Impact of hemodialysis and post-dialysis period on granular activity levels

Novel Approach to Intradialytic Progressive Resistance Exercise Training

Physical activity levels are typically undesirably low in chronic kidney disease patients, especially in those undergoing haemodialysis, and particularly on dialysis days. Intradialytic exercise programmes could be a solution to this issue and have been reported to be safe and relatively easily implemented in dialysis clinics. Nevertheless, such implementation has been failing in part due to barriers such as the lack of funding, qualified personnel, equipment, and patient motivation. Intradialytic aerobic exercise has been the most used type of intervention in dialysis clinics. However, resistance exercise may be superior in eliciting potential benefits on indicators of muscle strength and mass. Yet, few intradialytic exercise programmes have focused on this type of intervention, and the ones which have report inconsistent benefits, diverging on prescribed exercise intensity, absent or subjective load progression, equipment availability, or exercise supervision. Commonly, intradialytic resistance exercise interventions use free weights, ankle cuffs, or elastic bands which hinder load progression and exercise intensity monitoring. Here, we introduce a recently developed intradialytic resistance exercise device and propose an accompanying innovative resistance exercise training protocol which aims to improve the quality of resistance exercise interventions within dialysis treatment sessions.

Glittre activities of daily living test is reliable and valid in hemodialysis patients

PURPOSE

To examine the validity, and the relative and absolute within-day reliability of the TGlittre in chronic kidney disease patients undergoing hemodialysis (HD).

MATERIALS AND METHODS

Thirty HD patients (52 ± 12 years) undertook the TGlittre twice on a single day, in a cross-sectional design. For validation purposes, participants TGlittre performance and accelerometry-based physical activity were correlated. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were determined to assess within-day reliability.

RESULTS

There was a moderate correlation between TGlittre performance and moderate to vigorous physical activity (r= -0.587; p= 0.001). The relative reliability of the test showed an ICC of 0.96. For the absolute reliability, the SEM was 13.05 s (0.22 min), and the MDC was 36.17 s (0.60 min).

CONCLUSIONS

TGlittre performance is associated with moderate to vigorous physical activity in HD patients, highlighting that those with higher levels of physical activity are likely to perform better on the TGlittre. Additionally, TGlittre shows a good to excellent intra-rater reliability and a low SEM. An MDC value was established.Implications for rehabilitationPatients on hemodialysis have a low physical capacity and often struggle to simply complete their physical activities of daily living.The TGlittre is a tool for assessing functional capacity through completion of multiple physical activities of daily living and can be easily applied in a clinical setting.TGlittre is a valid test that elicit reliable physiological, hemodynamic, and physical performance responses in HD patients.

Continuous Long-Term Physical Activity Monitoring in Hemodialysis Patients

Background

Physical inactivity is common in patients receiving hemodialysis, but activity patterns throughout the day and in relation to dialysis are largely unknown. This knowledge gap can be addressed by long-term continuous activity monitoring, but this has not been attempted and may not be acceptable to patients receiving dialysis.

Methods

Ambulatory patients with end-stage kidney disease receiving thrice-weekly hemodialysis wore commercially available wrist-worn activity monitors for 6 months. Step counts were collected every 15 minutes and were linked to dialysis treatments. Physical function was assessed using the Short Physical Performance Battery (SPPB). Fast time to recovery from dialysis was defined as ≤2 hours. Mixed effects models were created to estimate step counts over time.

Results

Of 52 patients enrolled, 48 were included in the final cohort. The mean age was 60 years, and 75% were Black or Hispanic. Comorbidity burden was high, 38% were transported to and from dialysis by paratransit, and 79% had SPPB <10. Median accelerometer use (199 days) and adherence (95%) were high. Forty-two patients (of 43 responders) reported wearing the accelerometer every day, and few barriers to adherence were noted. Step counts were lower on dialysis days (3991 [95% CI, 3187 to 4796] versus 4561 [95% CI, 3757 to 5365]), but step-count intensity was significantly higher during the hour immediately after dialysis than during the corresponding time on nondialysis days (188 steps per hour increase [95% CI, 171 to 205]); these levels were the highest noted at any time. Postdialysis increases were more pronounced among patients with fast recovery time (225 [95% CI, 203 to 248] versus 134 [95% CI, 107 to 161] steps per hour) or those with SPPB ≥7. Estimates were unchanged after adjustment for demographics, diabetes status, and ultrafiltration rate.

Conclusions

Long-term continuous monitoring of physical activity is feasible in patients receiving hemodialysis. Highly granular data collection and analysis yielded new insights into patterns of activity after dialysis treatments.

Effect of Statewide Lockdown in Response to COVID-19 Pandemic on Physical Activity Levels of Hemodialysis Patients

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.