ABSTRACT
BACKGROUND: Chronic kidney failure (CRF) in addition to cardiovascular comorbidities and aging decrease physical activity capacity. An adapted rehabilitation program might be strongly recommended in this population. The aim of the study is to evaluate a 3 months exercise training program with ergocycle at the anaerobic threshold (AT) during dialysis sessions on effort tolerance, quality of life, blood pressure and lipidic disorders. METHODS: Six patients meanly aged 72 were evaluated before (t(0)) and after (t(3)) the rehabilitation program by: maximal cardiorespiratory ergotest, a 6-Minute Walk Test (6MWT) and 2 quality of life tests: Medical Outcome Survey Short Form 36-items and the Kidney Disease Quality of Life (SF 36, KDQol). RESULTS: Physical activity during dialysis is well tolerated. There was no undesirable event during rehabilitation sessions. The dyspnea and muscular weariness threshold linked to the AT increased meanly by 39% (8.83 ± 0.87 vs. 12.25 ± 1.23 mL/min per kg). Distances walked during 6 MWT increased for all patients (351.83 ± 72.17 vs. 412.80 ± 82 meters) Moreover, physical component scale improved (+4.7), mean systolic blood pressure (-7 mmHg) and mean triglycerides concentration (-19%) decreased. CONCLUSION: An exercise training program during dialysis sessions with ergocycle and working intensity based on AT seems safe and an effective alternative to improve the effort functional capacity by hemodialysis patients.
Subject(s)
Anaerobic Threshold , Exercise Therapy/methods , Exercise Tolerance/physiology , Exercise/physiology , Kidney Failure, Chronic/rehabilitation , Aged , Blood Pressure , Female , Humans , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Lipids/blood , Male , Middle Aged , Oxygen Consumption , Quality of Life , Renal Dialysis , Walking/physiologyABSTRACT
BACKGROUND: Few studies specifically investigating elderly patients on peritoneal dialysis (PD) have been conducted and great uncertainty remains on the factors involved in the vital prognosis. The objective of this study was to describe our population of patients aged 75 years or older at the time PD was initiated and to study their survival in terms of the relevant nephro-geriatric criteria inventoried at the beginning of treatment. METHODS: We retrospectively analyzed the data of all the elderly patients that began first-line PD in our center between 1 January 1997 and 31 July 2006 (n = 112). RESULTS: Mean duration of survival on PD was 19.6 +/- 13.9 months; by the end of the study 87 patients had died and 7 had been transferred to hemodialysis. The Cox model multivariate analysis of survival allowed us to select 5 independent predictive variables that had a considerable impact on survival: absence of nephrologic care before dialysis, associated comorbidities (Charlson Comorbidity Index), loss of physical and/or mental autonomy (AGGIR group), and polymedication. Above and beyond the weight of these clinical variables, institutionalization or, more generally, social isolation was a determining factor for the duration of survival in PD. CONCLUSION: Any patient considered for peritoneal dialysis should be evaluated by a multidisciplinary team in collaboration with geriatric specialists for both the overall medical situation and the social and family environment.
Subject(s)
Peritoneal Dialysis , Renal Insufficiency/mortality , Renal Insufficiency/therapy , Aged , Aged, 80 and over , Female , Humans , Male , Multivariate Analysis , Prognosis , Retrospective Studies , Survival Rate , Time FactorsABSTRACT
BACKGROUND: The assessment of the peritoneal membrane capacity and physiology of the individual patient is becoming increasingly important. It allows the prescription of an individualized peritoneal dialysis (PD)-regimen, and the monitoring of peritoneal membrane function over time. The PDC(TM) program offers the possibility to evaluate the peritoneal membrane characteristics and to predict solute and water removal by simulation of different treatment regimens. METHODS: This study evaluates the relevance of the PDC(TM) program when routinely used. The PDC(TM) data of 336 patients from nine different centres in Europe were evaluated. RESULTS: The area parameter was 20 985+/-7578 cm/1.73 m(2) (mean+/-SD). The reabsorption of fluid after dissipation of glucose, Jv(AR), was 1.97+/-1.00 ml/min/1.73 m(2). The large pore fluid flux, Jv(L), was 0.11+/-0.07 ml/min/1.73 m(2). A multivariate model for prediction of serum albumin included dialysate protein loss, Jv(L), Jv(AR), nPCR, A(0)/deltaX, BMI and gender (R(2)=0.81, P<0.001). Total clearance fell with increasing PD duration (P<0.001). A negative relation between A(0)/deltaX and ultrafiltration (rho=-0.26, P<0.05), a positive relation between A(0)/deltaX and peritoneal creatinine clearance (rho=0.52, P<0.05) and urea clearance (rho=0.36, P<0.05), and a positive relation between measured peritoneal creatinine and urea clearance (rho=0.64, P<0.01) was observed. CONCLUSIONS: In summary, the present study shows that the PDC(TM) program is a robust, accurate method to describe the peritoneal membrane transport characteristics. Analysis of PDC(TM) data of large groups of patients, especially if followed up over time, can give interesting information on the physiology of the peritoneal membrane and the impact of different parameters on it.
