Intradialytic exercise in end-stage renal disease: An umbrella review of systematic reviews and/or meta-analytical studies.

OBJECTIVES: This umbrella review aimed to understand the clinical benefits and adverse events associated with different modalities of intradialytic exercise in patients with end-stage renal disease undergoing hemodialysis. DATA SOURCES: The search was performed until September 10th, 2020 on Scopus, Web of Science, the Cochrane Database, CINAHL, and PubMed. METHODS: This umbrella review was conducted following the PRISMA guideline statement. The methodological quality of the reviews was assessed with the AMSTAR-2. Standardized mean differences with 95% confidence intervals were estimated. The I-squared statistic was used to assess heterogeneity and the Eggers' test was performed to test asymmetry/small-study effects. RESULTS: Eleven reviews were included and 48 unique meta-analyses were examined. Nine were supported by suggestive evidence (P < 0.05, small heterogeneity, absence of small-study effects, and excess significance bias). Clinical benefits were found for functional capacity associated with aerobic exercise (d = 0.81; k = 6), resistance training (d = 0.58; k = 6), neuromuscular electrical stimulation (d = 0.70; k = 5), and inspiratory muscle training (d = 1.13; k = 2), measured by the distance covered in the 6-minutes walking test. This outcome was also associated with aerobic exercise (d = 0.28; k = 7) and combined exercise, measured by VO2peak (d = 1.01; k = 5) and by the duration of the cardiopulmonary test (d = 1.07; k = 4). Isometric quadriceps muscle strength improved with neuromuscular electrical stimulation (d = 1.19; k = 7) while patients' perception of vitality improved with combined exercise (d = 0.60; k = 3). CONCLUSIONS: Suggestive evidence was found for the associations between various modalities of intradialytic exercise and functional capacity. Combined exercise was associated with improvements in physical and psychosocial variables. Few or no adverse events were reported.

Resistance training in hemodialysis patients: a review.

PURPOSE: Few studies have examined the role of resistance training (RT) in chronic kidney patients on hemodialysis (HD). This study reviews the literature about resistance exercise for patients on HD and describes protocols and clinical outcomes. METHODS: A search of the MEDLINE database found 21 eligible publications, of which 14 studies applied only RT and 7 combined RT and aerobic training. FINDINGS: Regarding the period of exercise training, 14 studies applied intradialytic exercise. The main outcome reported was muscle strength, which was assessed through knee strength and handgrip measures. CONCLUSIONS: All studies reviewed presented at least one significant result in relation to biochemical parameters, physical capacity, strength, body composition, or quality of life. CLINICAL RELEVANCE: This review demonstrates that RT improves muscle strength, some biochemical parameters, and quality of life of the HD patients.

Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized controlled clinical trial.

BACKGROUND: Chronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life. METHODS/DESIGN: A prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height(2); circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life. DISCUSSION: CKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients. TRIAL REGISTRATION: The protocol for this study is registered with the Brazilian Registry of Clinical Trials (ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN: U1111-1127-9390 [http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/]).

Association of intradialytic hypotension and convective volume in hemodiafiltration: results from a retrospective cohort study.

BACKGROUND: Hemodiafiltration (HDF), as a convective blood purification technique, has been associated with favorable outcomes improved phosphate control, removal of middle-molecules such as Beta2-microglobulin and the occurrence of intradialytic hypotension (IDH) as compared to diffusive techniques. The aim of this retrospective cohort study in dialysis patients receiving HDF in one urban dialysis facility in Mexico City was to investigate the occurrence of IDH during HDF treatments with varying convective volume prescriptions. METHODS: Subjects were stratified into equal groups of percentiles of convective volume prescription: Group 1 of 0 to 7.53 liters, group 2 of 7.54 to 14.8 liters, group 3 of 14.9 to 16.96 liters, group 4 of 16.97 to 18.9 liters, group 5 of 21 to 19.9 liters and group 6 of 21.1 to 30 liters. Logistic Regression with and without adjustment for confounding factors was used to evaluate factors associated with the occurrence of IDH. RESULTS: 2276 treatments of 154 patients were analyzed. IDH occurred during 239 HDF treatments (10.5% of all treatments). Group 1 showed 31 treatments (8.2%) with IDH whereas group 6 showed IDH in only 15 sessions (4% of all treatments). Odds Ratio of IDH for Group 6 was 0.47 (95% CI 0.25 to 0.88) as compared to Group 1 after adjustment. CONCLUSIONS: In summary the data of this retrospective cohort study shows an inverse correlation between the occurrence of IDH and convective volume prescription. Further research in prospective settings is needed to confirm these findings.

Combined resistance and aerobic exercise is better than resistance training alone to improve functional performance of haemodialysis patients--results of a randomized controlled trial.

BACKGROUND AND PURPOSE: This study aims to compare the effects of combined resistance and aerobic exercise with a resistance programme alone on functional performance among haemodialysis patients. DESIGN: The design was a randomized controlled trial. SETTING: The setting was the dialysis unit of a Brazilian university hospital. PATIENTS: Haemodialysis patients were assigned to one kind of intervention or another. INTERVENTION: The patients were assigned to receive the resistance exercise combined with an aerobic training or to maintain an ongoing resistance programme alone for a period of 10 weeks. MAIN OUTCOME MEASURE: The functional performance of patients was assessed before and after the intervention through the 6-minute walk test (6MWT). The difference over time of the 6MWT was compared between the groups through two-way repeated-measures ANOVA. RESULTS: Thirteen patients were allocated for each group of intervention. The difference in distance walked before and after intervention in the combined training group was of +39.7 ± 61.4 m, and the difference in the resistance training group was of -19.2 ± 53.9 m, p = 0.02. CONCLUSIONS: Although the best protocol of exercise for patients on dialysis is not yet clear, in our sample of haemodialysis patients the combination of aerobic and resistance training was more effective than resistance training alone to improve functional performance.

Efectos del ejercicio físico intradiálisis en pacientes con insuficiencia renal crónica terminal / Effects of intradialytic exercise in end stage renal disease patients

INTRODUCTION: Currently in Chile there are not rehabilitation programs based on exercise in end stage renal disease patients (ERSD) as in the case of cardiorespiratory diseases. The lack of evidence and knowledge seem to be the main causes. AIM: To provide updated evidence that shows the effects generated intradialytic exercise on various aspects deteriorated in this type of patients. METHODS: 7 of 14 studies found in four scientific data base were included. Selection criteria: published since 2005, distributed participants in a group exercise (aerobic, strength or combined) and a control group and random assignment of patients. Methodological quality was measured according to Van Tulder criteria. RESULTS: There is high quality evidence that shows intradialytic exercise improves muscle strength of lower extremities, functional capacity and decrease in serum CRP levels. There is moderate quality evidence that shows a drop in serum leptin levels, potassium and phosphate, and an improvement in sleep quality questionnaire PSQI. There is low quality evidence that shows an improvement in quality of life questionnaires, Kt/ V and serum creatinine. CONCLUSION: The intradialytic exercise is a therapeutic tool that generates multiple health benefits for ESRD patients. The rehabilitation of the ESRD patient is a new area that should be studied in order to implement these programs in dialysis centers in Chile.

INTRODUCCIÓN: Actualmente en Chile no existen programas de rehabilitación basados en el ejercicio físico en pacientes con insuficiencia renal crónica terminal (IRCT) como ocurre en el caso de patologías cardiorespiratorias. La falta de evidencia y conocimiento parecen ser las causas principales. OBJETIVO: Proporcionar evidencia actualizada que demuestre los efectos que genera el ejercicio físico intradiálisis sobre distintos aspectos deteriorados en éste tipo de pacientes. MÉTODOS: Se seleccionaron 7 de 14 estudios encontrados en 4 buscadores científicos. Criterios de selección: publicación desde 2005, participantes distribuidos en un grupo de ejercicio físico (aeróbico, fuerza o combinados) y un grupo control, y asignación de pacientes aleatoria. La calidad metodológica se midió según los criterios de Van Tulder. RESULTADOS: Existe evidencia de alta calidad que demuestra que el ejercicio físico intradiálisis mejora la fuerza muscular de extremidades inferiores, la capacidad física y disminución en los niveles séricos de PCR. Existe evidencia de calidad moderada que demuestra una baja en los niveles séricos de leptina, potasio y fosfato, y una mejora en el cuestionario sobre calidad del sueño PSQI. Existe evidencia de baja calidad que demuestra una mejora en cuestionarios sobre calidad de vida, Kt/V y niveles séricos de creatinina. CONCLUSIONES: El ejercicio físico intradiálisis es una herramienta terapéutica que genera múltiples beneficios en la salud del paciente con IRCT. La rehabilitación del paciente IRCT es una nueva área que debe ser estudiada para así poder implementar éstos programas en los centros de diálisis de Chile.

Constant work-rate test to assess the effects of intradialytic aerobic training in mildly impaired patients with end-stage renal disease: a randomized controlled trial.

OBJECTIVE: To investigate if high-intensity constant work rate (CWR) would constitute a more appropriate testing strategy compared with incremental work rate (IWR) to assess the effectiveness of intradialytic aerobic training in patients with end-stage renal disease (ESRD). DESIGN: Randomized controlled trial. SETTING: Nephrology unit at the university hospital. PARTICIPANTS: Patients (N=28; 47.0±11.9y) under hemodialysis (4.4±4.3y) were randomly assigned to exercise and control groups. INTERVENTION: Patients included in the exercise group underwent a moderate-intensity intradialytic aerobic training program 3 times per week for 12 weeks. MAIN OUTCOME MEASURES: Cardiopulmonary and perceptual responses were obtained during an IWR and a high-intensity CWR test to the limit of tolerance on a cycle ergometer. RESULTS: Training-induced increases in peak oxygen uptake (Vo(2)peak) and time to exercise intolerance (Tlim). Mean improvement in Tlim (97.4%±75.6%) was significantly higher than increases in Vo(2)peak (12%±11.3%) (P<.01); in fact, while Tlim improved 50% to 200% in 9 of 12 patients, Vo(2)peak increases were typically in the 15% to 20% range. CWR test revealed lower metabolic, ventilatory, cardiovascular, and subjective stresses at isotime; in contrast, submaximal responses during the incremental work rate (at the gas exchange threshold) remained unaltered after training. CONCLUSIONS: A laboratory-based measure of endurance exercise capacity (high-intensity CWR test to Tlim) was substantially more sensitive than oxygen uptake at the peak IWR test to unravel the physiologic benefits of an intradialytic aerobic training program in mildly impaired patients with ESRD.

Nutrición parenteral intrahemodialítica / Intrahemodialytic parenteral nutrition

Los estudios demuestran grandes ventajas al manejar nutrición parenteral intrahemodialítica (NPID). La ventaja más trascendente es respecto a la condición clínico metabólica del paciente. Las desventajas puedenser metabólicas, mecánicas, y económicas. La valoración del estado nutricional considera aspectos antropométricos y bioquímicos. Los carbohidratos se indican a 5mg/kg/min de dextrosa; los aminoácidosdeben proveer 1.3g de proteínas kg/día; los lípidos se administran a 0.5ml/min al inicio de la infusión; elvolumen se realizará en función a cada uno de los nutrimentos; los oligoelementos y vitaminas no estánindicadas en la NPID.

Studies show great advantages in handling intrahemodialytic parenteral nutrition (NPID). The most significant advantage is to the metabolic clinical condition of the patient. The disadvantages may be metabolic, mechanical, and economic. The assessment of nutritional status must considered anthropometricand biochemical aspects. Carbohydrates are listed 5 mg/kg/min dextrose, amino acids should provideprotein 1.3 g/kg/ day, lipids must be administered 0.5 ml/min at the start of the infusión, the volumen is madeaccording to each nutrients, trace elements and vitamins are not listed in the NPID.

Efeitos do treinamento muscular inspiratório nos pacientes em hemodiálise / Effects of inspiratory muscle training in hemodialysis patients

INTRODUÇÃO: A doença renal crônica associada ao tratamento hemodialítico pode apresentar uma diversidade de complicações músculo-esqueléticas, além de trazer repercussões à função pulmonar. OBJETIVO: Avaliar os efeitos do treinamento muscular inspiratório na força muscular inspiratória, função pulmonar e capacidade funcional em pacientes com insuficiência renal crônica submetidos à hemodiálise. MÉTODO: Ensaio clínico não controlado, composto por 15 indivíduos com diagnóstico médico de insuficiência renal crônica, submetidos à hemodiálise. Foram avaliados pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) através da manovacuometria; função pulmonar pela espirometria e a capacidade funcional através da distância percorrida e consumo de oxigênio obtido no teste da caminhada dos seis minutos (TC6M). No período de oito semanas, foi aplicado o protocolo de treinamento muscular respiratório (TMI) durante a sessão de hemodiálise, com carga estabelecida de 40 por cento da PImáx e uma frequência semanal de três dias alternados. RESULTADOS: Houve um aumento significativo na variável distância percorrida após o treinamento (455 ± 98 versus 558 ± 121; p = 0,003). Não foram encontradas diferenças estatísticas na comparação antes e após treinamento nas demais variáveis do estudo. CONCLUSÃO: O estudo não apresentou diferença estatística na força muscular respiratória, na função pulmonar e no consumo de oxigênio. Observou-se apenas um aumento na distância do TC6M.

INTRODUCTION: Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function. OBJECTIVE: To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functional capacity in patients with chronic kidney failure undergoing hemodialysis. METHOD: Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40 percent of PImax and weekly frequency of three alternate days. RESULTS: A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values. CONCLUSION: The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.

Method to observe hemodynamic and metabolic changes during hemodiafiltration therapy with exercise.

Intradyalitic exercise programas are important to improve patient's hemodynamic stability. Blood pressure and metabolic changes are correlated when heat accumulation is due to increment of the body core temperature (+1.0 °C). However, increase in temperature could be controlled by lowering dialysate's temperature using two main modalities techniques (isothermic and thermoneural) with different patient's thermal balance consequences, not yet well studied. In this work, a new method to observe the main physiological parameters (hearth rate variability (HRV), blood pressure, BTM dialysate temperature control and substrate utilization by indirect calorimtery) which are involved in hemodiafitration (HDF), are displayd. An experiment was carried out in a group of 5 patients waiting kidney transplant. In each patient, EE was assessed as well as the HRV during isothermic and thermoneutral modalities as a manner of cross and prospective study (a) at before therapy, (b) during therapy and (c) at the end of the HDF therapy. Power extraction was also measured by a BTM (Blood Temperature Monitor from Fresenius Inc), in order to determine how the dialysate temperature was controlled. The results showed important method's advantages which place the BTM performance as unstable control system with the possibility to produce undesirable HRV changes as the vagotonical response. However more patient cases are needed in order to identify the real advantage of this new method.

Efeito do treinamento muscular periférico na capacidade funcional e qualidade de vida nos pacientes em hemodiálise / Effect of peripheral muscle training on functional capacity and quality of life in hemodialysis patients

O treinamento muscular periférico (TMP) pode promover a redução dos sintomas relacionados à patologia de base e ao tratamento, além da melhoria funcional. este estudo avalia os efeitos do TMP na capacidade funcional e na qualidade de vida (QV) de pacientes em hemodiálise. Método: Ensaio clínico. Estudaram-se sete indivíduos com idade entre 29 e 84 anos, portadores de DRC. Os pacientes foram avaliados antes do protocolo e após, por meio do Teste de Caminhada de 6 minutos (TC6M), de questionário de QV SF-36 e pelo Teste de Caminhada de 6 minutos (TC6M), de questionário de QV SF-36 e pelo teste de 1 RM para extensores de joelho. Foram aplicados duas vezes por semana durante cinco meses. A carga utilizada foi de 50% da obtida no teste de 1RM para força e, para resistência, utilizaram-se 30% da carga obtida no teste. Foram trabalhados todos os grupos musculares de membros inferiores (MI), além dos abdominais e glúteos com exercícios isométricos, isotônicos e isotônicos livres de carga. Resultados: A média das cargas tolerada por MID: 4,17+-3,03 vs 6,07+-2,62 vs8,42+-3,30k; MIE 4,85+-3,13 vs 6,21+-2,82 vs 8,57+-3,99kg, p<0,05. O QQV teve maior média nos domínios: limitação por aspecto físico e vitalidade. No TC6M, não foi verificado melhora. Conclusão: O TMP, durante a hemodiálise, é capaz de promoveraumento de força muscular de MI, além de alterar positivamente domínios referentes à QV. Como desfechos secundários, foram observados redução da dor em MI, das cãimbras e da necessidade de medicação para controle destes sintomas.

The peripheral muscle training (TMP) can promote the reduction of symptoms related to underlying disease and treatment, as well as functional improvement. This study evaluates the effects of TMP in functional capacity and quality of life (QOL) of hemodialysis patients. Method: Clinical trial. We studied seven subjects aged between 29 and 84 years, with CKD. Patients were evaluated before and after the protocol, through the test 6-minute walk (6MWT), the QOL questionnaire SF-36 and the Test of 6-minute walk (6MWT), the QOL questionnaire SF-36 and the test of an MRI for knee extensors. Were applied twice a week for five months. The load used was obtained in 50% of 1RM test for strength and for resistance, we used 30% of the load test result. We worked all the muscle groups of the lower limbs (MI) in addition to abdominal and gluteal exercises with isometric and isotonic sports drinks free of charge. Results: The average load tolerated by MID: 4.17 + -3.03 vs 6.07 + -2.62 VS8, 42 -3.30 + k; MIE 4.85 + -3.13 vs 6.21 + 8.57 + -2.82 vs -3.99 kg, p <0.05. The QQV had the highest average in the areas: limitation by physical appearance and vitality. In the 6MWT, was not seen improvement. Conclusion: TMP during hemodialysis, can promoveraumento IM muscle strength, and change positively related to QOL domains. As secondary endpoints, pain reduction were observed in MI, the cramps and the need for medication to control these symptoms.

Evaluación y entrenamiento de la condición física del paciente con enfermedad renal crónica terminal / Physycal fitness in patient with end-stage renal disease

La mala condición física es un factor de riesgo importante de mortalidad por problemas de origen cardiovascular, siendo además un predictor de diferentes enfermedades. Cuando la condición física es evaluada adecuadamente, puede ser utilizada como un valioso indicador de salud, expectativa de vida y calidad de vida en pacientes con enfermedad renal crónica terminal (ERCT), por lo cual debiera ser un procedimiento de rutina en el manejo de estos pacientes. El ejercicio físico es presentado como Un medio efectivo para tratar y prevenir las principales alteraciones músculo esqueléticas originadas por la ERCT y por el sedentarismo que presentan estos pacientes. Por esta razón se debería diseñar programas individuales de entrenamiento físico basados en los resultados de la evaluación de la condición física, en el conocimiento del estilo de vida, en la actividad física diaria realizada por cada paciente. Ese tipo de entrenamiento debería permitir a los pacientes desarrollar su máximo potencial físico, mejorar su salud física y mental y disminuir las consecuencias negativas de a ERCT.

Low physical fitness is an important risk factor for cardiovascular and all-causes morbidity and mortality; indeed, it is even a predictor of these problems. When properly measured, the assessment of physical fitness can be a highly valuable indicator of health, life expectancy and quality of life on patients with end stage renal disease (ESRD), therefore, should be performed routinely in the clinical setting. Physical exercise is proposed as a highly effective means of treating and preventing the main causes muscle skeletal disorders and sedentary life style that presents those patients. Individually adapted training programs could be prescribed based on fitness assessment results and an adequate knowledge of patient lifestyle, daily physical activity and personal goals. Such training programs would allow patients to develop their maximum physical potential, improve their physical and mental health, and attenuate the negative consequences of ESRD.

Arterial line pressure control enhanced extracorporeal blood flow prescription in hemodialysis patients.

BACKGROUND: In hemodialysis, extracorporeal blood flow (Qb) recommendation is 300-500 mL/min. To achieve the best Qb, we based our prescription on dynamic arterial line pressure (DALP). METHODS: This prospective study included 72 patients with catheter Group 1 (G1), 1877 treatments and 35 arterio-venous (AV) fistulae Group 2 (G2), 1868 treatments. The dialysis staff was trained to prescribe Qb sufficient to obtain DALP between -200 to -250 mmHg. We measured ionic clearance (IK: mL/min), access recirculation, DALP (mmHg) and Qb (mL/min). Six prescription zones were identified: from an optimal A zone (Qb > 400, DALP -200 to -250) to zones with lower Qb E (Qb < 300, DALP -200 to -250) and F (Qb < 300, DALP > -199). RESULTS: Treatments distribution in A was 695 (37%) in G1 vs. 704 (37.7%) in G2 (P = 0.7). In B 150 (8%) in G1 vs. 458 (24.5%) in G2 (P < 0.0001). Recirculation in A was 10.0% (Inter quartile rank, IQR 6.5, 14.2) in G1 vs. 9.8% (IQR 7.5, 14.1) in G2 (P = 0.62). IK in A was 214 +/- 34 (G1) vs. 213 +/- 35 (G2) (P = 0.65). IK Anova between G2 zones was: A vs. C and D (P < 0.000001). Staff prescription adherence was 81.3% (G1) vs. 84.1% (G2) (P = 0.02). CONCLUSION: In conclusion, an optimal Qb can de prescribed with DALP of -200 mmHg. Staff adherence to DLAP treatment prescription could be reached up to 81.3% in catheters and 84.1% in AV fistulae.

Exercícios físicos durante a hemodiálise: uma revisão sistemática / Physical exercise during hemodialysis: a systematic review

Introdução: A doença renal crônica (DRC) gera alterações fisiológicas e funcionais causadas pela diminuição da atividade física, fraqueza muscular, anemia, alterações metabólicas, bem como acarreta prejuízo na qualidade de vida. O exercício físico se apresenta como recurso terapêutico na prevençãoe reversão destas alterações. Este estudo teve como principal objetivo fazer uma revisão sistemática de estudos sobre treinamento por exercício durante a hemodiálise (HD). Método: Revisão sistemática da literatura, utilizando busca primária e secundária em bases de dados computadorizadas. Resultados: A pesquisa resultou da análise de 26 artigos que apresentaram resultados de 22 estudos. Discussão: As principais adaptações relacionadas ao exercício foram as funcionais, fisiológicas e psicológicas. Tais achados são relevantes, dadas as alterações causadas em todos os sistemas corporais. Além disso, a perda de massa muscular é o mais significante preditor de mortalidade nos pacientes em HD, e o exercício físico é um importante fator no controle e reversão da perda muscular. Entretanto, várias foram as limitações metodológicas nestes estudos, tais como as amostras, falta de homogeneidade dos exercícios e não inclusão de alguns subgrupos de pacientes. Conclusão: As evidências demonstradas neste estudo sugerem que programas de exercícios físicos adequadamente prescritos durante a HD são seguros para os pacientes e podem gerar benefícios para estes indivíduos. No entanto, os programas de treinamento físico durante HD ainda não se tornaram rotina na maioria dos centros dialíticos. Estes fatos se devem, em parte, às lacunas deixadas na literatura, bem como pela escassez de profissionais qualificados para a implementação de tais programas.

Introduction: Chronic kidney disease (CKD) generates physiological and functional alterations caused by the reduction of physical activity, muscular weakness, sickle cell anemia, metabolic alterations, and in addition, harms the quality of life. Physical exercise is presented as a therapeutic resource in the prevention and reversion of these alterations. The main objective of this study is a systematic review of the literature regarding exercise training during hemodialysis (HD). Method: Systematic review of literature using primary and secondary search in computer database. Results: The research resulted from the analysis of 26 articles which presented results of 22 studies. Discussion: The main adaptations related to exercise were functional, physiological and psychological. Such findings are relevant, in view of the alterations caused in all body systems. Additionally, the loss of muscle mass is the most significant predictor of mortality in HD patients and physical exercise is an important factor in the control and reversion of muscle mass. However, there were several methodological limitations in these studies, including samples, lack of homogeneity of the exercises, and the non-inclusion of some sub-groups of patients. Conclusion: The evidence demonstrated in this study suggests that physical exercise programs adequately prescribed during HD are safe for the patients and may generate benefits for these individuals. Nevertheless, the physical training programs during HD have not yet become routine in most dialysis centers. These factors are partly due to gaps in the literature, as well as the shortage of qualified professionals for the implementation of such programs.

Efeitos de um programa de exercícios físicos no condicionamento de pacientes em hemodiálise / Effects of a physical exercising program on conditioning of hemodialysis patients

Introdução: As repercussões da insuficiência renal crônica (IRC) são observadas em todos os sistemas do corpo, levando a um prejuízo na capacidade cardiorrespiratória e a descondicionamento físico. Objetivos: Avaliar os efeitos de um programa de exercícios físicos no condicionamento de pacientes em hemodiálise. Material e métodos: Participaram deste estudo, cinco pacientes com idade média de 45±9 anos. Foram avaliados: teste de caminhada de 6 minutos, teste ergométrico, pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax), resistência dos músculos inspiratórios e força damusculatura flexora das mãos. O programa de exercícios foi realizado em três sessões semanais, nos dias da diálise, num total de 24 sessões. Estes pacientes submeteram-se a um período de aquecimento, seguido de exercícios para membros superiores, bicicleta ergométrica, esteira rolante, período deresfriamento, treinamento específico para musculatura flexora dos dedos e para a musculatura inspiratória. Resultados: Houve redução significativa da pressão arterial sistólica de repouso no teste de caminhada de 6 minutos após o tratamento de 153±16 para 132±18 mmHg. Foi observada melhorasignificativa na PImax (de -86±29 para -117±3 cmH2O) e na PEmax (de 75±31 para 94±20 cmH2O). A força da musculatura flexora das mãos apresentou aumento significativo (de 13,5±2,5 para 16,6±2,3 libras/polegadas2 à direita e de 12,2±1,9 para 15,5±2,8 libras/polegadas2 à esquerda), bem como o consumomáximo de oxigênio (de 25,5±5,1 para 39,9±5,0 mLO2/Kg/min). Conclusão: O programa de exercícios físicos mostrou benefícios para o pacienteem hemodiálise na medida em que melhorou seu condicionamento. Trabalhos direcionados a estes pacientes devem ser estimulados.

Introduction: The repercussions of chronic kidney failure (CKF) can affect a number of body systems, and lead to reduced cardiopulmonary capacity anddeconditioning. Objectives: To evaluate the effects of an exercising program to the physical conditioning of patients undergoing hemodialysis. Methods: 5patients underwent this study (mean age 45 ± 9 years). Evaluated parameters included: 6 minute walking test (6MWT), and measurements of maximum oxygen consumption (VO2max), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), inspiratory muscle endurance and strength ofthe finger flexion muscles. The exercising program was carried out 3 times/week, in dialysis days, until 24 sessions were completed. In the exercise training, there was a warm-up period, followed by upper extremities exercises, stationary bicycling, treadmill training, a recovery period and specific training for finger flexion muscles and inspiratory muscles. Results: There was a significant decrease in rest systolic blood pressure in the 6MWT after the training period (from 153±16 to 132±18 mmHg). There were significant improvement in both MIP (from -86±29 to -117±3 cmH2O), and MEP (from 75±31 to 94±20 cmH2O).Increases were observed in the strength of the finger flexion muscles (from 13.5±2.5 to 16.6±2.3 pounds/square inches at right and from 12.2±1.9 to15.5±2.8 pounds/square inches at left), and in VO2max (from 25.5±5.1 to 39.9±5.0 mLO2/Kg/min). Conclusion: The physical exercising program wasassociated with benefits to the hemodialysis patients as revealed by the increase in their physical performance. Studies directed to such patients should be stimulated.

[Self-esteem in Mexican pediatric patients on peritoneal dialysis and kidney transplantation]. / Autoestima en pacientes pediátricos mexicanos con diálisis peritoneal y trasplante renal.

It has been reported in literature that self-esteem increases in patients who pass from continuous ambulatory peritoneal dialysis to renal transplantation. However, our clinical observations in the Department of Nephrology of Hospital Infantil de México Federico Gómez indicate otherwise. Therefore, we carried out this research on 60 patients, children and adolescents, male and female between the ages from 8 to 15 years old, and we applied them the Coopersmith self-esteem questionnaire, which has been validated in mexican population. These findings indicate that the social environment continuous ambulatory peritoneal dialysis patients feel more adapted than patients in renal transplant (p = 0.05). However it was also observed that these patients tried to show a better image on their situation through compensatory mechanisms (defense p = 0.03). It was concluded that it would be necessary to follow the adaptation of the transplanted patients, in order to help them achieve complete rehabilitation.