Jessica L F Andrade, Ayden T Heitmann, Miguel K Rodrigues, Dave K Marchand, Adelson M Rodrigues, Bruno P Biluca, Rene Freitas, Thiago Reis, Miguel A Goes, Mayron F Oliveira
{"title":"运动作为维持性血液滤过患者的辅助治疗。","authors":"Jessica L F Andrade, Ayden T Heitmann, Miguel K Rodrigues, Dave K Marchand, Adelson M Rodrigues, Bruno P Biluca, Rene Freitas, Thiago Reis, Miguel A Goes, Mayron F Oliveira","doi":"10.23876/j.krcp.24.243","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Fatigue and sedentarism are common in kidney disease and dialysis treatment. Although hemodiafiltration effectively removes solutes and improves mortality, the influence of exercise as an adjunct therapy on maintenance hemodiafiltration programs remains understudied.</p><p><strong>Methods: </strong>A multicenter 6-month study was assessed comparing individuals with chronic kidney disease enrolled in exercise training (exercise group) during dialysis (intradialytic vs. interdialytic) compared to usual care (control group). Physical tests included a YMCA step test for endurance, handgrip, and one-repetition maximum for muscle strength. Single-pool, standard, and equilibrated Kt/Vurea were surrogates for hemodiafiltration adequacy.</p><p><strong>Results: </strong>Eighty-nine patients (54 ± 15 years) and 33 control patients (60 ± 17 years) underwent the exercise protocol. The mean disease vintage was 108 ± 84 and 132 ± 108 months, respectively, while the dialysis vintage was 60 ± 42 and 60 ± 36 months. Control-group Kt/Vurea showed improvement from baseline to month 6 (single-pool, 1.18 ± 0.03 to 1.30 ± 0.04; standard, 1.94 ± 0.04 to 2.09 ± 0.04; equilibrated, 1.09 ± 0.03 to 1.21 ± 0.02; p < 0.001). However, exercise-group Kt/Vurea showed a comparatively greater improvement between the baseline and month 6 (single pool, 1.19 ± 0.05 to 1.47 ± 0.04; standard, 1.99 ± 0.03 to 2.15 ± 0.03; equilibrated, 1.08 ± 0.03 to 1.24 ± 0.03; p < 0.001). The exercise group had a statistically significant increase in the handgrip test (279.5 ± 78.5 N to 295.2 ± 76.5 N, p < 0.01) and fat-free mass (13.9 ± 2.8 kg/m2 to 14.4 ± 2.7 kg/m2, p < 0.01). There were no statistically significant differences between the interdialytic and intradialytic groups in dialysis adequacy and exercise variables.</p><p><strong>Conclusion: </strong>Supervised exercise for maintenance hemodiafiltration patients was associated with improvements in dialysis efficiency/performance outcomes. 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Although hemodiafiltration effectively removes solutes and improves mortality, the influence of exercise as an adjunct therapy on maintenance hemodiafiltration programs remains understudied.</p><p><strong>Methods: </strong>A multicenter 6-month study was assessed comparing individuals with chronic kidney disease enrolled in exercise training (exercise group) during dialysis (intradialytic vs. interdialytic) compared to usual care (control group). Physical tests included a YMCA step test for endurance, handgrip, and one-repetition maximum for muscle strength. Single-pool, standard, and equilibrated Kt/Vurea were surrogates for hemodiafiltration adequacy.</p><p><strong>Results: </strong>Eighty-nine patients (54 ± 15 years) and 33 control patients (60 ± 17 years) underwent the exercise protocol. The mean disease vintage was 108 ± 84 and 132 ± 108 months, respectively, while the dialysis vintage was 60 ± 42 and 60 ± 36 months. Control-group Kt/Vurea showed improvement from baseline to month 6 (single-pool, 1.18 ± 0.03 to 1.30 ± 0.04; standard, 1.94 ± 0.04 to 2.09 ± 0.04; equilibrated, 1.09 ± 0.03 to 1.21 ± 0.02; p < 0.001). However, exercise-group Kt/Vurea showed a comparatively greater improvement between the baseline and month 6 (single pool, 1.19 ± 0.05 to 1.47 ± 0.04; standard, 1.99 ± 0.03 to 2.15 ± 0.03; equilibrated, 1.08 ± 0.03 to 1.24 ± 0.03; p < 0.001). The exercise group had a statistically significant increase in the handgrip test (279.5 ± 78.5 N to 295.2 ± 76.5 N, p < 0.01) and fat-free mass (13.9 ± 2.8 kg/m2 to 14.4 ± 2.7 kg/m2, p < 0.01). There were no statistically significant differences between the interdialytic and intradialytic groups in dialysis adequacy and exercise variables.</p><p><strong>Conclusion: </strong>Supervised exercise for maintenance hemodiafiltration patients was associated with improvements in dialysis efficiency/performance outcomes. 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引用次数: 0
摘要
背景：疲劳和久坐在肾脏疾病和透析治疗中很常见。虽然血液滤过能有效地去除溶质并提高死亡率，但运动作为辅助治疗对维持血液滤过计划的影响仍未得到充分研究。方法：一项为期6个月的多中心研究评估了在透析期间（透析内与透析间）与常规治疗（对照组）进行运动训练（运动组）的慢性肾脏疾病患者。体能测试包括YMCA步进测试耐力、握力和肌肉力量的单次最大重复。单池、标准和平衡Kt/ v尿素是血液滤过充分性的替代品。结果：89例患者（54±15岁）和33例对照患者（60±17岁）接受了运动方案。平均发病时间分别为108±84和132±108个月，透析时间分别为60±42和60±36个月。对照组Kt/Vurea从基线到第6个月均有改善(单池，1.18±0.03至1.30±0.04；标准，1.94±0.04至2.09±0.04；平衡，1.09±0.03至1.21±0.02；P < 0.001)。然而，运动组Kt/Vurea在基线和第6个月之间表现出相对更大的改善(单池，1.19±0.05至1.47±0.04；标准，1.99±0.03至2.15±0.03；平衡，1.08±0.03至1.24±0.03；P < 0.001)。运动组握力测试（279.5±78.5 N ~ 295.2±76.5 N, p < 0.01）、无脂质量（13.9±2.8 kg/m2 ~ 14.4±2.7 kg/m2, p < 0.01）增加有统计学意义。透析充分性和运动变量在透析间期组和透析内组之间无统计学差异。结论：维持性血液滤过患者的监督运动与透析效率/表现结果的改善有关。结果支持运动作为血液透析患者的辅助治疗，无论是在透析期还是透析期。
Exercise as an adjunctive therapy for patients on maintenance hemodiafiltration.
Background: Fatigue and sedentarism are common in kidney disease and dialysis treatment. Although hemodiafiltration effectively removes solutes and improves mortality, the influence of exercise as an adjunct therapy on maintenance hemodiafiltration programs remains understudied.
Methods: A multicenter 6-month study was assessed comparing individuals with chronic kidney disease enrolled in exercise training (exercise group) during dialysis (intradialytic vs. interdialytic) compared to usual care (control group). Physical tests included a YMCA step test for endurance, handgrip, and one-repetition maximum for muscle strength. Single-pool, standard, and equilibrated Kt/Vurea were surrogates for hemodiafiltration adequacy.
Results: Eighty-nine patients (54 ± 15 years) and 33 control patients (60 ± 17 years) underwent the exercise protocol. The mean disease vintage was 108 ± 84 and 132 ± 108 months, respectively, while the dialysis vintage was 60 ± 42 and 60 ± 36 months. Control-group Kt/Vurea showed improvement from baseline to month 6 (single-pool, 1.18 ± 0.03 to 1.30 ± 0.04; standard, 1.94 ± 0.04 to 2.09 ± 0.04; equilibrated, 1.09 ± 0.03 to 1.21 ± 0.02; p < 0.001). However, exercise-group Kt/Vurea showed a comparatively greater improvement between the baseline and month 6 (single pool, 1.19 ± 0.05 to 1.47 ± 0.04; standard, 1.99 ± 0.03 to 2.15 ± 0.03; equilibrated, 1.08 ± 0.03 to 1.24 ± 0.03; p < 0.001). The exercise group had a statistically significant increase in the handgrip test (279.5 ± 78.5 N to 295.2 ± 76.5 N, p < 0.01) and fat-free mass (13.9 ± 2.8 kg/m2 to 14.4 ± 2.7 kg/m2, p < 0.01). There were no statistically significant differences between the interdialytic and intradialytic groups in dialysis adequacy and exercise variables.
Conclusion: Supervised exercise for maintenance hemodiafiltration patients was associated with improvements in dialysis efficiency/performance outcomes. The results support exercise as an adjunct therapy for hemodiafiltration patients whether conducted during the intradialytic or interdialytic period.
期刊介绍：
Kidney Research and Clinical Practice (formerly The Korean Journal of Nephrology; ISSN 1975-9460, launched in 1982), the official journal of the Korean Society of Nephrology, is an international, peer-reviewed journal published in English. Its ISO abbreviation is Kidney Res Clin Pract. To provide an efficient venue for dissemination of knowledge and discussion of topics related to basic renal science and clinical practice, the journal offers open access (free submission and free access) and considers articles on all aspects of clinical nephrology and hypertension as well as related molecular genetics, anatomy, pathology, physiology, pharmacology, and immunology. In particular, the journal focuses on translational renal research that helps bridging laboratory discovery with the diagnosis and treatment of human kidney disease. Topics covered include basic science with possible clinical applicability and papers on the pathophysiological basis of disease processes of the kidney. Original researches from areas of intervention nephrology or dialysis access are also welcomed. Major article types considered for publication include original research and reviews on current topics of interest. Accepted manuscripts are granted free online open-access immediately after publication, which permits its users to read, download, copy, distribute, print, search, or link to the full texts of its articles to facilitate access to a broad readership. Circulation number of print copies is 1,600.
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