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BACKGROUND: Individuals with chronic kidney disease (CKD) often experience reduced muscle strength and diminished health-related quality of life (HRQoL), and engaging in regular exercise may improve them. The aim of this study was to assess the effect of intradialytic exercise using non-immersive virtual reality (VR) on body composition of patients with CKD on hemodialysis (HD). METHODS: This was a substudy in a clinical trial of intradialytic exercise intervention using a non-immersive VR game in which the patient interacted by moving the lower limbs. Body composition was determined by BCM Fresenius multifrequency stereoscopic bioimpedance. Body mass index (BMI), fat tissue index (FTI), lean tissue index (LTI), extracellular/intracellular water (EIW), and phase angle (PA) were recorded in 52 patients, 24 in the control group (CG) and 28 in the exercise group (EG). RESULTS: Statistically significant differences were observed between both groups. The LTI increased in the EG while it decreased in the CG. The FTI and the EIW decreased in the EG compared to the increase observed in the CG. CONCLUSIONS: Intradialytic exercise using non-immersive VR was associated with an increase in LTI and a decrease in FTI of CKD patients on HD.
Subject(s)
Body Composition , Renal Dialysis , Renal Insufficiency, Chronic , Virtual Reality , Humans , Male , Renal Insufficiency, Chronic/therapy , Renal Insufficiency, Chronic/physiopathology , Female , Middle Aged , Aged , Exercise Therapy/methods , Body Mass Index , Quality of Life , Exercise/physiology , Adult , Electric ImpedanceABSTRACT
BACKGROUND AND OBJECTIVE: Patient activation is a concept that refers to the willingness to manage one's health and medical care. To assess it, a patient activation measure (PAM) has been developed and validated. Several studies report low activation in patients with chronic diseases. However, information on activation in hemodialysis patients is scarce. The aim of the present study is to describe the activation level of patients on chronic treatment in an HD unit and its relationship with disease control parameters. MATERIALS AND METHODS: Cross-sectional observational study in patients with advanced chronic kidney disease on chronic HD treatment. Ninety-six patients were included. Activation was measured with the PAM-13 questionnaire. Its relationship with descriptive variables (age, sex, comorbidity, studies, habitat) and disease control variables (vascular access, blood flow, potassaemia, phosphataemia, interdialytic gain) was studied. For this purpose, Spearman's correlation test, multiple linear regression model and logistic model were used as statistical methods. RESULTS: The mean (SD) PAM-13 score was 63.19 (15.21). Activation was significantly associated with vascular access (P = 0.003), blood flow (P = 0.024), and interdialytic gain of patients (P = 0.008). CONCLUSIONS: Activation in patients on chronic hemodialysis treatment is low. Higher activation is related having an arteriovenous fistula, higher blood flow and lower interdialytic gain. Future studies are needed to confirm and apply our results.
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Introduction: Introduction: among the groups more affected by the COVID-19 pandemic were patients undergoing chronic hemodialysis (HD) treatment due to their comorbidities, advanced age, impaired innate and adaptive immune function, and increased nutritional risk due to their underlying inflammatory state. All of these factors contribute to a higher risk of severe complications and worse outcomes compared to the general population when infected with SARS-CoV-2. Objective: the objective of this study was to describe the nutritional characteristics of and their potential association with the prognosis of COVID-19 in patients undergoing chronic HD treatment. Method: a descriptive, retrospective, observational design. All cases of COVID-19 in patients undergoing chronic treatment at the Hemodialysis Unit of Hospital de Manises, Valencia, Spain, from the start of the pandemic to before vaccination were included. Results: for that, 189 patients were studied, who received chronic HD treatment in the hospital unit, 22 patients were diagnosed with COVID-19 (12 %) in that period. The mean age was 71 years, 10 were women, the Charlson index was 6.59 points, diabetes mellitus 10, vintage HD 51.6 months, 2 patients had previously received a currently non-functioning kidney transplant, 16 had arteriovenous fistula as vascular access, and 6 had central vascular access. The mean dialysis session time was 220.14 minutes and the initial value of the single dose of the Kt/V pool was 1.7. 16 patients had body composition measurement, a strong association (p < 0.05) was identified between mortality and BMI, as well as mortality and FTI. Furthermore, the differences between deceased and surviving groups in the serum levels of various variables related to nutritional status were analyzed, finding significant differences with p < 0.05 in the value of triglycerides and ferritin. Conclusions: higher body mass index and higher body fat content, along with lower baseline levels of triglycerides and ferritin, were significantly associated with higher COVID-19 mortality in patients on chronic hemodialysis. These findings suggest that the initial nutritional status of these patients can significantly influence the prognosis of SARS-CoV-2 infection.
Introducción: Introducción: entre los grupos más afectados por la pandemia de COVID-19 se encuentran los pacientes en tratamiento crónico de hemodiálisis (HD) por sus comorbilidades, edad avanzada, deterioro de la función inmune innata y adaptativa, y mayor riesgo nutricional por su estado inflamatorio de base. Todos estos factores contribuyen a un mayor riesgo de complicaciones graves y peores resultados en comparación con la población general cuando se infectan con SARS-CoV-2. Objetivo: el objetivo de este estudio es describir las características nutricionales y su potencial asociación con el pronóstico de COVID-19 en pacientes en tratamiento crónico de HD. Método: diseño observacional retrospectivo y descriptivo. Se incluyeron todos los casos de COVID-19 en pacientes en tratamiento crónico en la Unidad de Hemodiálisis del Hospital de Manises, Valencia, desde el inicio de la pandemia hasta antes de la vacunación. Resultados: de 189 pacientes que recibieron tratamiento de HD crónica en la unidad hospitalaria, 22 pacientes fueron diagnosticados con COVID-19 (12 %) en ese período. La edad media fue de 71 años, 10 eran mujeres, índice de Charlson de 6,59 puntos, diabetes mellitus 10, tiempo en diálisis 51,6 meses, 2 pacientes habían recibido previamente un trasplante renal actualmente no funcionante, 16 tenían fístula arteriovenosa como acceso vascular, y 6 tenían acceso vascular central. El tiempo medio de la sesión de diálisis fue de 220,14 minutos y el valor inicial de la dosis única del pool de Kt/V fue de 1,7. Tenían medición de la composición corporal 16 pacientes, se identificó una fuerte asociación (p < 0,05) entre mortalidad e IMC, así como mortalidad y FTI. Además las diferencias entre los grupos de fallecidos y sobrevivientes en los niveles séricos de diversas variables relacionadas con el estado nutricional fueron analizados, encontrando diferencias significativas con p < 0,05 en el valor de triglicéridos y ferritina. Conclusiones: un índice de masa corporal más alto y un mayor contenido de grasa corporal, junto con niveles basales más bajos de triglicéridos y ferritina, se asocian significativamente a una mayor mortalidad por COVID-19 entre los pacientes en hemodiálisis crónica. Estos hallazgos sugieren que el estado nutricional inicial de estos pacientes puede influir significativamente en el pronóstico de la infección por SARS-CoV-2.
Subject(s)
COVID-19 , Nutritional Status , Renal Dialysis , Humans , COVID-19/therapy , COVID-19/mortality , COVID-19/complications , COVID-19/epidemiology , Male , Female , Retrospective Studies , Aged , Prognosis , Middle Aged , Spain/epidemiology , Aged, 80 and over , Kidney Failure, Chronic/therapy , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/mortality , Body Mass IndexABSTRACT
BACKGROUND: Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well-being are often reported in patients on haemodialysis (HD). AIMS: We aimed to explore needs, barriers and facilitators-as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well-being. METHODS: This is an observational cross-sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal-aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well-being from the perspective of patients, their carers and HCPs. RESULTS: In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private. CONCLUSIONS: Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support.
Subject(s)
Caregivers , Health Personnel , Humans , Cross-Sectional Studies , Health Personnel/psychology , Caregivers/psychology , Emotions , Healthy LifestyleABSTRACT
Chronic dialysis patients have an increased risk of severe COVID-19 infection-related complications. The aim of this study was to quantify the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) and physical activity levels of patients undertaking hemodialysis (HD). This was an observational study that compared data from two periods of time, before the COVID-19 pandemic vs pandemic. We used the Medical Outcomes Survey Short Form (SF-36) to measure the HRQoL and the Human Activity Profile (HAP) questionnaire was used to measure the physical activity. Data were analyzed with a mixed ordinal linear regression. A total of 27 eligible participants were interviewed during COVID-19 pandemic (median age 78 years). The linear regression model showed that the pandemic, after controlling for the covariates age, comorbidity, albumin, and hemoglobin, had a significant impact on the HRQoL. Physical function (-15.7) and social functioning subscales (-28.0) worsened (p = 0.001), and the physical component scale also showed a significant decrease (-3.6; p = 0.05). Time had a significant impact on the Human Activity Profile, with an average activity score diminished with the pandemic (-13.9; p = 0.003). The COVID-19 pandemic had a very negative impact on HRQoL and physical activity level of subjects undertaking hemodialysis. Interventions to improve HRQoL and activity levels of patients undertaking HD are recommended.
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Introducción y objetivo: La música ha estado estrechamente unida a la medicina desde la antigüedad, y ha aportado numerosos beneficios a la salud de los pacientes. El paciente con enfermedad renal crónica en tratamiento de hemodiálisis (HD), generalmente, presenta una calidad de vida relacionada con la salud (CVRS) inferior a los valores de referencia de la población general. El objetivo del presente estudio es verificar si la intervención de música clásica en directo e in situ durante el tratamiento de HD tiene efectos sobre la CVRS de los pacientes.Materiales y métodos: Se realizó un estudio de intervención, prospectivo y aleatorizado por grupos, en pacientes con enfermedad renal crónica en tratamiento con HD. Durante 4 semanas un grupo de pacientes recibía la intervención con música clásica en directo 30 o 40min durante las sesiones de HD, mientras el grupo control realizaba el tratamiento habitual. Variables descriptivas: edad, sexo, meses en tratamiento, Kt/V, hemoglobina y albúmina. Variable resultado: CVRS, se midió con el cuestionario de salud Kidney Diseasse Quality of life (KDQOL-SF) antes y después de la intervención musical. (AU)
Introduction and objective: Music has been closely linked to medicine since ancient times, and has brought numerous benefits to the health of patients. Patients with chronic kidney disease undergoing hemodialysis (HD) generally have a health-related quality of life (HRQL) lower than the reference values of the general population. The objective of the present study is to verify if the intervention of classical music live and in situ during the treatment of HD has effects on the HRQL of the patients.Materials and methods: A prospective, group-randomized intervention study of 4 weeks duration was carried out in patients with chronic kidney disease undergoing HD. Descriptive variables are included for data analysis: age, sex, months in treatment, Kt/V, hemoglobin and albumin. Result variable: HRQL, measured with the Kidney Disease health questionnaire Quality of Life (KDQOL-SF) before and after the musical intervention. (AU)
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Renal Insufficiency, Chronic , Music Therapy , Quality of Life , Renal Dialysis , Prospective Studies , Surveys and QuestionnairesABSTRACT
BACKGROUND: Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program. MATERIALS AND METHODS: Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program. RESULTS: The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests - 330 (95% CI:[- 533, - 126];p = 0.003), outpatient visits - 351 ([- 566, - 135];p = 0.003), and radiology tests - 111 ([- 209, - 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start. CONCLUSION: The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.
Subject(s)
Quality of Life , Virtual Reality , Exercise Therapy , Health Expenditures , Humans , Renal DialysisABSTRACT
Background: Chronic kidney disease is an exponentially growing medical and economic worldwide problem. There are specific elements used to assess patient's functional capacity loss and overall deterioration in order to determine the patient's clinical status, and muscle impairment is one of the most common. It is therefore necessary to develop reliable and applicable methods to determine muscle impairment in patients with chronic kidney disease. Methods: This is a prospective, nonexperimental, descriptive methodological investigation performed in patients undergoing hemodialysis. This study analyzes the reliability and validity of muscle strength assessments performed with handheld dynamometry in patients with chronic kidney disease undergoing hemodialysis. Results: Results show overall high reliability and validity in the assessment of muscle strength of the lower limbs. Conclusion: To our knowledge, this is the first study to assess handheld dynamometry in patients undergoing hemodialysis, presenting promising results with a relatively affordable and easily applicable method.
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BACKGROUND: Chronic kidney disease patients on hemodialysis treatment are characterized by increased levels of inflammatory markers and oxidative stress, in addition to a significant deterioration in physical function. The benefits of physical exercise on the functional capacity of this patients are well known; however, it can also improve the endogenous antioxidant defense system and the inflammatory state, but still very few studies have been carried out. This is the first study to analyze the effect of a 4-month exercise program with combined aerobic and strength training in patients undergoing hemodialysis, under two modalities. METHODS: Seventy-one patients undergoing hemodialysis were enrolled and randomized in two groups, one of them performing an intra-dialysis exercise program (n = 36), and the other carrying out a home-based exercise program (n = 35). Serum levels of oxidative stress and inflammation biomarkers were determined before and after the intervention. RESULTS: IL-6 plasma levels showed a significant decrease in the intra-dialysis group after exercise (42.61 ± 9.21 to 26.40 ± 7.84, p = 0.03), while CRP levels decreased significantly in the home-based group (16.12 ± 24.18 to 8.50 ± 11.28, p = 0.03). MCP-1, TNF-α, ICAM-1 and the oxidative stress markers MDA, GSH and GSSG, did not undergo significant changes after the intervention. CONCLUSION: Four months of combined strength and aerobic endurance exercise improve the inflammatory status of hemodialysis patients by significantly reducing IL-6 levels in those subjects who perform intra-dialysis exercise and CRP levels in those who do it at home.
Subject(s)
Interleukin-6 , Renal Dialysis , Biomarkers , Exercise , Humans , Oxidative Stress , Single-Blind MethodABSTRACT
BACKGROUND: Chronic kidney disease is closely related to a high risk of death and disability, poor physical performance and frailty. The main objective of this research was to analyse how intradialytic administration of a non-immersive virtual reality (VR) exercise programme would affect physical function and adherence to exercise in these patients. METHODS: A total of 56 individuals participated in two 12-week periods in a crossover randomized controlled trial. Each patient underwent a functional capacity evaluation before and after each study period. The functional tests administered included the 4-m gait speed test, Short Physical Performance Battery (SPPB), timed up-and-go (TUG) test, one-legged stance test (OLST) for balance, sit-to-stand 10 (STS-10) and sit-to-stand 60 (STS-60) tests and 6-min walking test (6MWT). Adherence to the exercise programme was also recorded. To assess the effect of VR exercise on the functional test outcomes over time, the patients were analysed using a two-way repeated-measures analysis of variance with time and treatment as the within-participant factors. RESULTS: By the end of the 12 weeks of exercise, compared with the control period, 33 participants showed significant change in physical function as measured through the 4-m gait speed test (0.14 m/s), SPPB (1.2 points), TUG (-1.7 s), OLST (7.1 s), STS-10 (-5.8 s), STS-60 (5 repetitions) and 6MWT (85.2 m), with adherence rates exceeding 70%. There were no changes in the biochemical data or in the medications in the period of the study. CONCLUSION: An intradialytic non-immersive VR exercise programme improves patient physical function.
Subject(s)
Exergaming , Walking Speed , Exercise , Exercise Therapy , Gait , Humans , Physical Functional PerformanceABSTRACT
Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.
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BACKGROUND: There are still many barriers when implementing exercise routines within daily dialysis care, even though benefits are well-known. Developing cost-effective strategies is necessary to overcome these barriers and include exercise as a complementary therapy in dialysis. AIM: To compare several exercise programs on hemodialysis patient's functional capacity and health-related quality of life. DESIGN: This study was a 16-week follow-up, two-parallel group trial with balanced randomization. SETTING: Participants in this study belonged to a private hospitalized care center. POPULATION: Referred sample of 71 patients that suffered end-stage chronic kidney disease who underwent hemodialysis for at least 3 months and had a medical stable condition. METHODS: Thirty-six participants performed for 16 weeks an intradialytic exercise program lead by the nursing staff of the hemodialysis unit and 35 a home-based program supervised by physical therapists of the hospital. RESULTS: The main researcher and the data analyst were both blinded to participant allocation. There was a significant effect in time for both groups. Participants improved significantly in the Short Performance Physical Battery (SPPB), One-Leg Heel-Rise (OLHR) and 6 Minute-Walk Test (6MWT), and in the Physical Activity Scale for the Elderly (PASE) and Short Survey Form 36 (SF-36) questionnaires. CONCLUSIONS: Nurse-led and home-based exercise interventions produce beneficial effects involving physical function, activity levels and health-related quality of life in patients undergoing hemodialysis. CLINICAL REHABILITATION IMPACT: The study emphasizes the importance of exercise rehabilitation routines in fragile populations such as dialysis patients, and the potential to overcome barriers for its daily implementation.
Subject(s)
Hemodialysis Units, Hospital , Quality of Life , Aged , Exercise , Exercise Therapy , Humans , Renal DialysisABSTRACT
BACKGROUND: The determination of Kt/V by ionic dialysance is a technique that has extended its use in hemodialysis clinics. The clinical guidelines have reflected the need to validate this method as a determinant of the dose of dialysis. OBJECTIVES: Determine in daily practice, the influence of hemodialysis characteristics and medication on Kt/V results by ionic dialysance (Kt/V OCM) and compare them with Kt/V measures by serum urea (Kt/V Daugirdas). DESIGN: Cross-sectional and observational study. PARTICIPANTS: 127 patients on chronic hemodialysis. MEASUREMENTS: Descriptive variables, study variables (Kt/VOCM, Kt/VDaugidas), and the variables that modified the effect (patient temperature, serum sodium, vascular access, recirculation, blood flow, hemodialysis technique, dialyzer, acid concentrate, conductivity, dialyzate flow). RESULTS: The mean of Kt/V Daugirdas was 1.84 and the Kt/VOCM mean 1.65; Pearson's was CC r=0.54; P<0.001 and Lin CCC=0.48. In the linear regression, the variables related to hemodialysis technique showed no statistical association with the measurement obtained by Kt/VOCM. Monosodium phosphate and 20% sodium chloride dispensing were associated with a higher Kt/VOCM. CONCLUSIONS: The different technical aspects noted during HD sessions do not influence Kt/V OCM outcomes. Kt/V determined by ionic dialysance isn't similar to that determined by serum urea. When assessing dialysis doses measured by dialysance, consider that it is not the same as determined with serum urea, but it provides an approximation to estimate dialysis doses in real time. It is necessary to consider if drugs or supplements have been administered that can modify it when interpreting the results.
Subject(s)
Renal Dialysis , Urea , Cross-Sectional Studies , Dialysis Solutions , Humans , IonsABSTRACT
Renal replacement treatment has not been generalized to the elderly for different reasons. The main objective of the present cohort study is to compare survival in patients older than 80 years with chronic kidney disease stage 5 on renal replacement treatment with those on conservative treatment. The use of healthcare resources is compared too. A Cox proportional hazards regression analysis was run with the outcome variable death during the follow-up period. The independent variables were treatment type, age, gender, smoking habit, serum albumin, hemoglobin, Charlson Index, diabetes mellitus, arterial hypertension, ischemic cardiopathy, and neoplasm. For outcome variable "death," renal replacement treatment obtained a hazard ratio of 0.273 (P .006, CI95% 0.108-0.686) vs conservative treatment. In conclusion, patients older than 80 years with chronic kidney disease stage 5 on renal replacement treatment presented a lower mortality risk than those receiving conservative treatment. Comorbidity and age are both associated with mortality, but do not cancel out the survival advantage. In healthcare resources, the renal replacement treatment group made greater use of tests, medical visits and consumption of hospital dispensing drugs, but there were no differences with respect to the days of hospital admission or assistance in home hospitalization.
Subject(s)
Conservative Treatment , Kidney Failure, Chronic/mortality , Kidney Failure, Chronic/therapy , Renal Dialysis , Utilization Review , Aged, 80 and over , Biomarkers/blood , Comorbidity , Female , Humans , Male , Retrospective Studies , Survival RateABSTRACT
Intradialytic exercise can improve physical function and health-related quality of life (HRQoL) in hemodialysis (HD) patients, but is not implemented in routine clinical practice. Virtual reality (VR) exercise has resulted in benefits in non-dialysis contexts, but implementation in HD patients has been limited. The aim of this review was to provide an overview of VR, present the results of a 12-week intradialytic VR exercise intervention, and compare VR to conventional exercise. The secondary aim was to review the effect of VR exercise during the last 30 minutes of the HD session on hemodynamic stability. We conclude that VR exercise during HD is safe and can improve physical function and HRQoL, and can be performed safely toward the end of the HD session.
Subject(s)
Exercise Therapy/methods , Kidney Failure, Chronic/therapy , Muscle Weakness/rehabilitation , Quality of Life , Renal Dialysis/methods , Virtual Reality , Aged , Female , Humans , Kidney Failure, Chronic/diagnosis , Male , Middle Aged , Muscle Weakness/etiology , Muscular Diseases/etiology , Muscular Diseases/rehabilitation , Renal Dialysis/adverse effects , Treatment OutcomeABSTRACT
It has been suggested that physical exercise in chronic hemodialysis could improve dialysis dose and reduce postdialysis rebound. A randomized controlled trial was performed to compare a group of patients doing physical exercise during the first 2 h of hemodialysis sessions and another group doing physical exercise at home. The descriptive variables, dialysis doses measured by KtV, and rebounds (urea, creatinine, potassium, phosphorus), were recorded. For 69 patients: the mean KtV was 1.84; the 30-min rebound of creatinine was 32.37%, urea 24.39%, potassium 15.31%, and phosphorus 51.29%. For each patient, the basal measurement was compared with those determined when performing physical exercise; no statistically significant differences were observed between the changes determined to dose and rebound in the group with hemodialysis exercise compared to those of the home exercise group. In conclusion, performing physical exercise during the first 2 hours of hemodialysis sessions neither lowered postdialysis molecules rebound nor improved dialysis dose.
Subject(s)
Exercise/physiology , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , Aged , Aged, 80 and over , Creatinine/metabolism , Female , Humans , Male , Middle Aged , Phosphorus/metabolism , Potassium/metabolism , Time Factors , Urea/metabolismABSTRACT
Fundamento y objetivo: El citomegalovirus (CMV) es uno de los agentes patógenos más importantes en el paciente trasplantado renal. Puede ocasionar infección y enfermedad, de graves consecuencias, directas e indirectas. Pacientes y método: Estudio observacional descriptivo retrospectivo de todos los trasplantes renales realizados en el Hospital La Fe entre 1994 y 2005 (n=996). El diagnóstico de infección o enfermedad por CMV se realizó mediante serología, cultivo, determinación de antigenemia pp65 o cuantificación de CMV por reacción en cadena de la polimerasa (PCR) en sangre periférica. La profilaxis recibida fue aciclovir en 20 pacientes (2,4%), ganciclovir en 478 (56,8%), valganciclovir en 166 (19,7%,) y ninguna en 178 (21%). Resultados: La serología para CMV era positiva en 802 donantes (83%) y en 860 receptores (89%). Entre los receptores que padecieron enfermedad por CMV (N=60), perdieron el injerto cuatro y fallecieron seis. La infección precoz y la enfermedad precoz fueron significativamente más frecuentes (p<0,05) en los casos donante positivo-receptor negativo (D+/R-). Padecer infección precoz o tardía se asociaba a muerte por cualquier causa (odds ratio [OR] 2,03, intervalo de confianza del 95% [IC 95%] 1,24-3,31, p<0,05). La enfermedad precoz o tardía por CMV se asociaba a mayor pérdida del injerto por cualquier causa (OR 1,97, IC 95% 1,14-3,43, p<0,05). Tras regresión logística permanecía significativa la asociación entre infección por CMV y muerte por cualquier causa. Conclusiones: En pacientes con trasplante renal, presentar infección por CMV se asocia a muerte por cualquier causa (AU)
Background and objective: Cytomegalovirus (CMV) is one of the most important pathogens in renal transplant patients. It can cause infection and illness, as well as serious direct and indirect consequences. Patients and method: Descriptive retrospective observational study of all kidney transplants performed in the Hospital La Fe of Valencia between 1994 and 2005 (n=996). The diagnosis of CMV disease and disease was performed by serology, culture, pp65 antigenemia determination or quantification of CMV-PCR (polymerase chain reaction) in peripheral blood. Prophylaxis included acyclovir in 20 patients (2.4%), ganciclovir in 478 (56.8%), valganciclovir in 166 (19.7%) and none in 178 (21%). Results: CMV serology was positive in 802 donors (83%) and in 860 recipients (89%). Among the recipients who suffered from CMV disease (N=60), four lost the graft and six died. Early infection and early disease were significantly more frequent (p<0.05) in positive donor-negative recipient cases (D+/R-). Having early or late infection was associated with death from any cause (OR 2.03, CI 95% 1.24 to 3.31, p<0.05). Early or late CMV infection was associated with increased graft loss from any cause (OR 1.97, CI 95% 1.14 to 3.43, p<0.05). After logistic regression, the association between CMV infection and death from all causes remained significant. Conclusions: In renal transplant patients, having CMV infection was associated with death from any cause (AU)
Subject(s)
Humans , Kidney Transplantation/adverse effects , Cytomegalovirus Infections/complications , Cytomegalovirus/pathogenicity , Tissue Donors/statistics & numerical data , Donor Selection/standardsABSTRACT
BACKGROUND AND OBJECTIVE: Cytomegalovirus (CMV) is one of the most important pathogens in renal transplant patients. It can cause infection and illness, as well as serious direct and indirect consequences. PATIENTS AND METHOD: Descriptive retrospective observational study of all kidney transplants performed in the Hospital La Fe of Valencia between 1994 and 2005 (n=996). The diagnosis of CMV disease and disease was performed by serology, culture, pp65 antigenemia determination or quantification of CMV-PCR (polymerase chain reaction) in peripheral blood. Prophylaxis included acyclovir in 20 patients (2.4%), ganciclovir in 478 (56.8%), valganciclovir in 166 (19.7%) and none in 178 (21%). RESULTS: CMV serology was positive in 802 donors (83%) and in 860 recipients (89%). Among the recipients who suffered from CMV disease (N=60), four lost the graft and six died. Early infection and early disease were significantly more frequent (p<0.05) in positive donor-negative recipient cases (D+/R-). Having early or late infection was associated with death from any cause (OR 2.03, CI 95% 1.24 to 3.31, p<0.05). Early or late CMV infection was associated with increased graft loss from any cause (OR 1.97, CI 95% 1.14 to 3.43, p<0.05). After logistic regression, the association between CMV infection and death from all causes remained significant. CONCLUSIONS: In renal transplant patients, having CMV infection was associated with death from any cause.
Subject(s)
Cytomegalovirus Infections/epidemiology , Kidney Transplantation , Postoperative Complications/epidemiology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Young AdultABSTRACT
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Subject(s)
Female , Middle Aged , Humans , Hypertension/complications , Osteoporosis, Postmenopausal/complications , Bone Density , Fosinopril/pharmacokineticsABSTRACT
BACKGROUND AND OBJECTIVE: The renin-angiotensin system (SRA) acts on the bone metabolism and decreases the mineralization. Menopausal women frequently are hypertense and have risk of developing osteoporosis. The inhibition of SRA could favour the mineralization and protect the bone mass of hypertense women in treatment with antihypertensive drugs that are angiotensin converting enzyme inhibitors. PATIENTS AND METHOD: Cohorts prospective study. 50 menopausal women were recruited and divided in one cohort of non hypertense patients and one cohort of hypertense women who initiated antihypertensive treatment with oral fosinopril. Baseline and after 1 year bone mineral density of lumbar spine and femoral neck was made. RESULTS: There were no significant differences between the bone mass of both groups. Significant changes between the baseline and after the treatment were not demonstrated in the cohort exposed. In the group of non exposed women were demonstrated differences in lumbar spine (baseline, 0.874 g/cm(2); final, 0.854 g/cm(2); p = 0.002) and femoral neck (baseline, 0.743 g/cm(2); final, 0.725 g/cm(2); p = 0.016). CONCLUSIONS: The menopausal and hypertense women who followed treatment with fosinopril did not present the physiological loss of bone mass that affected to menopausal women without treatment.
