in Chronic Kidney Disease Working Group, Rome, Italy.,Clinica e Immunologia Medica, University Hospital of Parma, Parma, Italy
| |
Collapse
|
26
|
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)
Collapse
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
| | | |
Collapse
|
27
|
Battaglia Y, Ullo I, Massarenti S, Esposito P, Prencipe M, Ciancio G, Provenzano M, Fiorini F, Andreucci M, Storari A, Sabatino A, Fiaccadori E, Granata A. Ultrasonography of Quadriceps Femoris Muscle and Subcutaneous Fat Tissue and Body Composition by BIVA in Chronic Dialysis Patients. Nutrients 2020; 12:nu12051388. [PMID: 32408709 PMCID: PMC7285004 DOI: 10.3390/nu12051388] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023] Open
Abstract
Protein Energy Wasting (PEW) in hemodialysis (HD) patients is a multifactorial condition due to specific pathology-related pathogenetic mechanisms, leading to loss of skeletal muscle mass in HD patients. Computed Tomography and Magnetic Resonance Imaging still represent the gold standard techniques for body composition assessment. However, their widespread application in clinical practice is difficult and body composition evaluation in HD patients is mainly based on conventional anthropometric nutritional indexes and bioelectrical impedance vector analysis (BIVA). Little data is currently available on ultrasound (US)-based measurements of muscle mass and fat tissue in this clinical setting. The purpose of our study is to ascertain: (1) if there are differences between quadriceps rectus femoris muscle (QRFM) thickness and abdominal/thigh subcutaneous fat tissue (SFT) measured by US between HD patients and healthy subjects; (2) if there is any correlation between QRFM and abdominal/thigh SFT thickness by US, and BIVA/conventional nutritional indexes in HD patients. We enrolled 65 consecutive HD patients and 33 healthy subjects. Demographic and laboratory were collected. The malnutrition inflammation score (MIS) was calculated. Using B-mode US system, the QRFM and SFT thicknesses were measured at the level of three landmarks in both thighs (superior anterior iliac spine, upper pole of the patella, the midpoint of the tract included between the previous points). SFT was also measured at the level of the periumbilical point. The mono frequency (50 KHz) BIVA was conducted using bioelectrical measurements (Rz, resistance; Xc, reactance; adjusted for height, Rz/H and Xc/H; PA, phase angle). 58.5% were men and the mean age was 69 (SD 13.7) years. QRFM and thigh SFT thicknesses were reduced in HD patients as compared to healthy subjects (p < 0.01). Similarly, also BIVA parameters, expression of lean body mass, were lower (p < 0.001), except for Rz and Rz/H in HD patients. The average QRFM thickness of both thighs at top, mid, lower landmarks were positively correlated with PA and body cell mass (BCM) by BIVA, while negatively correlated with Rz/H (p < 0.05). Abdominal SFT was positively correlated with PA, BCM and basal metabolic rate (BMR) (p < 0.05). Our study shows that ultrasound QRFM and thigh SFT thicknesses were reduced in HD patients and that muscle ultrasound measurements were significantly correlated with BIVA parameters.
Collapse
Affiliation(s)
- Yuri Battaglia
- Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-393-432-0061
| | - Ines Ullo
- Division of Nephrology, ASST Sette Laghi, 21100 Varese, Italy;
| | - Sara Massarenti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Prencipe
- Division of Nephrology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71100 Foggia, Italy;
| | - Giovanni Ciancio
- Division of Rheumatology, University of Ferrara, 44121 Ferrara, Italy;
| | - Michele Provenzano
- Division of Nephrology and Dialysis, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Fulvio Fiorini
- Division of Nephrology and Dialysis, “Santa Maria della Misericordia” Hospital, 45100 Rovigo, Italy;
| | - Michele Andreucci
- Division of Nephrology and Dialysis, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy;
| | - Alice Sabatino
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
| | - Enrico Fiaccadori
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
| | - Antonio Granata
- Division of Nephrology, San Giovanni di Dio Hospital, 92100 Agrigento, Italy;
| | | |
Collapse
|
28
|
Regolisti G, Sabatino A, Fiaccadori E. Exercise in patients on chronic hemodialysis: current evidence, knowledge gaps and future perspectives. Curr Opin Clin Nutr Metab Care 2020; 23:181-189. [PMID: 32235267 DOI: 10.1097/mco.0000000000000656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Physical inactivity is common in hemodialysis patients, and is associated with disability and poor outcomes. We summarize the effects of aerobic, resistance or mixed exercise training on aerobic capacity, muscle mass and strength, dialysis efficiency, quality of life and cardiovascular adaptation according to clinical studies on this population, also focusing on knowledge gaps as topics for future research. Finally, we put evidence into clinical context deriving practical indications for exercise implementation in these patients. RECENT FINDINGS In hemodialysis patients, aerobic or mixed exercise training increases predominantly aerobic capacity, whereas resistance training seems more effective in increasing muscle strength. Data concerning dialysis efficiency are equivocal, although phosphate and potassium clearances seem to be improved. There is also inconclusive evidence concerning changes in cardiovascular risk factors. All types of exercise improve patients' quality of life. However, there is a need for protocol standardization and selection of easily measurable endpoints. In clinical practice, it is advised that exercise implementation be performed gradually, and goals be tailored to individual pretraining fitness levels to maximize patient adherence and clinical benefits. SUMMARY The overall evidence suggests that exercise training is beneficial and well tolerated in hemodialysis patients, although heterogeneity across studies hinders generalization of results. In any case, a gradual and individualized approach should be used to implement exercise in these patients.
Collapse
Affiliation(s)
- Giuseppe Regolisti
- UO Clinica e Immunologia Medica, Azienda Ospedaliero-Universitaria di Parma
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Alice Sabatino
- UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Enrico Fiaccadori
- UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| |
Collapse
|
29
|
Fukushima RLM, Micali PN, do Carmo EG, Orlandi FDS, Costa JLR. Cognitive abilities and physical activity in chronic kidney disease patients undergoing hemodialysis. Dement Neuropsychol 2019; 13:329-334. [PMID: 31555406 PMCID: PMC6753914 DOI: 10.1590/1980-57642018dn13-030010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/19/2019] [Indexed: 11/22/2022] Open
Abstract
Hemodialysis (HD) is a common treatment for Chronic Kidney Disease (CKD). OBJECTIVE the objective of the present study was twofold. First, to assess the level of physical activity and cognitive function in hemodialysis (HD) patients and, second, to compare cognitive function of active and insufficiently active HD patients. METHODS the sample consisted of 84 HD patients. Data collection took place in two different Renal Replacement Therapy Units (RRTU) in Brazil. A sociodemographic and clinical structured interview, the International Physical Activity Questionnaire (IPAQ) and the Addenbrooke's Cognitive Examination Revised (ACE-R) were used for data collection. The Mann Whitney U-test was used to compare cognitive function between groups. The significance level adopted was p≤.05. RESULTS the majority of the patients were insufficiently active. The total average score on the cognitive test was lower than recommended and physically active HD patients had a significant score in the fluency domain. CONCLUSION we found that HD patients are at greater risk of developing cognitive deficits. Physical activity was shown to be a potential non-pharmacological, low-cost therapeutic alternative for improving cognitive abilities in HD patients. The present study can help health professionals to encourage HD patients to engage in regular physical activity and contributes to the development of specific protocols for these patients.
Collapse
Affiliation(s)
- Raiana Lídice Mór Fukushima
- Universidade Estadual PaulistaRinggold standard institution - Physical EducationRio ClaroSPBrazilUniversidade Estadual Paulista, Ringgold standard institution - Physical Education, Rio Claro, São Paulo, SP, Brazil.
| | - Pollyanna Natalia Micali
- Universidade Estadual Paulista Julio de Mesquita FilhoRinggold standard institution - Educação FísicaRio ClaroSPBrazilUniversidade Estadual Paulista Julio de Mesquita Filho Ringgold standard institution - Educação Física Rio Claro, São Paulo, SP, Brazil.
| | - Elisangela Gisele do Carmo
- Universidade Estadual Paulista Julio de Mesquita FilhoRinggold standard institution - Educação FísicaRio ClaroSPBrazilUniversidade Estadual Paulista Julio de Mesquita Filho Ringgold standard institution - Educação Física Rio Claro, São Paulo, SP, Brazil.
| | - Fabiana de Souza Orlandi
- Universidade Federal de São PauloRinggold standard institutionSao CarlosSPBrazilUniversidade Federal de São Paulo, Ringgold standard institution, Sao Carlos, SP, Brazil.
| | - José Luiz Riani Costa
- Universidade Estadual Paulista Julio de Mesquita FilhoInstituto de BiociênciasRinggold standard institution - Instituto de BiociênciasRio ClaroSPBrazilUniversidade Estadual Paulista Julio de Mesquita Filho Instituto de Biociências Campus de Rio Claro Ringgold standard institution - Instituto de Biociências, Rio Claro, SP, Brazil.
| |
Collapse
|
30
|
Zelko A, Skoumalova I, Kolarcik P, Rosenberger J, Rabajdova M, Marekova M, Geckova AM, van Dijk JP, Reijneveld SA. The effects of intradialytic resistance training on muscle strength, psychological well-being, clinical outcomes and circulatory micro-ribonucleic acid profiles in haemodialysis patients: Protocol for a quasi-experimental study. Medicine (Baltimore) 2019; 98:e15570. [PMID: 31083229 PMCID: PMC6531031 DOI: 10.1097/md.0000000000015570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Intradialytic resistance training (IRT) protects patients' muscle mass and functions against protein-energy wasting, malnutrition and cachexia. However, the evidence of the effects of such an intervention in haemodialysis patients is limited and not conclusive. To improve the applicability of such interventions, we need a better understanding of molecular, functional and psycho-social adaptation in dialysed patients following a physical training. Therefore, the aim of this study is to investigate the effects of IRT on lower extremity muscle functions, quality of life, and anxiety and depression, clinical outcomes and circulatory micro-ribonucleic acid (miRNA) profiles in patients on chronic haemodialysis therapy. METHODS We will perform a quasi-experimental study in 3 dialysis centres. Patients will be recruited via their nephrologists and will be allocated to an experimental and a control group based on the location of the patients' dialysis centre. Patients allocated to the experimental group will undergo a 12-week IRT, while the control group will remain physically inactive during dialysis. The primary outcome is the change in the maximal force produced during an isometric contraction of lower extremity muscles. Secondary outcomes regard quality of life, anxiety and depression, clinical outcomes and circulatory miRNA profiles. Patients' level of health literacy defined as the ability to get and understand health information will be also measured in the study as a potential modifier of effects. DISCUSSION This quasi-experimental study can add in an important way to our understanding of the effects of resistance training on dialysis patients' muscle strength, quality of life and disease-specific outcomes.
Collapse
Affiliation(s)
- Aurel Zelko
- Institute of Physical Education and Sport, Pavol Jozef Safarik University, Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Ivana Skoumalova
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, Netherlands
| | - Peter Kolarcik
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jaroslav Rosenberger
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
- 2nd Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Fresenius Medical Care - Dialysis Services Kosice, Kosice, Slovakia
| | - Miroslava Rabajdova
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Maria Marekova
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Andrea Madarasova Geckova
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jitse P. van Dijk
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, Netherlands
- Olomouc University Society and Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
| | - Sijmen A. Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, Netherlands
| |
Collapse
|
31
|
Martins do Valle F, Valle Pinheiro B, Almeida Barros AA, Ferreira Mendonça W, de Oliveira AC, de Oliveira Werneck G, de Paula RB, Moura Reboredo M. Effects of intradialytic resistance training on physical activity in daily life, muscle strength, physical capacity and quality of life in hemodialysis patients: a randomized clinical trial. Disabil Rehabil 2019; 42:3638-3644. [PMID: 31034264 DOI: 10.1080/09638288.2019.1606857] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: We evaluated the effects of supervised intradialytic resistance training on physical activity in daily life (PADL), muscle strength, physical capacity and quality of life (QoL) in hemodialysis patients.Methods: Twenty-four hemodialysis patients were randomly assigned to either a 12-weeks moderate-intensity resistance training or a control period. An accelerometer evaluated PADL for seven consecutive days, measuring the time spent in different activities and positions of daily routine and the number of steps taken. Muscle strength, physical capacity and QoL were evaluated.Results: After 12 weeks of training, we did not find significant difference (post-pre values) in walking time (-1.2 ± 18.3 vs. -9.2 ± 13.1 min/day); standing time (-10.2 ± 28.6 vs. 3.2 ± 20.1 min/day); sitting time (20.8 ± 58.9 vs. -30.0 ± 53.0 min/day); lying down time (-9.3 ± 57.9 vs. 34.6 ± 54.0 min/day); number of steps taken [-147 (1834) vs. -454 (2066)] and muscle strength in training and control group, respectively. There was a significant increase in the six-minute walking test distance (48.8 ± 35.9 vs. 6.9 ± 45.9 m, p < 0.05) and some domains of QoL in the training compared to the control group.Conclusions: PADL was not modified after 12 weeks of intradialytic resistance training in hemodialysis patients. However, the exercise program was able to increase the physical capacity and some domains of QoL.Implications for rehabilitationPhysical activity in daily life was not modified after 12 weeks of intradialytic resistance training in hemodialysis patients.The exercise program was able to increase the physical capacity, efficacy of dialysis and some domains of quality of life in hemodialysis patients.The protocol used in this study was safe since no complications were observed during and after resistance training.These results should be interpreted with caution because we applied a moderate resistance training in both lower limbs and in the contralateral arteriovenous fistula upper limb, using perceived exertion by Borg scale to exercise prescription. Moreover, the safety protocol evaluation was not conducted.
Collapse
Affiliation(s)
- Felipe Martins do Valle
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Bruno Valle Pinheiro
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.,School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - William Ferreira Mendonça
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Ana Carla de Oliveira
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Gustavo de Oliveira Werneck
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - Maycon Moura Reboredo
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Brazil.,School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| |
Collapse
|
32
|
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 ).
Collapse
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
| | | |
Collapse
|
33
|
Sabatino A, Regolisti G, Delsante M, Di Motta T, Cantarelli C, Pioli S, Grassi G, Batini V, Gregorini M, Fiaccadori E. Noninvasive evaluation of muscle mass by ultrasonography of quadriceps femoris muscle in End-Stage Renal Disease patients on hemodialysis. Clin Nutr 2018; 38:1232-1239. [PMID: 29866494 DOI: 10.1016/j.clnu.2018.05.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/28/2018] [Accepted: 05/05/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND & AIMS Protein-Energy Wasting (PEW) is a pathological condition of renal patients with advanced Chronic Kidney Disease characterized by a progressive reduction of energy and protein assets. Nutritional status assessment, especially for what concerns muscle mass, is essential for both the identification of patients at risk for the development of PEW, as well as monitoring the effects of nutritional interventions. Ultrasound methods are easily applicable at the bedside for quantitative assessment of skeletal muscle. The present study was aimed at evaluating quadriceps rectus femoris thickness (QRFT) and quadriceps vastus intermedius thickness (QVIT) in patients on chronic hemodialysis. METHODS This was a prospective observational study. Three groups of adult patients were studied: young healthy subjects, well-nourished hospitalized patients with normal renal function, and End-Stage Renal Disease patients on hemodialysis (ESRD-HD). QRFT and QVIT were measured at two sites bilaterally (8 measures/patient) and were compared between groups, and also between subgroups of ESRD-HD patients stratified on the basis of conventional nutritional status parameters. RESULTS We enrolled 35 healthy subjects, 30 hospitalized patients, and 121 ESRD-HD patients on hemodialysis. QRFT and QVIT of ESRD patients on hemodialysis were lower than those of both control groups (P < 0.001). After stratifying ESRD patients into subgroups based on nutritional variable cut-offs commonly used to define PEW in this clinical setting (BMI [≥ 23 vs <23 kg/m2], albumin [≥3.8 vs <3.8 g/dL]) and malnutrition inflammation score (MIS) status (<6 vs ≥6), QRFT and QVIT of patients with worse nutritional status were significantly lower than those of well-nourished ESRD-HD patients (P value range: <0.001 to <0.05). CONCLUSION Skeletal muscle ultrasound is a simple and easily applicable bedside technique in the dialysis units, and could represent an adequate tool for the identification of patients with reduced muscle mass.
Collapse
Affiliation(s)
- Alice Sabatino
- Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Giuseppe Regolisti
- Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Marco Delsante
- Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Tommaso Di Motta
- Postgraduate School of Nephrology, Parma University, Parma, Italy
| | | | | | - Giulia Grassi
- Nephrology and Dialysis South, Cecina-Piombino, Livorno, Italy
| | | | | | - Enrico Fiaccadori
- Acute and Chronic Renal Failure Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; Postgraduate School of Nephrology, Parma University, Parma, Italy.
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Chen JB, Lee WC, Cheng BC, Moi SH, Yang CH, Lin YD. Impact of risk factors on functional status in maintenance hemodialysis patients. Eur J Med Res 2017; 22:54. [PMID: 29282123 PMCID: PMC5745856 DOI: 10.1186/s40001-017-0298-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/15/2017] [Indexed: 12/29/2022] Open
Abstract
Objectives To survey by measuring patient’s functional status which is crucial when end-stage renal disease patients begin a dialysis program. The influence of the disease on patients can be examined by the measurement of Karnofsky Performance Status (KPS) scores, together with a quality of life survey, and clinical variables. Methods The details for the dataset in the study were collected from patients receiving regular hemodialysis (HD) in one hospital, which were available retrospectively for 1166 patients during the 5-year study period. KPS scores were applied for quantifying functional status. To identify risk factors for functional status, clinical factors including demographics, laboratory data, and HD vintage were selected. This study applied a classification and regression tree approach (CART) and logistic regression to determine risk factors on functional impairment among HD patients. Results Ten risk factors were identified by CART and regression model (age, primary kidney disease subclass, treatment years, hemoglobin, albumin, creatinine, phosphorus, intact parathyroid hormone, ferritin, and cardiothoracic ratio). The results of logistic regression with selected interaction models showed older age or higher hematocrit, blood urea nitrogen, and glucose levels could significantly increase the log-odds of obtaining low KPS scores at in-person visits. Conclusions In interaction results, the combination of older age with higher albumin level and higher creatinine level with longer HD treatment years could significantly decrease the log-odds of a low KPS score assessment during in-person visits. Age, hemoglobin, albumin, urea, creatinine levels, primary kidney disease subclass, and HD duration are the major determinants for functional status in HD patients. Electronic supplementary material The online version of this article (10.1186/s40001-017-0298-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Ben-Chung Cheng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Sin-Hua Moi
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan
| | - Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan. .,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.
| | - Yu-Da Lin
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan.
| |
Collapse
|