Efficacy and Safety of Intra-Dialytic Exercise Training in Hemodialysis Patients

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00209775%3A_____%2F20%3AN0000032" target="_blank" >RIV/00209775:_____/20:N0000032 - isvavai.cz</a>

Výsledek na webu

<a href="https://is.muni.cz/do/med/noninvasive_methods_in_cardiology/Noninvasive_methods_in_cardiology_2020.pdf" target="_blank" >https://is.muni.cz/do/med/noninvasive_methods_in_cardiology/Noninvasive_methods_in_cardiology_2020.pdf</a>

DOI - Digital Object Identifier

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Jazyk výsledku

angličtina

Název v původním jazyce

Efficacy and Safety of Intra-Dialytic Exercise Training in Hemodialysis Patients

Popis výsledku v původním jazyce

End-stage Renal Disease (ESRD) affects 5%–10% of the world’s population and with a ~6-7% growth continues to increase at a significantly higher rate (Fig. 1). Approximately 70-75% of patients with ESRD are undergoing dialysis treatment (hemodialysis or peritoneal dialysis) and around 25-30% lives with kidney transplants (1). Most dialysis patients can be allocated to three geographical regions: the United States, the EU and Japan, which together represent 40% of all dialysis patients (1). However, the dialysis patient population growth rate is much lower (1- 4%/year) in those countries than in other regions such as Asia, Latin America, the Middle East and Africa (8-9%/year). The prevalence of people treated for ESRD shows a high degree of variation across countries. In the EU, there is an average of 1.160 patients per million inhabitants (8.5% of the EU population suffers from diabetes and 90% of ESRD patients are over 65 years old). The countries with the highest prevalence are Portugal, Germany, Cyprus, Belgium and France. ESRD kills more people than breast od prostate cancer (1). Around 38.000.000 EU inhabitants have CKD stages 3 - 5, but most don´t know it because ESRD has no symptoms until the advanced stages. Regular ambulatory hemodialysis (HD) is the major treatment option for patients with end-stage renal disease (ESRD). Due to a high prevalence of chronic kidney disease, the numbers of HD patients are growing rapidly. Within the EU, last year 330.000 patients received a total of 50.000.000 dialysis treatments in 5.400 centers. In EU, out of 590.000 patients, 56% are on MD, 5% on peritoneal dialysis (PD) and 39% are living with kidney transplants. Transplantation is the most effective therapy; it is also the fastest growing of the three forms of treatment (+3% each year). Treatment of ESRD is quite expensive and costs tend to rise: dialysis alone costs 14.000.000 € per year to EU healthcare systems. Nowadays, the dialysis consumes 2% of healthcare budgets EU member-countries and the costs are expected to double in the next 5 years (1). The formidable development and investment in high-technology diagnostic and therapeutic procedures for patients with chronic kidney failure (CKD) in the past decades had increased the survival rate. Nevertheless, the overall mortality and quality of life of these patients is still not satisfactory enough. Dialysis patients are for long-term exposed to the negative impact of chronic disease that is systemic, progressive, incurable and further aggravated by sedentary lifestyle (2). The most typical pathologies in ESRD patients include low exercise endurance (VO2max), poor physical condition, protein-energy malnutrition, inflammatory cachexia and uremic acidosis. Paradoxically, other side effects are related to the chronic treatment by hemodialysis 2-3 times weekly. During the HD procedure most of patients are in supine position for up to 4 hours, which brings further decondition. High level of fatigue and long-term tiredness are very frequent and unpleasant problems. Together, these factors result in a progressive downward spiral of deconditioning. In sum, the patients with ESRD are affected by renal failure itself, side effects of dialysis procedure and comorbidities worsening, which all contribute to very poor motivation to physical activity. Therefore, inactivity is right considered as the main cause of further progression of the disease, decreased aerometabolic capacity and skeletal muscle wasting. Thus, it is reasonable to encourage patients on HD or PD to increase their level of physical exercise. Intra-dialytic exercise is a common recommendation given to encourage patients to be physically active. The first studies about positive effects of exercise in patients with ESRD dates back to 70´s (3). Up to the present, exercise training has proven to be an immensely beneficial tool of improving health in patients with ESRD (Fig. 2), and dozens of published studies in the last two decades have clearly demonstrated the effectiveness of various forms of ID-RHB, especially in reducing fatigue, increasing physical fitness and overall quality of life (4, 5, 6, 7 and 8). McAdams-Demarco et al. (2012) studied the survival in 143 maintenance HD patients stratified according to activity of daily living disability (Fig. 3). They demonstrated that ADL disability was independently associated with 3.37 times higher mortality (9).

Název v anglickém jazyce

Efficacy and Safety of Intra-Dialytic Exercise Training in Hemodialysis Patients

Popis výsledku anglicky

End-stage Renal Disease (ESRD) affects 5%–10% of the world’s population and with a ~6-7% growth continues to increase at a significantly higher rate (Fig. 1). Approximately 70-75% of patients with ESRD are undergoing dialysis treatment (hemodialysis or peritoneal dialysis) and around 25-30% lives with kidney transplants (1). Most dialysis patients can be allocated to three geographical regions: the United States, the EU and Japan, which together represent 40% of all dialysis patients (1). However, the dialysis patient population growth rate is much lower (1- 4%/year) in those countries than in other regions such as Asia, Latin America, the Middle East and Africa (8-9%/year). The prevalence of people treated for ESRD shows a high degree of variation across countries. In the EU, there is an average of 1.160 patients per million inhabitants (8.5% of the EU population suffers from diabetes and 90% of ESRD patients are over 65 years old). The countries with the highest prevalence are Portugal, Germany, Cyprus, Belgium and France. ESRD kills more people than breast od prostate cancer (1). Around 38.000.000 EU inhabitants have CKD stages 3 - 5, but most don´t know it because ESRD has no symptoms until the advanced stages. Regular ambulatory hemodialysis (HD) is the major treatment option for patients with end-stage renal disease (ESRD). Due to a high prevalence of chronic kidney disease, the numbers of HD patients are growing rapidly. Within the EU, last year 330.000 patients received a total of 50.000.000 dialysis treatments in 5.400 centers. In EU, out of 590.000 patients, 56% are on MD, 5% on peritoneal dialysis (PD) and 39% are living with kidney transplants. Transplantation is the most effective therapy; it is also the fastest growing of the three forms of treatment (+3% each year). Treatment of ESRD is quite expensive and costs tend to rise: dialysis alone costs 14.000.000 € per year to EU healthcare systems. Nowadays, the dialysis consumes 2% of healthcare budgets EU member-countries and the costs are expected to double in the next 5 years (1). The formidable development and investment in high-technology diagnostic and therapeutic procedures for patients with chronic kidney failure (CKD) in the past decades had increased the survival rate. Nevertheless, the overall mortality and quality of life of these patients is still not satisfactory enough. Dialysis patients are for long-term exposed to the negative impact of chronic disease that is systemic, progressive, incurable and further aggravated by sedentary lifestyle (2). The most typical pathologies in ESRD patients include low exercise endurance (VO2max), poor physical condition, protein-energy malnutrition, inflammatory cachexia and uremic acidosis. Paradoxically, other side effects are related to the chronic treatment by hemodialysis 2-3 times weekly. During the HD procedure most of patients are in supine position for up to 4 hours, which brings further decondition. High level of fatigue and long-term tiredness are very frequent and unpleasant problems. Together, these factors result in a progressive downward spiral of deconditioning. In sum, the patients with ESRD are affected by renal failure itself, side effects of dialysis procedure and comorbidities worsening, which all contribute to very poor motivation to physical activity. Therefore, inactivity is right considered as the main cause of further progression of the disease, decreased aerometabolic capacity and skeletal muscle wasting. Thus, it is reasonable to encourage patients on HD or PD to increase their level of physical exercise. Intra-dialytic exercise is a common recommendation given to encourage patients to be physically active. The first studies about positive effects of exercise in patients with ESRD dates back to 70´s (3). Up to the present, exercise training has proven to be an immensely beneficial tool of improving health in patients with ESRD (Fig. 2), and dozens of published studies in the last two decades have clearly demonstrated the effectiveness of various forms of ID-RHB, especially in reducing fatigue, increasing physical fitness and overall quality of life (4, 5, 6, 7 and 8). McAdams-Demarco et al. (2012) studied the survival in 143 maintenance HD patients stratified according to activity of daily living disability (Fig. 3). They demonstrated that ADL disability was independently associated with 3.37 times higher mortality (9).

Druh

C - Kapitola v odborné knize

CEP obor

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OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

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Návaznosti

V - Vyzkumna aktivita podporovana z jinych verejnych zdroju

Rok uplatnění

2020

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název knihy nebo sborníku

Noninvasive methods in cardiology 2020

ISBN

978-80-210-9715-5

Počet stran výsledku

12

Strana od-do

79-90

Počet stran knihy

119

Název nakladatele

Masaryk University Press

Místo vydání

Brno

Kód UT WoS kapitoly

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