Exploring the impact of short daily haemodialysis on muscle strength and bone health in end-stage kidney disease patients.

BACKGROUND: Short-daily haemodialysis (SDH) has been strongly recommended over conventional haemodialysis (CHD) for end-stage kidney disease patients, though few studies have directly compared the effects of these two haemodialysis (HD) modalities on clinical variables related to patient's health. METHODS: We conducted a cross-sectional study in individuals undergoing HD, comparing epidemiological, clinical, metabolic, inflammatory, anthropometric, bone health/metabolism, and skeletal muscle function according to dialysis modality. One-hundred seventy-eight patients (20.8% females, 62 ± 2.5 years old), were analysed in this study, 86 (48%) of whom were undergoing CHD versus 92 (51%) who were undergoing SDH. RESULTS: SDH patients had significantly higher serum albumin levels (3.93 vs. 3.66 g/dL, P < 0.0001) and higher Kt/v (2.6 vs. 2.38, P < 0.0001). SDH group presented a significantly lower number of erythropoietin-stimulating agents compared with CHD group (percentage: 53.3 vs. 83.7%, P < 0.0001) and had lower levels of serum phosphate (4.9 vs. 5.3 mg/dL, P = 0.004) and parathyroid hormone (PTH) (398.4 vs. 480.4 pg/mL, P < 0.001) compared with CHD patients. In terms of bone health and metabolism, SDH patients had significantly higher total BMD, femur BMD, lumbar BMD, and femoral neck BMD compared with CHD patients (all P < 0.05). SDH patients also had lower anti-osteogenic and inflammatory biomarkers, including FGF23, sclerostin, TNF, IL-18, IL-17a, and C-reactive peptide (all P < 0.05). CHD modality was demonstrated to be a risk factor for low BMD (odds ratio: 4.02; 95% CI: 1.59-10.2, P = 0.003). In terms of skeletal muscle function, SDH patients had significantly higher 6-minute walking test (444.6 vs. 424.9 m, P = 0.04) and higher fat-free mass (52.3 vs. 51.68 kg, P = 0.02) compared with CHD patients. Higher fat-free mass and handgrip strength were associated with a 34% and 23% lower risk of low BMD, respectively. SDH patients had lower levels of the uremic toxin asymmetric dimethyl-l-arginine (ADMA) (1.8 vs. 2.07 µM, P = 0.002) and fasting blood glucose (132.6 vs. 141.7 mg/dL, P < 0.02) than CHD group. SDH patients also displayed higher levels of haemoglobin when compared with CHD group (11.9 vs. 10.2 g/dL, P < 0.0001). CONCLUSIONS: The present study improves our understanding of the relationship between dialysis modality and clinical variables that may influence HD patient's health. Grip strength and lean mass were positively correlated with bone mineral density in HD patients regardless of dialysis modality. SDH was associated with better bone mineral density, inflammatory profile, and skeletal muscle function when compared with CHD patients. These findings provide more evidence of the clinical benefits of SDH that should be explored in greater detail.

Impact of cluster set resistance training on strength, functional capacity, metabolic and inflammatory state in older hemodialysis subjects: A randomized controlled clinical trial.

BACKGROUND AND AIMS: Hemodialysis-associated neuromuscular dysfunction appears to be counteracted by resistance training (RT) in older patients with chronic kidney disease (CKD). Thus, the aim of the present study was to evaluate the impact of cluster-set RT protocol on anthropometric parameters, functional capacities, and biochemical variables in older patients with CKD. METHODS AND RESULTS: Seventy-eight older patients (age: 57.55 ± 4.06 years) with CKD undergoing maintenance hemodialysis participated, and were randomly divided into control group (CG, N = 26), traditional RT (RT, N = 26) and cluster-set RT (RT-CS, N = 26) groups. Participants completed 24 weeks of RT three times per week, 1 h and 30 min before the hemodialysis session. Patients from the RT-CS group displayed increased adherence as compared to the RT group (66.35 % versus 61.73 %, p < 0.0001). There was an improvement of all anthropometric variables, handgrip strength, timed up and-go (TUG) and six-minute walking test (6MWT) following both training protocols when compared to control group and pre-intervention values. Fasting blood glucose decreased for both RT and RT-CS groups as compared with pre-intervention, without differences between training protocols and CG. Glycated hemoglobin, inflammatory cytokines, and triglycerides decreased in RT and RT-CS groups as compared with pre-intervention and CG, without differences between them. Furthermore, the RT-CS protocol resulted in a greater number of people who were responsive to training when compared to traditional training. CONCLUSIONS: RT-CS is a clinically valuable tool to improve anthropometric parameters, handgrip strength, TUG, 6MWT, fasting blood glucose, and cytokines in CKD older patients.