ABSTRACT
BACKGROUND: The arteriovenous (AV) access function of hemodialysis (HD) patients can be impaired by afferent artery stiffness due to preexisting microcalcification and by venous stenosis secondary to neointimal hyperplasia in whose development participates an upregulated local inflammatory process. Fetuin-A is a circulating potent inhibitor of vascular calcification and plays an important anti-inflammatory role. The aims of this prospective study were to investigate the relationship between baseline serum fetuin-A levels and: blood flow (QA) values at baseline, AV access failure (thrombosis or intervention for stenosis) during follow-up and primary unassisted AV access patency. METHODS: We measured baseline serum fetuin-A levels and QA values of the AV access in 64 HD patients under routine QA surveillance for stenosis. Patients were classified into tertiles according to their baseline fetuin-A levels (g/L): <0.5 (tertile-1), 0.5-1.20 (tertile-2), and >1.20 (tertile-3). RESULTS: Fetuin-A was positively correlated with QA (Spearman coefficient = 0.311, p = 0.012). Fourteen patients (21.9%) underwent AV access failure and they had lower fetuin-A (0.59 ± 0.32 g/L) and lower QA (739.4 ± 438.8 mL/min) values at baseline compared with the remaining patients (1.05 ± 0.65 g/L and 1273.0 ± 596.3 mL/min, respectively) (p = 0.027 and p < 0.001, respectively). The AV access failure rate was highest (34.8%) in tertile-1 (lowest fetuin-A level). Unadjusted Cox regression analysis showed a decrease in the risk of AV access patency loss by increasing fetuin-A concentration (hazard ratio 0.395 (95% confidence interval: 1.42-1.69), p = 0.044) but it was not confirmed in the adjusted model, although the hazard ratio was low (0.523). Kaplan-Meier analysis showed that patients in tertile-3 (highest fetuin-A concentration) had the highest primary unassisted AV access patency (λ2 = 4.68, p = 0.030, log-rank test). CONCLUSION: If our results are confirmed in further studies, fetuin-A could be used as a circulating biomarker to identify HD patients at greater risk for AV access dysfunction, who would benefit from much closer dialysis access surveillance.
Subject(s)
Arteriovenous Shunt, Surgical , Renal Dialysis , Humans , Renal Dialysis/adverse effects , alpha-2-HS-Glycoprotein , Prospective Studies , Constriction, Pathologic/etiology , Arteriovenous Shunt, Surgical/adverse effects , Biomarkers , Vascular PatencyABSTRACT
Introducción: El síndrome de piernas inquietas (SPI) es un trastorno neurológico caracterizado por una molesta sintomatología, asociado a deterioro de calidad de vida e higiene de sueño. Rotigotina constituye una novedosa alternativa terapéutica, si bien existen escasos estudios publicados sobre rotigotina en pacientes en hemodiálisis (HD) con SPI. Objetivos: 1.- Establecer la prevalencia de SPI en nuestra unidad de HD. 2.- Evaluar la eficacia y el perfil de seguridad asociado a rotigotina así como su efecto sobre la sintomatología, calidad de vida e higiene del sueño en nuestra población en HD con SPI. Material y métodos: Estudio unicéntrico, prospectivo de 12 semanas de duración. Dos fases (6 semanas): fase 1 (no tratamiento) y fase 2 (rotigotina). Analizamos: 1.- Datos demográficos, bioquímicos, parámetros de adecuación de HD y tratamiento médico relacionado con SPI. 2.- Cuestionario sobre síntomas en extremidades inferiores (QS). 3.- Escala de gravedad de los síntomas (GRLS). 4.- Calidad de vida SPI: John Hopkins RLS-QoL (JH-QoL). 5.- Higiene del sueño: Escala SCOPA. Resultados: Se incluyó a 66 pacientes en HD. De ellos, 14 con SPI; el 44,4% eran hombres, con 70,2±9,9 años y 111,1±160,8 meses en HD. El 22,9%, con SPI. Únicamente en la fase 2 observamos una mejoría significativa para QS (10±2,4 vs. 5,7±1,0), GRLS (21±4 vs. 5,7±4,6), JH-QoL (22,1±4,4 vs. 4,3±4,0) y SCOPA (16±5,3 vs. 6,7±1,9). Un 77,7 y un 11,1% presentaron remisión parcial (>20%) y completa (>80%), respectivamente. Un 55,5% alcanzó sintomatología «cero». Un único paciente presentó intolerancia digestiva y ninguno, augmentation efect. No observamos cambios en datos bioquímicos, adecuación dialítica ni tratamiento médico. El análisis intergrupos mostró una mejoría significativa en la fase 2 con relación a QS, GRLSS, JH-QoL y SCOPA. Conclusiones: En nuestro estudio, el SPI urémico presentó una prevalencia considerable. Rotigotina mejoró la sintomatología clínica, la calidad de vida y la higiene de sueño en los pacientes con SPI en HD, por lo que resulta ser un fármaco seguro, con mínimos efectos adversos y con cumplimento terapéutico completo. No obstante, serían necesarios futuros estudios para confirmar el beneficio de rotigotina en la población en HD con SPI (AU)
Background: Restless legs syndrome (RLS) is a neurological disorder characterised by bothersome symptoms associated with impaired quality of life and sleep hygiene. Rotigotine is a novel therapeutic alternative, although few studies have been published in patients on haemodialysis (HD) with RLS treated with rotigotine. Objectives: 1.- To establish the prevalence of RLS in our HD unit. 2.- To evaluate the efficacy and safety profile of rotigotine and its effect on symptoms, quality of life and sleep hygiene in our HD population with RLS. Material and methods: A single-centre, 12-week prospective study. Two stages (6 weeks): stage 1 (no treatment) and stage 2 (rotigotine). We analysed: 1.- Demographic data, biochemistry data, HD suitability parameters and RLS medical treatment data. 2.- Lower extremity symptoms questionnaire (QS). 3.- RLS severity symptoms scale (SRLSS). 4.- RLS Quality of life: John Hopkins RLS-QoL (JH-QoL). 5.- Sleep hygiene: SCOPA Scale. Results: We included 66 HD patients, 14 with RLS; 44.4% male, 70.2±9.9 years and 111.1±160.8 months on HD. And 22.9% RLS. Exclusively in stage 2, a significant improvement for QS (10±2.4 vs. 5.7±1.0), SRLSS (21±4 vs. 5.7±4.6), JH-QoL (22.1±4.4 vs. 4.3±4.0) and SCOPA (16±5.3 vs. 6.7±1.9) were observed. A 77.7 and 11.1%, showed partial (> 20%) and complete (> 80%) remission, respectively, while 55.5% achieved «zero» symptoms. Only one patient had gastrointestinal intolerance and none experienced augmentation effect. No changes in biochemical data, suitability for dialysis or medical treatment were found. The inter-group analysis showed a significant improvement in relation to QS, SRLSS, JH-QoL and SCOPA in stage 2. Conclusions: RLS showed a considerable prevalence in our HD unit. Rotigotine improved clinical symptoms, quality of life and sleep hygiene in RLS patients on HD and was found to be a safe drug with minimal side effects and total therapeutic compliance. Nevertheless, future studies should be performed to confirm the benefits of rotigotine in RLS patients on haemodialysis (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Restless Legs Syndrome/epidemiology , Restless Legs Syndrome/drug therapy , Quality of Life , Sleep Hygiene , Renal Dialysis/methods , Treatment Outcome , Dopamine Agonists/therapeutic use , Prospective Studies , Severity of Illness Index , Uremia/complications , Uremia/diagnosis , Surveys and Questionnaires , 28599 , Renal Insufficiency, Chronic/etiologyABSTRACT
BACKGROUND: Restless legs syndrome (RLS) is a neurological disorder characterised by bothersome symptoms associated with impaired quality of life and sleep hygiene. Rotigotine is a novel therapeutic alternative, although few studies have been published in patients on haemodialysis (HD) with RLS treated with rotigotine. OBJECTIVES: 1.- To establish the prevalence of RLS in our HD unit. 2.- To evaluate the efficacy and safety profile of rotigotine and its effect on symptoms, quality of life and sleep hygiene in our HD population with RLS. MATERIAL AND METHODS: A single-centre, 12-week prospective study. Two stages (6 weeks): stage 1 (no treatment) and stage 2 (rotigotine). We analysed: 1.- Demographic data, biochemistry data, HD suitability parameters and RLS medical treatment data. 2.- Lower extremity symptoms questionnaire (QS). 3.- RLS severity symptoms scale (SRLSS). 4.- RLS Quality of life: John Hopkins RLS-QoL (JH-QoL). 5.- Sleep hygiene: SCOPA Scale. RESULTS: We included 66 HD patients, 14 with RLS; 44.4% male, 70.2±9.9 years and 111.1±160.8 months on HD. And 22.9% RLS. Exclusively in stage 2, a significant improvement for QS (10±2.4 vs. 5.7±1.0), SRLSS (21±4 vs. 5.7±4.6), JH-QoL (22.1±4.4 vs. 4.3±4.0) and SCOPA (16±5.3 vs. 6.7±1.9) were observed. A 77.7 and 11.1%, showed partial (> 20%) and complete (> 80%) remission, respectively, while 55.5% achieved «zero¼ symptoms. Only one patient had gastrointestinal intolerance and none experienced augmentation effect. No changes in biochemical data, suitability for dialysis or medical treatment were found. The inter-group analysis showed a significant improvement in relation to QS, SRLSS, JH-QoL and SCOPA in stage 2. CONCLUSIONS: RLS showed a considerable prevalence in our HD unit. Rotigotine improved clinical symptoms, quality of life and sleep hygiene in RLS patients on HD and was found to be a safe drug with minimal side effects and total therapeutic compliance. Nevertheless, future studies should be performed to confirm the benefits of rotigotine in RLS patients on haemodialysis.
Subject(s)
Dopamine Agonists/therapeutic use , Renal Dialysis/adverse effects , Restless Legs Syndrome/drug therapy , Tetrahydronaphthalenes/therapeutic use , Thiophenes/therapeutic use , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Quality of Life , Restless Legs Syndrome/etiology , Restless Legs Syndrome/psychology , Severity of Illness Index , Sleep Hygiene , Treatment OutcomeABSTRACT
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.
Subject(s)
Arteriovenous Shunt, Surgical/standards , Renal Dialysis/methods , Vascular Access Devices/standards , Aneurysm/etiology , Aneurysm/surgery , Angioplasty/methods , Antibiotic Prophylaxis/standards , Arteriovenous Shunt, Surgical/adverse effects , Arteriovenous Shunt, Surgical/instrumentation , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/methods , Catheterization, Peripheral/standards , Clinical Decision-Making , Constriction, Pathologic , Equipment Failure , Evidence-Based Medicine , Humans , Infection Control , Needles , Physical Examination , Rheology , Spain , Thrombosis/etiology , Thrombosis/prevention & control , Thrombosis/therapy , Vascular Access Devices/adverse effectsABSTRACT
El acceso vascular para hemodiálisis es esencial para el enfermo renal tanto por su morbimortalidad asociada como por su repercusión en la calidad de vida. El proceso que va desde la creación y mantenimiento del acceso vascular hasta el tratamiento de sus complicaciones constituye un reto para la toma de decisiones debido a la complejidad de la patología existente y a la diversidad de especialidades involucradas. Con el fin de conseguir un abordaje consensuado, el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV), que incluye expertos de las cinco sociedades científicas implicadas (nefrología [S.E.N.], cirugía vascular [SEACV], radiología vascular e intervencionista [SERAM-SERVEI], enfermedades infecciosas [SEIMC] y enfermería nefrológica [SEDEN]), con el soporte metodológico del Centro Cochrane Iberoamericano, ha realizado una actualización de la Guía del Acceso Vascular para Hemodiálisis publicada en 2005. Esta guía mantiene una estructura similar, revisando la evidencia sin renunciar a la vertiente docente, pero se aportan como novedades, por un lado, la metodología en su elaboración, siguiendo las directrices del sistema GRADE con el objetivo de traducir esta revisión sistemática de la evidencia en recomendaciones que faciliten la toma de decisiones en la práctica clínica habitual y, por otro, el establecimiento de indicadores de calidad que permitan monitorizar la calidad asistencial (AU)
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare (AU)
Subject(s)
Humans , Vascular Access Devices , Renal Dialysis/methods , Renal Dialysis/trends , Arteriovenous Fistula/epidemiology , Catheterization, Central Venous/methods , Quality of Life , Renal Dialysis/instrumentation , Arteriovenous Fistula/prevention & control , Catheter Ablation/methods , Quality Indicators, Health Care , Angioplasty/methodsABSTRACT
Introducción: Los pacientes en hemodiálisis (HD) se caracterizan por una gran pérdida muscular. Recientemente, la electroestimulación neuromuscular (EENM) constituye una nueva alternativa terapéutica para mejorar la condición física de estos pacientes. No existen estudios acerca de la EENM sobre la composición corporal en HD. Objetivo: Analizar el efecto de la EENM sobre la fuerza muscular, capacidad funcional y composición corporal en nuestros pacientes en HD. Material y métodos: Estudio prospectivo unicéntrico (12 semanas). Los pacientes fueron asignados a grupo electroestimulación (EM) o control (CO). El grupo EM incluía un programa de electroestimulación cuadricipital intradiálisis (Compex® Theta 500i). El grupo C recibió cuidado habitual en HD. Analizamos: 1) parámetros nutricionales; 2) composición muscular del cuádriceps; 3) fuerza de extensión máxima del cuádriceps (FEMQ) y handgrip (HG); 4) sit to stand to sit (STS10), six-minutes walking test (6MWT) y 5) composición corporal (bioimpedancia eléctrica). Resultados: De un total de 20 pacientes, el 55% fueron hombres. Edad media: 67,7 años, con 30,3 meses en HD. Principal etiología: DM (35%). Hubo 13 pacientes en EM y 7 en el grupo CO. Al final del estudio, únicamente EM presentó mejoría en (*p<0,05): FEMQ* (11,7±7,1 vs. 13,4±7,4kg), STS10 (39,3±15,5 vs. 35,8±13,7s) y 6MWT* (9,9%; 293,2 vs. 325,2m). Igualmente, el grupo EM incrementó el área muscular (AMQ*: 128,6±30,2 vs. 144,6±22,4cm2) y disminuyó el área grasa cuadricipital (AGQ*: 76,5±26,9 vs. 62,1±20,1cm2). No se observaron cambios relevantes en el resto de la composición corporal, parámetros nutricionales ni adecuación dialítica. Conclusiones: 1) La EENM mejoró la fuerza muscular, la capacidad funcional y la composición muscular del cuádriceps de nuestros pacientes. 2) Con los resultados obtenidos, la EENM podría ser una nueva alternativa terapéutica para evitar la atrofia muscular y el deterioro progresivo de la condición física de estos pacientes. 3) No obstante, serían necesarios futuros estudios para establecer los potenciales efectos beneficiosos de la EENM en los pacientes en HD (AU)
Introduction: Haemodialysis (HD) patients are characterised by significant muscle loss. Recently, neuromuscular electrical stimulation (NMES) has emerged as a new therapeutic alternative to improve these patients physical condition. To date, no studies on the effects of NMES on body composition in HD patients have been published. Objective: To analyse the effect of NMES on muscle strength, functional capacity and body composition in our HD patients. Material and methods: A 12-week, single-centre, prospective study. The patients were assigned to an electrical stimulation (ES) or control (CO) group. The ES group was subjected to intradialytic electrical stimulation of the quadriceps (Compex® Theta 500i), while the CO group received standard HD care. We analysed the following: 1) nutritional parameters; 2) muscle composition of the quadriceps; 3) maximum quadriceps extension strength (mes) and hand-grip (HG); 4) «sit to stand to sit» (STS10) and «six-minute walking test» (6MWT); 5) body composition (bioelectrical impedance analysis). Results: Of 20 patients, 55% were men. Mean age 67.7 years, 30.3 months in HD. Main aetiology: DM (35%). In the ES group were 13 patients, and 7 in the CO group. At the end of the study, an improvement was only observed in the ES group (*P<.05): MES* (11.7±7.1 vs. 13.4±7.4kg), STS10 (39.3±15.5 vs. 35.8±13.7s) and 6MWT* (9.9%, 293.2 vs. 325.2m). Furthermore, increased quadriceps muscle area (QMA*: 128.6±30.2 vs. 144.6±22.4cm2) and lowered quadriceps fat area (QFA*: 76.5±26.9 vs. 62.1±20.1cm2) were observed. No relevant changes in body composition, nutritional parameters and dialysis adequacy were found. Conclusions: 1) NMES improved muscle strength, functional capacity and quadriceps muscle composition in our patients. 2) Based on the results obtained, NMES could be a new therapeutic alternative to prevent muscle atrophy and progressive physical deterioration. 3) However, future studies are necessary to establish the potential beneficial effects of NMES in HD patients (AU)
Subject(s)
Humans , Electric Stimulation/methods , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , Muscle Strength/physiology , Body Composition/physiology , Rhabdomyolysis/epidemiology , Prospective StudiesABSTRACT
INTRODUCTION: Haemodialysis (HD) patients are characterised by significant muscle loss. Recently, neuromuscular electrical stimulation (NMES) has emerged as a new therapeutic alternative to improve these patients' physical condition. To date, no studies on the effects of NMES on body composition in HD patients have been published. OBJECTIVE: To analyse the effect of NMES on muscle strength, functional capacity and body composition in our HD patients. MATERIAL AND METHODS: A 12-week, single-centre, prospective study. The patients were assigned to an electrical stimulation (ES) or control (CO) group. The ES group was subjected to intradialytic electrical stimulation of the quadriceps (Compex® Theta 500i), while the CO group received standard HD care. We analysed the following: 1) nutritional parameters; 2) muscle composition of the quadriceps; 3) maximum quadriceps extension strength (mes) and hand-grip (HG); 4) «sit to stand to sit¼ (STS10) and «six-minute walking test¼ (6MWT); 5) body composition (bioelectrical impedance analysis). RESULTS: Of 20 patients, 55% were men. Mean age 67.7 years, 30.3 months in HD. Main aetiology: DM (35%). In the ES group were 13 patients, and 7 in the CO group. At the end of the study, an improvement was only observed in the ES group (*P<.05): MES* (11.7±7.1 vs. 13.4±7.4kg), STS10 (39.3±15.5 vs. 35.8±13.7s) and 6MWT* (9.9%, 293.2 vs. 325.2m). Furthermore, increased quadriceps muscle area (QMA*: 128.6±30.2 vs. 144.6±22.4cm2) and lowered quadriceps fat area (QFA*: 76.5±26.9 vs. 62.1±20.1cm2) were observed. No relevant changes in body composition, nutritional parameters and dialysis adequacy were found. CONCLUSIONS: 1) NMES improved muscle strength, functional capacity and quadriceps muscle composition in our patients. 2) Based on the results obtained, NMES could be a new therapeutic alternative to prevent muscle atrophy and progressive physical deterioration. 3) However, future studies are necessary to establish the potential beneficial effects of NMES in HD patients.
Subject(s)
Muscle Strength , Muscular Atrophy/prevention & control , Renal Dialysis/adverse effects , Transcutaneous Electric Nerve Stimulation , Aged , Aged, 80 and over , Body Composition , Electric Impedance , Female , Humans , Male , Middle Aged , Muscle Strength Dynamometer , Muscular Atrophy/etiology , Muscular Atrophy/therapy , Prospective Studies , Quadriceps Muscle/pathology , Quadriceps Muscle/physiopathologyABSTRACT
Introducción: La capacidad funcional disminuida y la importante atrofia muscular caracterizan a los pacientes en hemodiálisis (HD). El ejercicio físico intradiálisis y recientemente la electroestimulación neuromuscular (EMS), representan dos serias opciones terapéuticas para mejorar esta deteriorada condición física. Actualmente, no existen estudios publicados sobre el papel de la EMS y la composición corporal en los pacientes en HD. Objetivo: Analizar que efecto produce un programa de EMS sobre la fuerza muscular, capacidad funcional, parámetros nutricionales y composición corporal en nuestros pacientes en HD. Material y Métodos: Estudio unicéntrico, prospectivo de 12 semanas de duración. Los pacientes incluidos realizaron un programa adaptativo de EMS en ambos cuádriceps intradiálisis mediante el dispositivo Compex R Theta 500i. Analizamos: 1.- Parámetros nutricionales (Albumina, pre albúmina, triglicéridos, colesterol total y fracciones, ferritina y Proteína C reactiva). 2.- Datos musculares: Composición muscular cuadriceps, Fuerza extensión máxima cuádriceps (FEMQ) y handgrip (HG) brazo dominante. 3.- Test funcionales: Sit to stand to sit (STS10) y six- minutes walking test (6MWT). 4.- Composición corporal mediante biompedancia electrica (BIA). Resultados: 13 pacientes incluidos: (69.2% hombres). Edad media: 65.7 años y 33.9 meses en HD. I.Charlson medio 9.1. La principal etiología de la ERC fue la DM ( 38.5%). Al final del estudio se observó una mejoría en (*p<0.05): FEMQ* ( 11.7±7.1 vs 13.4±7.4 Kg), STS10 (39.3±15.5 vs 35.8±13.7 seg), 6MWT* (9.9%, 293.2 vs 325.2 m). En relación a la composición corporal, se observó únicamente un aumento significativo del área muscular (AMQ*: 128.6 ± 30.2 vs 144.6 ± 22.4 cm2) y una disminución del área grasa (AGQ*: 76.5 ± 26.9 vs 62.1 ± 20.1 cm2) a nivel quadricipital, sin cambios en el resto de datos analizados (% grasa abdominal, peso graso, peso magro, agua corporal total). No se objetivaron cambios relevantes en los parámetros nutricionales y de adecuación dialítica. Conclusiones: 1.- La electroestimulación neuromuscular intradialísis mejoró la fuerza muscular, la capacidad funcional y la composición muscular del cuadriceps de nuestros pacientes en HD. 2.- Nuestros resultados remarcan el carácter local de la electroes-timulación neuromuscular, dada la ausencia de cambios relevantes en el resto de los parámetros nutricionales y datos corporales analizados. 3.- No obstante, son necesarios futuros estudios mejor diseñados, de cara a discernir si la electroestimulación neuromuscular podría ser una nueva alternativa terapéutica para evitar la atrofia muscular y el deterioro progresivo de la condición física de éstos pacientes (AU)
Background: The reduced functional capacity and significant muscle atrophy characterized patients on hemodialysis. Intradialytic exercise and recently neuromuscular electrostimulation (EMS) represent two serious therapeutical options to improve the deteriorated physical condition. Until date, there are no published studies about the role of EMS and body composition in HD patients. Objectives: Analyze the effect a program of EMS on muscle strength, functional capacity, nutritional parameters and body composition in our HD patients. Methods: A 12 weeks single-center, prospective study. Patients included in the study performed an intradialysis EMS adaptive program in both quadriceps using the Compex R Theta 500i device. We analyzed: 1.- Nutritional parameters (albumin, pre-albumin, triglycerides, total cholesterol and fractions, ferritin and C-reactive protein). 2.- Muscular data: Muscular composition, Maximum length quadriceps strength (MLQS) and hand-grip (HG) dominant arm. 3.- Functional capacity test: Sit to stand to sit (STS10) and six- minutes walking test (6MWT). 4.- Body composition. Results: 13 HD patients included: 69.2 % men. Mean age 65.7 years and 33.9 months on HD. A significant (* p < 0,05) improvement was observed in MLQS* (11.7±7.1 vs 13.4±7.4 Kg), STS10* (39.3±15.5 vs 35.8±13.7 seg), 6MWT* (9.9%, 293.2 vs 325.2 m). There was a signi-ficant increase in the quadriceps muscular area (QMA*: 128.6 ± 30.2 vs 144.6 ± 22.4 cm2) and decrease of fat quadricipital area (FQA*: 76.5 ± 26.9 vs 62.1 ± 20.1 cm2). No significant changes were observed in nutritional parameters, body composition (body fat percentage, lean and fat mass, total body water) or dialysis adecuacy data. Conclusions: 1.- Intradialysis quadriceps EMS improved muscle strength, functional capacity and the quadriceps muscle composition in our HD patients. 2.- Our results underline the local aspects on EMS, given the absence of relevant changes on nutritional parameters and body composition. 3.- Future studies are manadatory in order to establish if EMS could be a new alternative to prevent muscle atrophy and the progressive deterioration of the physical condition of these patients (AU)
Subject(s)
Humans , Male , Female , Transcutaneous Electric Nerve Stimulation/instrumentation , Transcutaneous Electric Nerve Stimulation/methods , Neuromuscular Agents/administration & dosage , Renal Dialysis/methods , Motor Activity/genetics , Muscular Atrophy/complications , Muscular Atrophy/metabolism , Helsinki Declaration , Quadriceps Muscle/abnormalities , Transcutaneous Electric Nerve Stimulation/standards , Transcutaneous Electric Nerve Stimulation , Neuromuscular Agents/metabolism , Renal Dialysis/standards , Renal Dialysis , Motor Activity/physiology , Muscular Atrophy/blood , Muscular Atrophy/diagnosis , Quadriceps Muscle/injuries , Prospective StudiesABSTRACT
BACKGROUND: Elderly patients on haemodialysis (HD) are a steadily increasing group. They show a high complexity, dependency and comorbidity. Multiple benefits from exercise in HD patients have been reported; however, they have not been specifically evaluated in an elderly population. OBJECTIVE: To assess the effect of an adapted low intensity intradialytic exercise programme on muscle strength, functional capacity and health-related quality of life in our elderly patients (> 80 years) on HD. MATERIAL AND METHODS: HD patients were non-randomly assigned to an exercise training group (E) or a control group (C) in a 12-week single-centre prospective study. E included a combined exercise programme using balls, weights, elastic bands and cycle movements in the first 2 hours of HD sessions. C group patients received standard HD care. Endpoints were: 1) main biochemical data; 2) maximum quadriceps length strength (MQLS) and hand-grip (HG); 3) functional capacity tests: "Sit to stand to sit" (STS10) and "six-minutes walking test" (6MWT); 4) Beck Depressive Inventory (BDI); and 5) Health-related quality of life questionnaire: EuroQol-5D (EQ-5D). RESULTS: A total of 22 patients were included (50% men). Mean age was 83.2 years; patients had received HD for 44.1 month. Charlson index was 9.5. Main aetiology was diabetes mellitus (36.4%). Eleven patients were assigned to E group and 11 to C group. No related adverse effects were observed. At the end of the study, E group showed an overall improvement in tests (*P<.05): MQLS 10.5 ± 7.6 vs. 12.9 ± 10.1 kg, HG* 16.6 ± 8.7 vs. 18.2 ± 8.9 kg, STS10* 29.9 ± 10.6 vs. 25 ± 7.87 sec, 6MWT* 14.6%, 234.4 vs. 274.7 m, BDI* 14.4 ± 11.5 vs. 11.7 ± 10.8 and EQ-5D 49 ± 19.1 vs. 59.5 ± 20.3. No similar changes were observed in C group. Significant differences between groups were also found for HG, MQLS, STS10, 6MWT, BDI and EQ-5D. No significant changes were found in biochemical and anthropometric data, antidepressant treatment or suitable dialysis parameters at the end of the study. CONCLUSIONS: 1) An adapted low intensity exercise programme improved muscle strength, functional capacity and health-related quality of life in our elderly patients on HD. 2) Our results highlight the benefits from exercise in HD patients even in this elderly population. 3) In elderly patients on HD, it is worth considering an adapted low intensity intradialytic exercise programme as a part of a comprehensive care.
Subject(s)
Exercise Therapy , Renal Dialysis , Aged, 80 and over , Comprehensive Health Care , Depression , Female , Hand Strength , Humans , Male , Muscle Strength , Patient Acuity , Prospective Studies , Quality of Life , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Introducción: Los pacientes ancianos constituyen un grupo en continuo crecimiento en los programas de hemodiálisis (HD). Estos se caracterizan por su elevada complejidad, dependencia y comorbilidad asociada. Múltiples beneficios del ejercicio físico en los pacientes en HD han sido descritos, si bien no han sido completamente evaluados en la población anciana. Objetivos: Analizar el efecto de un programa adaptado de ejercicio físico intradiálisis sobre la fuerza muscular, la capacidad funcional y la calidad de vida relacionada con la salud en nuestros pacientes ancianos (>80 años) en HD. Material y métodos: Estudio prospectivo unicéntrico no aleatorizado (12 semanas) con 2 grupos comparativos. El grupo ejercicio (E) incluía un programa de ejercicio físico adaptado mediante pelotas medicinales, pesas, bandas elásticas y cicloergómetros en las primeras 2 h de HD. El grupo control (C) recibía el cuidado habitual en HD. Analizamos: 1) Parámetros bioquímicos. 2) Fuerza de extensión máxima de cuádriceps (FEMQ) y «hand-grip» (HG). 3) Tests de capacidad funcional: «sit to stand to sit» (STS10) y «six-minutes walking test» (6MWT). 4) Sintomatología depresiva: inventario Beck (BDI). 5) Calidad de vida: EuroQol-5D (EQ-5D). Resultados: Un total de 22 pacientes incluidos: 50% hombres. Edad media 83,2 años y 44,1 meses en HD. Charlson medio: 9,5. Principal etiología: DM (36,4%). Un total de 11 pacientes asignados al grupo E y 11 al grupo C. No se observaron efectos adversos relacionados. Al final del estudio, el grupo E presentó de forma global una mejoría en las pruebas realizadas (*p<0,05): FEMQ 10,5±7,6 vs. 12,9±10,1kg; HG* 16,6±8,7 vs. 18,2±8,9kg; STS10* 29,9±10,6 vs. 25±7,87sec; 6MWT* 14,6%, 234,4 vs. 274,7 m; BDI* 14,4±11,5 vs. 11,7±10,8 y EQ-5D 49±19,1 vs. 59,5±20,3. Estos cambios no se observaron en el grupo C al final del estudio. Del mismo modo, el análisis entre grupos mostró una diferencia significativa para HG, FEMQ, STS10, 6MWT, BDI y EQ-5D. No observamos cambios relevantes en los datos bioquímicos ni antropométricos, en la medicación antidepresiva ni en los parámetros de adecuación dialítica a la finalización. Conclusiones: 1) El programa adaptado de ejercicio físico intradiálisis mejoró la fuerza muscular, la capacidad funcional y la calidad de vida relacionada con la salud de nuestros pacientes ancianos en HD. 2) Aun en población anciana, nuestros resultados realzan los beneficios del ejercicio físico en los pacientes en HD. 3) Ante un paciente anciano en HD, merece la pena considerar la realización de ejercicio físico adaptado intradiálisis como una parte más del cuidado integral en HD (AU)
Background: Elderly patients on haemodialysis (HD) are a steadily increasing group. They show a high complexity, dependency and comorbidity. Multiple benefits from exercise in HD patients have been reported; however, they have not been specifically evaluated in an elderly population. Objective: To assess the effect of an adapted low intensity intradialytic exercise programme on muscle strength, functional capacity and health-related quality of life in our elderly patients (> 80 years) on HD. Material and methods: HD patients were non-randomly assigned to an exercise training group (E) or a control group (C) in a 12-week single-centre prospective study. E included a combined exercise programme using balls, weights, elastic bands and cycle movements in the first 2 hours of HD sessions. C group patients received standard HD care. Endpoints were: 1) main biochemical data; 2) maximum quadriceps length strength (MQLS) and hand-grip (HG); 3) functional capacity tests: "Sit to stand to sit" (STS10) and "six-minutes walking test" (6MWT); 4) Beck Depressive Inventory (BDI); and 5) Health-related quality of life questionnaire: EuroQol-5D (EQ-5D). Results: A total of 22 patients were included (50% men). Mean age was 83.2 years; patients had received HD for 44.1 month. Charlson index was 9.5. Main aetiology was diabetes mellitus (36.4%). Eleven patients were assigned to E group and 11 to C group. No related adverse effects were observed. At the end of the study, E group showed an overall improvement in tests (*P<.05): MQLS 10.5 ± 7.6 vs. 12.9 ± 10.1 kg, HG* 16.6 ± 8.7 vs. 18.2 ± 8.9 kg, STS10* 29.9 ± 10.6 vs. 25 ± 7.87 sec, 6MWT* 14.6%, 234.4 vs. 274.7 m, BDI* 14.4 ± 11.5 vs. 11.7 ± 10.8 and EQ-5D 49 ± 19.1 vs. 59.5 ± 20.3. No similar changes were observed in C group. Significant differences between groups were also found for HG, MQLS, STS10, 6MWT, BDI and EQ-5D. No significant changes were found in biochemical and anthropometric data, antidepressant treatment or suitable dialysis parameters at the end of the study. Conclusions: 1) An adapted low intensity exercise rogramme improved muscle strength, functional capacity and health-related quality of life in our elderly patients on HD. 2) Our results highlight the benefits from exercise in HD patients even in this elderly population. 3) In elderly patients on HD, it is worth considering an adapted low intensity intradialytic exercise programme as a part of a comprehensive care (AU)
Subject(s)
Aged, 80 and over , Aged , Humans , Renal Dialysis/methods , Exercise/physiology , Renal Insufficiency, Chronic/therapy , Prospective Studies , Case-Control Studies , Treatment OutcomeABSTRACT
Introducción: Los pacientes ancianos constituyen un grupo en continuo crecimiento en los programas de hemodiálisis. Éstos se caracterizan por su elevada complejidad, dependencia y comorbilidad asociada. Múltiples beneficios del ejercicio físico en los pacientes en hemodiálisis han sido descritos; si bien no han sido completamente evaluados en la población anciana en hemodiálisis. Objetivos: Analizar el efecto de un programa adaptado de ejercicio físico intradiálisis sobre la fuerza muscular, la capacidad funcional, la sintomatología depresiva y la calidad de vida en nuestros pacientes ancianos (>75 años) en hemodiálisis. Material y métodos: Estudio prospectivo de 12 semanas de duración. 11 pacientes incluidos (36.4% hombres). Edad media 83.9 años y 37.2 meses en hemodiá- lisis. Charlson medio: 9.7. Principal etiología: Diabetes Mellitus (45.5%), No filiada (27.3%), hipertensión (9.1%). Los pacientes incluidos realizaron un programa de ejercicio físico adaptado mediante pelotas medicinales, pesas, bandas elásticas y cicloergómetros en las primeras dos horas de hemodiálisis. Analizamos: 1.-Parámetros bioquímicos. 2. Datos musculares: Fuerza extensión máxima cuádriceps y hand-grip. 3.-Tests Test funcionales: Sit to stand to sit" y six-minutes walking test. 4.- Sintomatología depresiva: Inventario Beck. 5.-Calidad de Vida: EuroQol-5D. Resultados: De forma global, se observó una mejoría en las pruebas realizadas (*p<0.05): Fuerza extensión máxima del cuádriceps (10.5 ± 7.6 vs 12.9 ± 10 kg), hand-grip* (16.6 ± 8.7 vs 18.2 ± 8.9 kg), Sit to stand to sit 10* (29.9 ± 10.6 vs 25 ± 7.8 seg), six-minutes walking test* (22.6%, 234.4 vs 286.8 m), inventario de Beck* (14.4 ± 11.5 vs 11.7 ± 10.8) y EuroQol-5D (49.1 ± 19.1 vs 59.5 ± 20.3, p=0.064) al finalizar el estudio. Del mismo modo, no observamos cambios relevantes en los datos bioquímicos y antropométricos durante el estudio. Conclusiones: 1.-El programa adaptado de ejercicio físico intradiálisis mejoró la fuerza muscular, la capacidad funcional y la calidad de vida de nuestros pacientes ancianos en hemodiálisis. 2.- Aún en población anciana, nuestros resultados realzan los beneficios del ejercicio físico en los pacientes en hemodiálisis. 3.-Ante un paciente anciano en hemodiálisis, merece la pena considerar la realización de ejercicio físico adaptado intradiálisis como una parte más del cuidado integral en hemodiálisis (AU)
Introduction: Elderly patients are a group continuously growing in haemodialysis programs. They are characterized by their high complexity, dependency and associated comorbidity. Multiple benefits of physical activities in haemodialysis patients have been described; although they have not been fully evaluated in the elderly haemodialysis population. Objectives: To analyse the effect of an intradialytic adapted physical activity program on muscle strength, functional capacity, depressive symptoms and quality of life in our elderly patients (> 75 years) on haemodialysis. Methods: A prospective study of 12 weeks. 11 patients were included (36.4% male). Mean age of 83.9 years and haemodialysis vintage of 37.2 months. Mean Charlson index of 9.7. Main aetiologies: Diabetes Mellitus (45.5%), Not drafted (27.3%), hypertension (9.1%). Included patients performed a tailored physical exercise program using medicine balls, weights, elastic bands and ergometer in the first two hours of dialysis. We analyse: 1.-Biochemical parameters. 2.-Muscular Data: Maximum quadriceps extension strength and maximum handgrip strength. 3.-Functional tests: Sit to stand to sit" and six-minutes walking test. 4.-Depressive symptomatology: Beck Depression Inventory. 5.-Quality of Life: EuroQol-5D. Results: Overall, an improvement was observed in tests (*p<0.05): Maximum quadriceps extension strength (10.5 ± 7.6 vs. 12.9 ±10 kg), hand-grip* (16.6 ± 8.7 vs. 18.2 ± 8.9 kg) Sit to stand to sit 10* (29.9 ± 10.6 vs. 25 ± 7.8 sec), Six-minute walking test* (22.6%, 234.4 vs. 286.8 m), Beck Depression Inventory* (14.4 ± 11.5 vs. 11.7 ± 10.8) and EuroQol-5D (49.1 ± 19.1 vs. 59.5 ± 20.3, p = 0.064) at study end. Similarly, we observed no significant changes in biochemical and anthropometric data during the study. Conclusions: 1. Intradialytic adapted physical activity program improved muscle strength, functional capacity and quality of life in elderly haemodialysis patients. 2. Our results highlight the benefits of exercise in elderly haemodialysis patients. 3. It is worth considering conducting intradialytic adapted physical exercises as just another part of comprehensive care in haemodialysis (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Exercise/physiology , Exercise Therapy , Renal Dialysis , Renal Insufficiency, Chronic/rehabilitation , Muscle Strength/physiology , Quality of Life , Vital Capacity , Aging/physiologyABSTRACT
BACKGROUND: Patients on haemodialysis (HD) have a decreased physical and functional capacity. Several studies have reported the beneficial effects of exercise on the physical, functional and psychological functioning of HD patients. Despite these results, exercise programmes on HD are not commonplace. OBJECTIVE: To analyse the effect of an intradialysis endurance training programme on muscular strength and functional capacity in our HD patients. MATERIAL AND METHODS: A 6-month single-centre prospective study. HD patients were non-randomly assigned to an exercise group (group E) or a control group (group C). Exercise training included complete endurance training using balls, weights and elastic bands in the first 2 h of an HD session; group C received standard HD care. Analysed data: (1) biochemical parameters; (2) biceps and quadriceps muscle tone, maximum quadriceps length strength (MQLS) and dominant hand grip (HG); (3) functional capacity tests: sit-to-stand-to-sit (STS10) and 6-min walking test (6MWT). RESULTS: Forty patients were included, 55% were men; their mean age was 68.4 years; the patients were 61.6 months on HD; 16 patients were in group E and 24 in group C. In group E, muscular strength showed a significant improvement in MQLS (15.6 ± 10.7 vs. 17.7 ± 12.5 kg, p < 0.05) and HG (22.1 ± 13.2 vs. 24.1 ± 15.8 kg, p < 0.05) at the end of the programme, while a global decrease was reported in group C (MQLS 20.9 ± 9.3 vs. 16.2 ± 8.4 kg, p < 0.05; HG 25.1 ± 10.3 vs. 24.1 ± 11.1 kg). 6MWT significantly improved in group E (20%, 293.1 vs. 368 m, p < 0.001) and decreased in group C (10%, 350 vs. 315 m, p < 0.004). At the end of the programme, STS10 time was reduced in group E (2.1 ± 18.5 vs. 28.7 ± 20.6 s), while it rose in group C (31.5 ± 17.9 vs. 36.4 ± 19.8 s), though significant differences were not found. CONCLUSIONS: (1) The intradialysis training programme improved muscular strength and functional capacity in our HD patients. (2) These results support the benefits of exercise training for HD patients. (3) Nephrologists should consider exercise training as a standard practice for the care of HD patients.
Subject(s)
Exercise Therapy , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/rehabilitation , Renal Dialysis , Aged , Female , Follow-Up Studies , Hand Strength/physiology , Humans , Male , Muscle Strength/physiology , Physical Endurance/physiology , Prospective Studies , Treatment Outcome , Walking/physiologyABSTRACT
Introducción: Los pacientes en hemodiálisis se caracterizan por una progresiva pérdida muscular y deteriorada condición física. Recientemente, la electroestimulación neuromuscular resulta de gran interés como tratamiento coadyuvante del ejercicio físico en estos pacientes. No existen muchos estudios que avalen el papel de la electroestimulación en el paciente en hemodiálisis. Objetivos: Analizar el efecto de un programa de electroestimulación neuromuscular sobre la fuerza muscular, capacidad funcional y calidad de vida en nuestros pacientes en hemodiálisis. Material y métodos: Estudio prospectivo de 12 semanas de duración. 22 pacientes fueron incluidos. 62.8% hombres. Edad media 67.8 años y 35.6 meses de permanencia en hemodiálisis. Índex de Charlson medio: 9. Principales etiologías de la Insuficiencia renal crónica terminal: Hipertensión (13.6%), Diabetes Mellitus (27.3%), Glomerular (18.2%). Los pacientes incluidos realizaron un programa adaptativo de electroestimulación de ambos cuádriceps mediante el dispositivo Compex® Theta 500i. Analizamos: 1.-Datos musculares: Fuerza extensión máxima cuádricep y «Handgrip». 2.-Test funcionales: «Sit to stand to sit» y «Six-minutes Walking test». 3.- Síntomas en las extremidades inferiores: Cuestionario Electroestimulación. 4.- Grado satisfacción: Escala Valoración Subjetiva y. Escala Visual Analógica 5.-Calidad de vida: EuroQoL-5D. Resultados: Al finalizar el estudio, observamos una mejoría significativa (*p<0,05) de la fuerza máxima extensión del cuádriceps* (10.2 ± 6.7 vs 13.1 ± 8.1kg), Six minuters walking test* (9.5%, 290.5 vs 312.4m). En relación al grado de satisfacción observamos mediante una escala de valoración subjetiva una mejoría del 44% del estado general, un 72% de la condición física y un 80% de las molestias en miembros inferiores, así como la puntuación en el cuestionario de electrostimulación *(8.5 vs 5.8 sint/pac). El grado de satisfacción medio fue 7.8. En relación a la calidad de vida, observamos una mejoría significativa mediante el EuroQol5D* (52.7 vs 65.5%). No se observaron cambios relevantes en los datos bioquímicos o adecuación dialítica al finalizar el estudio. Conclusiones: La electroestimulación neuromuscular intradiálisis de ambos cuádriceps mejoró la fuerza muscular, la capacidad funcional y la calidad de vida de nuestros pacientes en hemodiálisis. Con los resultados obtenidos, la electroestimulación neuromuscular constituye una nueva alternativa terapéutica para mejorar la condición física y la calidad de vida de estos pacientes (AU)
Introduction: Haemodialysis patients are characterized by progressive muscle wasting and impaired physical condition. Recently, the neuromuscular electrostimulation is of great interest as adjunctive therapy of exercise in these patients. There are many studies that support the role of the electrostimulation in patients on haemodialysis. Objectives: To analyse the effect of a program of neuromuscular electrostimulation on muscle strength, functional capacity and quality of life in our patients on haemodialysis. Methods: Prospective study of 12 weeks of duration. 22 patients were included. 62.8% male. Mean age of 67.8 years and 35.6 months of haemodialysis vintage. Mean Charlson index was 9. Main aetiologies of chronic renal failure: hypertension (13.6%), diabetes mellitus (27.3%), Glomerular (18.2%). Included patients performed an adaptive electrostimulation program in both quadriceps by the Compex® Theta 500i device. Most relevant analyzed data: 1. Muscular data: Maximum length quadriceps strength and "hand-grip". 2. Functional capacity tests: «Sit to stand to sit» and «six-minutes walking test». 3. Symptoms in the lower extremities: Questionnaire of electrostimulation. 4. Level of satisfaction: Subjective Rating Scale and Visual Analogic Scale. 5. Quality of Life: EuroQoL-5D. Results: At the end of the study, we observed a significant improvement (p<0.05) of the maximum length quadriceps strength* (10.2 ± 6.7 vs 13.1 ± 8.1 kg), Six minutes walking test* (9.5%, 290.5 vs. 312.4 m). In relation to the level of satisfaction by subjective rating scale, an improvement of 44% of the overall, 72% of the physical condition and 80% of the discomfort in the lower limbs, and the score on the questionnaire of electrostimulation* were observed. *(8.5 vs 5.8 sint/pat). The mean level of satisfaction was 7.8. Relative to the quality of life, we observed a significant improvement through the EuroQol5D* (52.7 vs 65.5%). No significant changes were observed in biochemical data or dialysis adequacy at study end. Conclusions: The intra-dialytic neuromuscular electrostimulation of both quadriceps, improved muscle strength, functional capacity and quality of life of our patients on haemodialysis. With the results, neuromuscular electrostimulation is a new therapeutic alternative to improve fitness and quality of life of these patients (AU)
Subject(s)
Humans , Male , Female , Renal Dialysis , Renal Dialysis/psychology , Cardiac Pacing, Artificial , Muscle Weakness/complications , Muscle Weakness/diagnosis , Renal Dialysis/adverse effects , Renal Dialysis/nursing , Cardiac Pacing, Artificial/nursing , Muscle Weakness/nursing , Muscle Weakness/prevention & controlABSTRACT
No disponible
Subject(s)
Humans , Metabolic Syndrome/physiopathology , Cardiovascular Diseases/physiopathology , Renal Insufficiency, Chronic/physiopathology , Renal Dialysis , Risk Factors , Indicators of Morbidity and MortalityABSTRACT
Los pacientes en hemodiálisis presentan una importante disminución de la condición física y la capacidad funcional. Ampliamente son conocidos los numerosos beneficios del ejercicio físico en los pacientes con insuficiencia renal en éstos aspectos. Hasta la fecha, existe mínima experiencia con la electroestimulación neuromuscular en los pacientes en hemodiálisis. Objetivos: 1. Analizar el efecto de un programa de entrenamiento físico intradiálisis combinado con electroestimulación neuromuscular sobre la fuerza muscular y la capacidad funcional en nuestros pacientes en hemodiálisis. 2. Analizar la seguridad, eficacia y tolerancia de la electroestimulación neuromuscular en nuestros pacientes en hemodiálisis. Métodos: Los pacientes en hemodiálisis realizaron un programa completo de entrenamiento físico mediante balones medicinales, pesas, bandas elásticas y cicloergómetros combinado con electroestimulación neuromuscular en las primeras dos horas de hemodiálisis durante 12 semanas en un estudio prospectivo unicéntrico. La electroestimulación se realizó en ambos cuádriceps usando el Compex ® Theta 500i. Principales datos analizados: 1. Fuerza extensión máxima cuádriceps (FEMQ) y handgrip brazo dominante (HG). 2. Test funcionales:Sit to stand to sit (STS10) y six-minutes walking test (6MWT). 3. Escala Visual Analógica (EVA) y cuestionario propio de electroestimulación neuromuscular (QE). Resultados: 11 pacientes incluidos (55% mujeres). Edad media 67.6 años y 62.3 meses en hemodiálisis. Se observó una mejoría significativa (*p<0.05) en la FEMQ*(13.7±8.1 vs 16.2±10.9kg), HG*(23.8±15.9 vs 25.1±15.9kg), STS10*(24.6±13.4 vs 20.1±10.1 seg) y 6MWT*(21%,332.6 vs 402.7 m). No observamos dolor muscular, rampas, hormigueos o calambres musculares relevantes en el cuestionario propio de electroestimulación. El grado medio de satisfacción (EVA) fue 9.4 puntos. Conclusiones: 1. El programa de entrenamiento físico intradiálisis combinado con electroestimulación neuromuscular mejoró la fuerza muscular y la capacidad funcional en nuestros pacientes en hemodiálisis. 2. La electroestimulación neuromuscular intradiálisis de ambos cuádriceps resultó segura, efectiva y bien tolerada en nuestros pacientes en hemodiálsis. 3. Éstos resultados constituyen una novedosa alternativa terapéutica relacionada con los beneficios del ejercicio físico en los pacientes en hemodiálisis (AU)
Patients on hemodialysis (HD) have a decreased physical and functional capacity. There is proven evidence about the benefits of exercise training on functional capacity in HD. Untildate, minimal experience with electroestimulation (ETEM) in HD patient sis reported. Objectives: 1. Analize the effect of intradialysis training program combined with electroestimulation on muscular strenght and functional capacity in our HD patients. 2. Analize the safety, efficacy and tolerance of ETEM in our HD patients. Methods: HD patients were enrolled into an exercise training program combined with ETEM in the first two hours of HD session during a 12 weeks single-center prospective study. ETEM included physical training using balls, weights, elastic bands and cycle ergometer. Leg electroestimulation were performed using the Compex® Theta 500i device in both quadriceps muscles. Most relevant analized data: 1. Maximum length quadriceps strength (MLQS) and hand-grip (HG) dominant arm. 2. Functional capacity tests: Sit to stand to sit (STS10) and six-minutes walking test (6MWT). 3. Visual analogic scale (VAS) and our own satisfaction electroestimulation questionnaire (SEQ) was completed. Results: 11 HD patients included: 55%women.Mean age 67.6 years and 62.3 months on HD.A significant (*p<0.05) improvement was observed in MLQS* (13.7±8.1 vs 16.2±10.9kg), HG*(23.8±15.9 vs 25.1±15.9kg), STS10*(24.6±13.4 vs 20.1±10.1 sec) and 6MWT* (21%, 332.6 vs 402.7 m). No relevant muscular pain, cramps, tingles or pricks were related in the SEQ. The VAS satisfaction degree was 9.4 points. Conclusions: 1. Intradialysis training program combined with quadriceps electroestimulation improved muscular strenght and functional capacity in our HD patients. 2. Intradialysis quadriceps electroestimulation was safe, effective and well tolerated in our HD patients. 3. These results represents a wide therapeutic possibility related to the benefits of exercise training for HD patients(AU)
Subject(s)
Adolescent , Humans , Renal Dialysis/methods , Renal Dialysis , Exercise/physiology , Transcutaneous Electric Nerve Stimulation/trends , Electric Stimulation/instrumentation , Electric Stimulation/methods , Electric Stimulation Therapy/instrumentation , Electric Stimulation Therapy/methods , Electric Stimulation Therapy , Physical Education and Training/methods , Physical Education and Training/organization & administration , Surveys and QuestionnairesABSTRACT
BACKGROUND/AIM: Cystatin C (Cys C) is an endogenous marker of glomerular filtration rate (GFR) unaffected by body composition. The aim of the present study was to assess the utility of Cys C-based GFR prediction equations (Hoek, Larsson and Stevens) and creatinine (modification of diet in renal disease-isotope dilution mass spectrometry--MDRD-IDMS, and Cockcroft-Gault--CG) compared with 51Cr-EDTA. METHODS: This study was carried out in 40 Caucasian older patients with advanced age (> or = 60) and chronic kidney disease stages 3-4. To assess the utility of prediction equations in relation to body composition, we measured lean mass (LM) with densitometry (DXA). Pearson's, Bland-Altman and Lin's coefficient (Rc) were used to study accuracy and precision. RESULTS: 51Cr-EDTA was 36.9 +/- 9.2 ml/min/1.73 m2 (22-60). Cys C levels were 2.2 +/- 0.8 mg/l (r = 0.085; p = 0.662 LM) and creatinine 2.8 +/- 1.1 mg/dl (r = 0.427; p = 0.021 LM). The most accurate equations were the Hoek, Larsson and Stevens formulae, with a bias of -0.2 (Rc 0.48), -2.9 (Rc 0.44) and 2.6 ml/min/1.73 m2 (Rc 0.58). The biases obtained with MDRD-IDMS and CG were -14.6 (Rc 0.35) and -12.5 (Rc 0.40). All correlations among biases obtained with creatinine-based formulae and LM were negative and statistically significant (p < 0.05). CONCLUSIONS: The results show superiority of Cys C-based GFR formulae over the MDRD-IDMS and CG equations. This significant underestimation obtained with conventional prediction equations was directly related to the influence of LM.
