A randomized controlled trial of exercise to prevent muscle mass and functional loss in elderly hemodialysis patients: Rationale, study design, and baseline sample.

Khin N Chan,Jonathan N Myers,Payam Massaband,Ralph Rabkin,Jenny Kiratli,Yiming Lit,Yu Chen

doi:10.1016/j.conctc.2019.100365

Abstract

BackgroundElderly maintenance hemodialysis (MHD) patients exhibit muscle wasting and impaired physical function. This trial determines whether MHD patients benefit from a 12-week home-based exercise program, protein supplementation, or both.Designand Methods: This is a randomized, blinded controlled trial involving 60 elderly MHD patients with impaired exercise capacity and function. Patients are randomized into either a homebased exercise program or normal care over a 12-week period. Measures at baseline include peak VO2, strength and body composition as well as cognitive and disease-specific questionnaires. Muscle biopsies are obtained and analyzed for protein signaling, expression of IGF-1, androgen receptors, and myostatin.ResultsAt baseline, patient characteristics in the exercise and normal care groups were similar by age, gender and anthropomorphic measures. Peak VO2 was impaired (14.7 ± 3.3 ml/kg/min), representing 55 ± 14% of the age-predicted value. Six-minute walk distance was 322 ± 71 m, and the mean 1-min sit to stand test was 18 ± 8 repetitions, representing 69 ± 16% and 55 ± 22% of the age-predicted values, respectively. Indices of muscle function, including upper and lower body and hand grip strength all indicate marked impairment. Quality of life (QoL) using the SF36, the Beeson cognitive test, and KDQOL all suggest marked impairments compared to age-expected reference values for non-MHD patients.ConclusionsPatients undergoing MHD exhibit markedly reduced physical function and QoL. Thus, there are potentially significant gains to be made through a program of aerobic and resistance exercise. We anticipate this trial will demonstrate that home-based exercise improves cardiopulmonary function, protein signaling and QoL, and increases muscle mass, strength, and body composition.

Highlights

In chronic kidney disease (CKD) muscle mass and physical function decline as renal failure progresses [1]
maintenance hemodialysis (MHD) patients have a considerable amount to gain from participation in an exercise program
There is a need for large-scale prolonged studies to establish the true long-term benefits of exercise on morbidity and mortality in this population, but a prerequisite to such studies is the development of a low-cost exercise program that will be relatively easy to administer and adhere to, and that will form part of routine MHD care

Summary

Introduction

In chronic kidney disease (CKD) muscle mass and physical function decline as renal failure progresses [1] These processes are accelerated in elderly dialysis patients since both the uremic environment and aging cause loss of muscle mass and function that together predispose these patients to frailty. Maintenance hemodialysis (MHD) patients exhibit muscle wasting and impaired physical function. This trial determines whether MHD patients benefit from a 12-week home-based exercise program, protein supplementation, or both. There are potentially significant gains to be made through a program of aerobic and resistance exercise We anticipate this trial will demonstrate that home-based exercise improves cardiopulmonary function, protein signaling and QoL, and increases muscle mass, strength, and body composition

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Conclusion