Abstract
BackgroundProtein-energy wasting (PEW) is common in hemodialysis patients and is a powerful predictor of morbidity and mortality. Although much progress has been made in recent years in identifying the causes and pathogenesis of PEW in hemodialysis patients, actual management by nutritional interventions is not always able to correct PEW. Some investigators suggest that physical exercise may increase the anabolic effects of nutritional interventions, and therefore may have a potential to reverse PEW. The aim of this study is to investigate the effect of intra-dialytic progressive exercise training and adequate nutritional supplementation on markers of PEW, functional capacities and quality of life of adult hemodialysis patients.Methods and designFifty end-stage renal disease patients undergoing hemodialysis, who meet the diagnostic criteria for PEW, will be randomly allocated into an exercise or control group for 6 months. The exercise consists of a progressive submaximal individualized cycling exertion using an adapted cycle ergometer, during the three weekly dialysis sessions. Biological markers of nutrition (albumin, prealbumin) will be followed monthly and all patients will be assessed for body composition, walk function, muscle strength, postural stability and quality of life at baseline and during the eighth week (t+2), the sixteenth week (t+4) and the twenty-fourth week (t+6) of the 6-month adapted rehabilitation program.DiscussionThe successful completion of this current trial may give precious clues in understanding PEW and encourage nephrologists to extend prescription of exercise programs as well as therapeutic and as preventive interventions in this high-risk population.Trial registrationThe protocol for this study was registered with the France Clinical Trials Registry NCT01813851.
Highlights
Protein-energy wasting (PEW) is common in hemodialysis patients and is a powerful predictor of morbidity and mortality
Despite significant progress in dialysis techniques and in the treatment of associated comorbidities, hemodialysis (HD) patients experience an impairment of their quality of life and have a much higher risk of mortality compared to an age-matched population
There are strong arguments in the literature to prescribe exercise in HD combined with nutritional interventions in patients suffering from PEW in an attempt to enhance the anabolic effects of nutrition and hereby reverse this high-risk state
Summary
Protein-energy wasting (PEW) is common in hemodialysis patients and is a powerful predictor of morbidity and mortality. Dialysis patients have decreased physical functioning (assessed by peak oxygen consumption (V_ O2 max), physical performance tests, and self-reported functioning), diminished muscle mass and altered muscle quality, and all of these features are associated with an increased mortality risk [4,5,6] These disturbances are directly related to renal failure and comorbidities, and to adverse effects from medical treatments and from the dialysis itself. Dialysis imposes immobilization over 12–18 hours a week, thereby directly contributing to sedentary behavior that can further worsen the medical condition of HD patients This vicious circle can lead to the development of disability, loss of independence, and death [8]. It seems rational to promote programs for exercise training in this population
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