Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise

Effect of respiratory muscle training in patients with chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effect of respiratory muscle training on respiratory muscle strength, lung function, cardiopulmonary fitness, and quality of life for chronic kidney disease patients.

METHODS

PubMed, Embase, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials published randomized controlled trials that evaluated the effect of respiratory muscle training for chronic kidney disease patients from inception to December 2021, and rerun on September 2022. The quality of included studies was evaluated according to the Cochrane Collaboration's risk of bias tool-2. The outcomes were analyzed as mean differences with a fixed/random effect model. The strength of evidence was evaluated with the Grading of Recommendation, Assessment, Development, and Evaluation approach.

RESULTS

Eleven randomized controlled trials were included. All but two of the studies were in hemodialysis patients. The follow-up time range was 4 to 12 weeks. Compared to controls, respiratory muscle training significantly improved maximal expiratory pressure (mean difference = 17.36, p = 0.013), maximal inspiratory pressure (mean difference = 18.26, p = 0.002), forced expiratory volume at 1 second (mean difference = 0.20, p= 0.020), forced vital capacity (mean difference = 0.26, p = 0.008), but not for 6-minute walk test (mean difference = 39.85, p= 0.138).

CONCLUSIONS

As a non-pharmacological therapy, respiratory muscle training can effectively improve maximal expiratory pressure, maximal inspiratory pressure, forced expiratory volume at 1 second, and forced vital capacity in patients with chronic kidney disease and is safe for such populations.

Influence of mild pulmonary congestion on diaphragmatic mobility and activities of daily living in chronic kidney disease: An experimental and clinical study

BACKGROUND

Pulmonary congestion is a strong predictor of mortality and cardiovascular events in chronic kidney disease (CKD); however, the effects of the mild form on functionality have not yet been investigated. The objective of this study was to assess the influence of mild pulmonary congestion on diaphragmatic mobility (DM) and activities of daily living (ADL) in hemodialysis (HD) subjects, as well as compare ADL behavior on dialysis and non-dialysis days. In parallel, experimentally induce CKD in mice and analyze the resulting pulmonary and functional repercussions.

METHODS

Thirty subjects in HD underwent thoracic and abdominal ultrasonography, anthropometric assessment, lung and kidney function, respiratory muscle strength assessment and symptoms analysis. To measure ADL a triaxial accelerometer was used over seven consecutive days. Twenty male mice were randomized in Control and CKD group. Thoracic ultrasonography, TNF-α analysis in kidney and lung tissue, exploratory behavior and functionality assessments were performed.

RESULTS

Mild pulmonary congestion caused a 26.1% decline in DM (R²=.261; P=.004) and 20% reduction in walking time (R²=.200; P=.01), indicating decreases of 2.23mm and 1.54min, respectively, for every unit increase in lung comet-tails. Regarding ADL, subjects exhibited statistically significant differences for standing (P=.002), walking (P=.034) and active time (P=.002), and number of steps taken (P=.01) on days with and without HD. In the experimental model, CKD resulted in increased levels of TNF-α on kidneys (P=.037) and lungs (P=.02), attenuation of exploratory behavior (P=.01) and significant decrease in traveled distance (P=.034). Thoracic ultrasonography of CKD mice showed presence of B-lines.

CONCLUSION

The mild pulmonary congestion reduced DM and walking time in subjects undergoing HD. Individuals were less active on dialysis days. Furthermore, the experimental model implies that the presence of pulmonary congestion and inflammation may play a decisive role in the low physical and exploratory performance of CKD mice.

Duration of hemodialysis associated with cardio-respiratory dysfunction and breathlessness: a multicenter study

Background

Patients with hemodialysis suffer with protein-energy wasting and uremic myopathy lead to lack of physical activity and poor functional performance. However, ventilation abnormality in patients undergone hemodialysis remains controversial regarding the respiratory impairment. Therefore, the study aimed to determine the effect of duration of dialysis on respiratory function.

Methods

A multicenter study with cross-sectional study was designed in four hemodialysis outpatient clinics. Respiratory muscle strength (i.e., maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)) pulmonary function test (i.e., forced vital capacity (FVC), forced expiratory volume in one second (FEV₁) and FEV₁/FVC ratio), functional capacity (6-minute walk test) and sensation of breathlessness were assessed prior to dialysis.

Results

A total of 100 hemodialysis patients were recruited with 38 females and 62 males. An average of duration of hemodialysis was 5.93± 4.96 years. Decreased MIP values, FEV₁ values, FVC values, %FEV₁ and %FVC were noted in patients with long duration of dialysis (defined as ≥ 5 years of dialysis) compared to those with short duration of dialysis (p_s < .05). In addition, increased sensation of breathlessness was observed in patients with long duration of dialysis (p < .05). Furthermore, participants with long duration of dialysis had an increased risk of ventilatory restriction (OR 6.093, p = .007).

The Effect of Respiratory Muscle Training on the Pulmonary Function, Lung Ventilation, and Endurance Performance of Young Soccer Players

This study investigated whether the addition of eight weeks of inspiratory muscle training (IMT) to a regular preseason soccer training program, including incremental endurance training (IET), would change pulmonary function, lung ventilation, and aerobic performance in young soccer players. Sixteen club-level competitive junior soccer players (mean age 17.63 ± 0.48 years, height 182 ± 0.05 cm, body mass 68.88 ± 4.48 kg) participated in the study. Participants were randomly assigned into two groups: experimental (n = 8) and control (n = 8). Both groups performed regular preseason soccer training, including endurance workouts as IET. In addition to this training, the experimental group performed additional IMT for eigght weeks with a commercially available respiratory muscle trainer (Threshold IMT), with a total of 80 inhalations (twice per day, five days per week). Pre- and post-intervention tests of pulmonary function, maximal inspiratory pressure, and the Cooper test were implemented. Eight weeks of IMT had a positive impact on expiratory muscle strength (p = 0.001); however, there was no significant effect on respiratory function parameters. The results also indicate increased efficiency of the inspiratory muscles, contributing to an improvement in aerobic endurance, measured by VO₂max estimated from running distance in the cardiorespiratory Cooper test (p < 0.005).

Effects of intradialytic exercise on cardiopulmonary capacity in chronic kidney disease: systematic review and meta-analysis of randomized clinical trials

Patients with chronic kidney disease show poorer functional and cardiorespiratory capacity than healthy individuals, and these impairments result in sedentarism. The aim of this study was to conduct a systematic review and meta-analysis of randomized clinical trials on the effects of different intradialytic exercise protocols on cardiopulmonary capacity in chronic kidney disease patients. The primary outcome was peak oxygen consumption (VO_2peak) and the secondary outcomes were exercise duration and ventilation in the cardiopulmonary test. The quality of the evidence was evaluated using the GRADE guidelines. Seven studies with a total of 124 participants met the inclusion criteria. Compared to the non-exercise group, the exercise group improved in mean VO_2peak (MD 4.06 [IC 0.81; 7.31]). In a separate analysis according to exercise modality, aerobic exercise plus strength training performed better than aerobic exercise alone (MD 5.28 [IC 3.90; 6.66]). In the exercise group, both exercise tolerance values (MD 3.10 [IC 1.70; 4.51]) and ventilation values in the cardiopulmonary test were better than those of the control group (MD 13.10 [IC 7.12; 19.09]). Thus, intradialytic exercise protocols can improve cardiopulmonary function, exercise tolerance and ventilatory efficiency in chronic kidney disease patients.

Cognitive abilities and physical activity in chronic kidney disease patients undergoing hemodialysis

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.

Effects of inspiratory muscle training on pulmonary functions and muscle strength in sedentary hemodialysis patients

[Purpose] This study was conducted to evaluate the effect of Inspiratory Muscle Trainer (IMT) on respiratory muscle strength and pulmonary functions. [Subjects and Methods] Fifteen sedentary unemployed patients were recruited from both genders who received regular hemodialysis sessions from at least three months. Those patients received Threshold IMT program for 12 weeks. Pulmonary functions and respiratory muscle strength in form of (PImax) and (PEmax) were measured by electronic spirometry and digital pressure vacuum meter respectively. Additionally oxygen saturation was measured by Finger pulse oximeter. All measurements were performed before and at the end of the treatment program after 12 weeks. [Results] The results of this study revealed significant improvement in FVC%, FEV1%, PEF%, PImax and PEmax after three months of treatment by using inspiratory muscle trainer while no significant difference was recorded regarding to FEV1/FVC% ratio and SpO₂. [Conclusion] Inspiratory muscle trainer is an effective therapeutic technique to improve respiratory muscle strength and pulmonary functions in patients undergoing hemodialysis.

Association of pre-operative estimated GFR on post-operative pulmonary complications in laparoscopic surgeries

Despite a large body of evidence showing the pandemic of chronic kidney disease, the impact of pre-operative kidney function on the risk of post-operative pulmonary complications (PPCs) is not well known. We used multivariable logistic regression analyses with 3-level hierarchical adjustments to identify the association of pre-operative estimated glomerular filtration rate (eGFR) with PPCs in laparoscopic surgeries. Among 452,213 patients between 2005 and 2013 in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database, a total of 3,727 patients (0.9%) experienced PPCs. We found a gradient association between lower eGFR and higher likelihood of PPCs in the unadjusted model. In the case-mix adjusted model, a reverse-J-shaped association was observed; a small albeit significant association with the highest eGFR category emerged. Further adjustment slightly attenuated these associations, but the PPCs risk in the eGFR groups of <30, 30-60, and ≥120 mL/min/1.73 m2 remained significant: odds ratios (95% confidence intervals) of 1.82 (1.54-2.16), 1.38 (1.24-1.54), and 1.28 (1.07-1.53), respectively (reference: 90-120 mL/min/1.73 m2). Our findings propose a need for careful pre-operative evaluation of cardiovascular and pulmonary functions and post-operative fluid management among patients with not only lower but also very high eGFR.

The role of the inspiratory muscle weakness in functional capacity in hemodialysis patients

Introduction

Inspiratory muscle function may be affected in patients with End-Stage Renal Disease (ESRD), further worsening the functional loss in these individuals. However, the impact of inspiratory muscle weakness (IMW) on the functional capacity (FC) of hemodialysis patients remains unknown. Thus, the present study aimed to evaluate the impact of IMW on FC in ESRD patients undergoing hemodialysis.

Materials and methods

ESRD patients on hemodialysis treatment for more than six months were evaluated for inspiratory muscle strength and FC. Inspiratory muscle strength was evaluated based on maximal inspiratory pressure (MIP). IMW was defined as MIP values less than 70% of the predicted value. FC was evaluated using the Incremental Shuttle Walk test (ISWT). Patients whose predicted peak oxygen uptake (VO₂peak) over the distance walked during the ISWT was less than 16mL/kg/min were considered to have FC impairment. Associations between variables were assessed by linear and logistic regression, with adjustment for age, sex, body mass index (BMI), presence of diabetes and hemoglobin level. Receiver-operating characteristic (ROC) analysis was used to determine different cutoff values of the MIP for normal inspiratory muscle strength and FC.

Results

Sixty-five ERSD patients (67.7% male), aged 48.2 (44.5–51.9) years were evaluated. MIP was an independent predictor of the distance walked during the ISWT (R² = 0.44). IMW was an independent predictor of VO₂peak < 16mL/kg/min. (OR = 5.7; p = 0.048) in adjusted logistic regression models. ROC curves showed that the MIP cutoff value of 82cmH₂O had a sensitivity of 73.5% and specificity of 93.7% in predicting normal inspiratory strength and a sensitivity and specificity of 76.3% and 70.4%, respectively, in predicting VO₂peak ≥ 16mL/kg/min.

Conclusions

IMW is associated with reduced FC in hemodialysis patients. Evaluation of the MIP may be important to functional monitoring in clinical practice and can help in the stratification of patients eligible to perform exercise testing.

Effects of non-invasive ventilatory support in tolerance to the effort of patients with hemodialysis

Abstract Introduction The kidney system is responsible for the maintenance of homeostasis and in patients with Chronic Kidney Disease the kidney functions changes, contributing for the development of various complications that will have adverse effects in tolerance to the physical exercise and in Quality of Life of this patients. Objective To evaluate the Effects of non-invasive ventilatory support in tolerance to the patients’ physical exercise in dialysis. Methods The patients performed two 6-minute walk tests, following an adapted protocol for treadmill, one of them without the use of non-invasive ventilatory support and the other with non-invasive ventilatory support during the walk. Besides, the patients answered a questionnaire of quality of life and the KDQOL-SFTM specific for the population under study. Results It was noticed that there was not statistical difference in the distance recorded during the 6-minute walk tests. Regarding the quality of life, the greater impact of the disease was in relation to “Professional Activity”. Conclusion In conclusion, a non-invasive ventilatory support did not cause significant effects in tolerance to the exercise of this population. However, we should take into consideration the limitations suffered during the research development.

Pulmonary Function in Patients with End-Stage Renal Disease: Effects of Hemodialysis and Fluid Overload

Background

Respiratory system disorders are one of the most prevalent complications in end-stage renal disease patients on hemodialysis. However, the pathogenesis of impaired pulmonary functions has not been completely elucidated in these patients. We designed a study to investigate acute effects of hemodialysis treatment on spirometry parameters, focusing on the relationship between pulmonary function and fluid status in hemodialysis patients.

Material/Methods

We enrolled 54 hemodialysis patients in this study. Multifrequency bioimpedance analysis (BIA) was used to assess fluid status before and 30 min after the midweek of hemodialysis (HD). Overhydration (OH)/extracellular water (ECW)% ratio was used as an indicator of fluid status. Fluid overload was defined as OH/ECW ≥7%. Spirometry was performed before and after hemodialysis.

Results

Forced vital capacity (FVC), FVC%, and forced expiratory volume in the first second (FEV1) levels were significantly increased after hemodialysis. FVC, FVC%, FEV1, FEV1%, mean forced expiratory flow between 25% and 75% of the FVC (FEF25–75), FEF25–75%, peak expiratory flow rate (PEFR), and PEFR% were significantly lower in patients with fluid overload than in those without. OH/ECW ratio was negatively correlated with FVC, FVC%, FEV1, FEV1%, FEF25–75, FEF25–75%, PEFR, and PEFR%. Stepwise multiple regression analysis revealed that male sex and increased ultrafiltration volume were independently associated with higher FVC, whereas increased age and OH/ECW ratio were independently associated with lower FVC.

Conclusions

Fluid overload is closely associated with restrictive and obstructive respiratory abnormalities in HD patients. In addition, hemodialysis has a beneficial effect on pulmonary function tests, which may be due to reduction of volume overload.

Respiratory muscle impairment in dialysis patients: can minimal dose of exercise limit the damage? A Preliminary study in a sample of patients enrolled in the EXCITE trial

AIM

Skeletal muscle atrophy and dysfunction with associated weakness may involve the respiratory muscles of dialysis patients. We evaluated the effect of moderate-intensity exercise on lung function and respiratory muscle strength.

METHODS

Fifty-nine patients (25 F, aged 65 ± 13 years) from two centers participating in the multicenter randomized clinical trial EXerCise Introduction To Enhance Performance in Dialysis (EXCITE) were studied. Subjects were randomized into a prescribed exercise group (E), wherein subjects performed two 10-min walking sessions every second day at an intensity below the self-selected speed, or a control group (C) with usual care. Physical performance was assessed by the 6-min walk test (6MWT). Patient lung function and respiratory muscle strength were evaluated by spirometry and maximal inspiratory pressure (MIP), respectively.

RESULTS

Forty-two patients (14 F) completed the study. At baseline, the groups did not differ in any parameters. In total, 7 patients (4 in E; 3 in C) showed an obstructive pattern. The pulmonary function parameters were significantly correlated with 6MWT but not with any biochemical measurements. Group E safely performed the exercise program. At follow-up, the spirometry parameters did not change in either group. A deterioration of MIP (-7 %; p = 0.008) was observed in group C, but not in group E (+3.3 %, p = ns). In E, an increase of 6MWT was also found (+12 vs. 0 % in C; p = 0.038).

CONCLUSION

In dialysis patients, a minimal dose of structured exercise improved physical capacity and maintained a stable respiratory muscle function, in contrast to the control group where it worsened.

Functional capacity, pulmonary and respiratory muscle strength in individuals undergoing hemodialysis

Abstract Introduction: Individuals with chronic kidney disease (CKD) undergoing hemodialysis (HD) present low cardiorespiratory fitness and functional capacity. Metabolic changes, due to the disease, can result in a variety of pathophysiological conditions that favor the development of respiratory muscle weakness. However, very little is known about the performance of the respiratory muscles and the influence of HD on them. Aim: To evaluate and correlate pulmonary function, functional capacity and respiratory muscle strength in patients with CKD undergoing HD. Methods: Cross-sectional study comprising 23 patients with CKD, that met the following inclusion criteria: patients of both genders, who perform HD three times a week for a minimum period of three months. Respiratory muscle strength was evaluated using a respiratory pressure meter, lung function through spirometry and functional capacity through the 6-minute walk test (6MWT) before the HD session. Results: All patients were male and mean age was 50.2 ± 15.8 years. The median duration of HD was 3 (1.5 to 6.0) years. The mean values obtained in comparison to those predicted were MIP% 36.0 ± 13.6, MEP% 49.5 ± 15.8, FVC% 93.8 ± 21.1, FEV1% 93.7 ± 21.1, FVC/VEF1% 104.1 ± 10.3, and 6MWT% 66.33 ± 20.53. A statistically significant positive correlation was observed between the 6MWT and MIP (r = .63, p =.001) and MEP (r = .67, p < .001), between the MIP and MEP (r =.79, p < .001) and between the FEV1 and FVC (r = .91, p < .001). Conclusion: Patients with CKD undergoing HD present changes in respiratory muscle strength, with the predicted values decreasing for age and gender, as well as the distance covered in the 6MWT, although, with normal spirometric values. Functional capacity was dependent on respiratory muscle strength, as well as the values of MIP and MEP, and the values of FVC and FEV1.

[Prevalence of nursing diagnosis of fluid volume excess in patients undergoing hemodialysis]

OBJECTIVE

To identify the prevalence of nursing diagnosis of fluid volume excess and their defining characteristics in hemodialysis patients and the association between them.

METHOD

Cross-sectional study conducted in two steps. We interviewed 100 patients between the months of December 2012 and April 2013 in a teaching hospital and one hemodialysis clinic. The inference was performed by diagnostician nurses between July and September 2013.

RESULTS

The diagnostic studied was identified in 82% of patients. The characteristics that were statistically associated: bounding pulses, pulmonary congestion, jugular vein distention, edema, change in electrolytes, weight gain, intake greater than output and abnormal breath sounds. Among these, edema and weight gain had the highest chances for the development of this diagnostic.

CONCLUSION

The analyzed diagnostic is prevalent in this population and eight characteristics presented significant association.

Impact of hemodialysis on dyspnea and lung function in end stage kidney disease patients

Background. Respiratory symptoms are usually underestimated in patients with chronic kidney disease undergoing maintenance hemodialysis. Therefore, we set out to investigate the prevalence of patients chronic dyspnea and the relationship of the symptom to lung function indices. Methods. Twenty-five clinically stable hemodialysis patients were included. The mMRC dyspnea scale was applied before and after hemodialysis. Spirometry, single breath nitrogen test, arterial blood gases, static maximum inspiratory (P_imax⁡) and expiratory (P_emax⁡) muscle pressures, and mouth occlusion pressure (P_0.1) were also measured. Results. Despite normal spirometry, all patients (100%) reported mild to moderate degree of chronic dyspnea pre which was reduced after hemodialysis. The sole predictor of (Δ) mMRC was the (Δ) P_0.1 (r = 0.71, P < 0.001). The P_imax⁡ was reduced before and correlated with the duration of hemodialysis (r = 0.614, P < 0.001), whilst after the session it was significantly increased (P < 0.001). Finally (Δ) weight was correlated with the (Δ) P_imax⁡  %pred (r = 0.533, P = 0,006) and with the (Δ) CV (%pred) (r = 0.65, P < 0.001). Conclusion. We conclude that dyspnea is the major symptom among the CKD patients that improves after hemodialysis. The neuromechanical dissociation observed probably is one of the major pathophysiologic mechanisms of dyspnea.

Insuficiência renal crônica no Brasil segundo enfoque de causas múltiplas de morte

Este estudo investiga a mortalidade por doença renal crônica (DRC) por meio das causas múltiplas de morte no Brasil e apresenta a análise de associação entre as causas de óbitos de pacientes em terapia renal substitutiva (TRS), considerando causas associadas de morbimortalidade e características epidemiológicas e sociodemográficas. Utilizou-se a base nacional em TRS centrada no indivíduo para os anos de 2000 a 2004 e a técnica multivariada Grade of Membership(GoM). Os resultados apontam quatro perfis: doenças transmissíveis, doenças glomerulares e do aparelho digestivo; lesões, envenenamentos e outras consequências de causas externas e reação anormal ou complicação tardia causadas por procedimentos cirúrgicos (hemodiálise); diabetes e doenças cardiovasculares; e perfil residual. Entre os resultados destaca-se que aproximadamente 48% dos óbitos decorreram, provavelmente, de complicações do tratamento (hemodiálise) e 39%, de diabetes, além de uma condição cardiovascular na declaração de óbito. Os achados deste estudo podem contribuir para um atendimento mais adequado dos pacientes com DRC e, principalmente, dos potenciais pacientes no sistema de saúde. A prevenção e o acompanhamento das doenças associadas, especialmente diabetes e hipertensão, têm papel importante na prevenção e progressão da DRC, que é uma doença complexa e exige múltiplas abordagens de tratamento.

High-flux dialysis improves pulmonary ventilation function in uremic patients

Lung injury commonly accompanies uremia caused by renal failure. Uremia is typically treated using hemodialysis (dialysis) to restore electrolyte and fluid balance. A more recent, less commonly used method, high-flux dialysis, has not yet been investigated for its potential benefit to lung function. The aim of the present study was to determine whether high‑flux dialysis affects pulmonary function. We assessed various pulmonary function parameters in patients with uremia before and after routine or high‑flux dialysis. Pulmonary function was assessed via determination of the forced vital capacity (FVC), maximum breathing capacity (MBC), forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF), maximal midexpiratory flow (MMEF) curve, maximal expiratory flow in 25% vital capacity (V25) and diffusion capacity of the lungs for carbon monoxide (DLco) in 42 patients with uremia and 24 healthy individuals. Patients with uremia were divided into two groups; the high‑flux group (treated with high-flux dialysis; n=21) and the routine group (treated with conventional dialysis; n=21). Lung function was reassessed in the two groups after 3 months of dialysis. The two groups of patients with uremia exhibited reduced lung function parameters compared with healthy individuals (all P<0.05), indicating the presence of impaired lung function secondary to uremia. Following dialysis, the FEV1, PEF, MMEF and V25 values increased significantly compared with their respective baseline values prior to treatment for each group (ANOVA, P<0.05). Furthermore, increases were more marked in patients treated with high-flux dialysis compared with those treated using routine dialysis (P<0.05). Thus, lung injury caused by uremia was shown to be improved following dialysis, with high-flux dialysis offering a greater benefit than routine dialysis.

Respiratory biofeedback accuracy in chronic renal failure patients: a method comparison

Objective:

To analyse respiratory biofeedback effects on respiratory muscle strengthening in chronic renal failure patients.

Design:

Randomized controlled study.

Setting:

Nephrology and dialysis centre.

Subjects and intervention:

Forty-one end-stage renal patients on haemodialysis treatment were allocated into three groups: control ( n = 10), G-1 (inspiratory muscle training using Threshold IMT device; n = 16) and G-2 (biofeedback; n = 15) and given respiratory muscle training (three sessions/week for six weeks).

Main measures:

Forced vital capacity (FVC), expiratory volume in the first second (FEV1), FEV1/FVC ratio, maximal voluntary ventilation (MVV) and maximal inspiratory (MIP) and expiratory (MEP) pressures were measured before and after the respiratory muscle training programme.

Results:

Both training methods were efficient since we found an increase after training in the FVC in the G-1 group (from 2.45 ± 0.17 to 2.85 ± 0.16; P = 0.001) and in the G-2 group (from 2.35 ± 0.19 to 2.55 ± 0.19; P = 0.007), in the FEV1 in G-1 (from 2.18 ± 0.16 to 2.46 ± 0.14; P = 0.01) and in G-2 (from 1.97 ± 0.17 to 2.20 ± 0.15; P < 0.0001), MIP in G-1 (from 70.63 ± 4.03 to 108.75 ± 7.41; P < 0.0001) and in G-2 (from 67.67 ± 5.02 to 96.33 ± 8.30; P < 0.001) and MEP in G-1 (from 73.13 ± 5.10 to 82.50 ± 6.74; P = 0.007) and in G-2 (from 67.67 ± 5.41 to 76.00 ± 4.29; P = 0.002).

Conclusions:

Respiratory biofeedback is efficient as a respiratory muscle training modality for patients with chronic renal failure.

Eficácia de um protocolo de exercícios físicos em pacientes com insuficiência renal crônica, durante o tratamento de hemodiálise, avaliada pelo SF-36

OBJETIVO: Analisar os efeitos de um protocolo de exercícios fisioterapêuticos em pacientes renais crônicos, durante a terapia hemodialítica, visando à melhora de sua qualidade de vida. MATERIAIS E MÉTODOS: Foram avaliados 27 pacientes, com idade média de 51 ± 10,5 anos, índice de massa corpórea média de 24,3 ± 3,8 e em tratamento hemodialítico há aproximadamente 50 ± 27,7 meses. Os pacientes assinaram o Termo de Consentimento Livre e Esclarecido e, durante três meses, participaram de um programa de tratamento, durante a hemodiálise, composto por alongamentos musculares de membros inferiores, de membro superior (que não apresentasse a fístula arteriovenosa), lombar e cervical (caso o paciente não apresentasse o cateter cervical de diálise); fortalecimentos musculares de membros inferiores e membro superior, sem o acesso vascular; e relaxamento. Foi aplicado o questionário de qualidade de vida SF-36 antes e após o período de tratamento. RESULTADOS: Após o tratamento, o teste SF-36 mostrou melhora significativa das seguintes variáveis: capacidade funcional, nível de dor, vitalidade e saúde mental. Também foi observado que, antes do tratamento, dez pacientes relatavam cãibras musculares e, após a fisioterapia, somente quatro pacientes continuaram relatando essas contrações. CONCLUSÃO: Conclui-se que a atuação da fisioterapia durante a hemodiálise contribuiu para a melhora da qualidade de vida de pacientes renais crônicos.

Força muscular respiratória e capacidade funcional na insuficiência renal terminal

OBJETIVO: Verificar a associação da força muscular respiratória com a capacidade funcional, força proximal de membros inferiores e variáveis bioquímicas em pacientes em hemodiálise (HD). MÉTODOS: Participaram deste estudo 30 indivíduos (18 homens), com 53,4 ± 12,9 anos e tempo de HD de 41,1 ± 55,7 meses. Foram avaliados pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax), distância percorrida no teste de caminhada de seis minutos (6MWT), número de repetições no teste de sentar-e-levantar em 30 segundos (TSL) e registrados os exames bioquímicos de rotina no serviço. RESULTADOS: Houve diminuição da PEmax em relação aos valores preditos (p = 0,015) e redução na distância percorrida no 6MWT quando comparados com equações de predição (p < 0,001). O logPImax e o logPEmax correlacionaram-se com o número de repetições no TSL (r = 0,476, p = 0,008; r = 0,540, p = 0,002, respectivamente), e com os níveis séricos de fósforo (r = 0,422, p = 0,020; r = 0,639, p < 0,001, respectivamente). A distância no 6MWT correlacionou-se com o logPEmax (r = 0,511; p = 0,004) e com o número de repetições no TSL (r = 0,561; p = 0,001). CONCLUSÃO: A redução da PEmax em pacientes com IRT em HD está associada à capacidade funcional, força proximal de membros inferiores e níveis de fósforo sérico, podendo representar, pelo menos em parte, o baixo desempenho físico-funcional desses pacientes.

Comparação entre o uso de bocal e máscara facial na avaliação de volumes pulmonares e capacidade vital em indivíduos saudáveis

Testes de função pulmonar são usados para determinar a gravidade, as conseqüências funcionais e o progresso de disfunções pulmonares e neuromusculares. As variações metodológicas com o bocal e a máscara facial e a cooperação do paciente podem interferir no desempenho das manobras e afetar as medidas. O objetivo deste estudo foi comparar os valores de volumes pulmonares (volume corrente [Vc], volume-minuto [Vm]), freqüência respiratória (FR) e capacidade vital (CV) em indivíduos saudáveis quando avaliados por meio do bocal e da máscara facial. Participaram do estudo 60 voluntários saudáveis, 14 homens e 46 mulheres, com média de idade de 22,9±7,1 anos. Para a avaliação com bocal, utilizou-se uma peça semirrígida descartável e clipe nasal; a máscara usada foi facial plástica com borda pneumática inflável. As medidas obtidas foram comparadas estatisticamente (nível de significância 5%). Os valores obtidos com o bocal e com a máscara facial foram, respectivamente: FR, 15 rpm x 13 rpm (p<0,01); Vm, 14,87 l/min x 10,02 l/min (p<0,01); Vc, 0,93 l x 0,8 l (p<0,01); CV, 3,85 l x 3,52 l (p<0,01). Os valores de volumes pulmonares e capacidade vital mostraram-se pois significativamente inferiores quando avaliados com a máscara facial em comparação ao bocal.