Activity In Hemodialysis Patients Research Articles

Alterations of Spontaneous Brain Activity in Hemodialysis Patients.

Cognitive impairment is prevalent in hemodialysis end-stage renal disease (ESRD) patients. It might be associated with poor prognosis. Nevertheless, the underlying mechanisms have not been completely clarified. This study explored spontaneous brain activity in ESRD patients on hemodialysis by using the amplitude of low-frequency fluctuation (ALFF). Nineteen ESRD patients on regular hemodialysis were included in this study. Eighteen age-, sex- and education level-matched volunteers were enrolled as the healthy control group. All participants had resting-state functional MRI scanning, neuropsychological tests, and laboratory testing. ALFF was used for assessing intrinsic brain activity. Independent samples t-test was used for obtaining group differences. Spearman correlation analysis was applied to assess the association between ALFF changes, neuropsychological, and clinical indices. Compared to the healthy control group, hemodialysis patients showed decreased ALFF in the precuneus, right angular gyrus/inferior lobule as well as increased ALFF in the left parahippocampus/hippocampus and right precentral/postcentral gyrus. The ALFF abnormalities in these regions were closely associated with hemoglobin levels. Also, increased ALFF in the left parahippocampus/hippocampus showed a negative correlation with the score of long-delayed free recall. Hemodialysis patients had aberrant ALFF in the default mode network (DMN) regions, particularly in the precuneus and parahippocampus/hippocampus, which may be correlated with neuropathological mechanisms involved in hemodialysis.

P1030ENDOTHELIAL DYSFUNCTION AND CARDIAC VALVE CALCIFICATION IN PATIENTS WITH DIABETIC KIDNEY DISEASE UNDERGOING CHRONIC HEMODIALYSIS

Abstract Background and Aims The character of endothelial dysfunction (ED), especially of nitric oxide (NO) system, in patients with diabetic kidney disease (DKD) undergoing chronic hemodialysis (HD) was not asserted enough. In this condition not clearly established the relationship of structural and functional activity of endothelium with the presence and severity of cardiac valve calcification (CVC) as independent predictor of cardiovascular morbidity and mortality. The purpose of the current study was to determine the role of ED in mechanisms of mitral (MVC) and aortic (AVC) valve calcification in HD patients with DKD. Method We enrolled 136 patients undergoing HD (male/female, 78/58; age, 53.9±1.0 years; HD duration, 47.6±4.2 month) in this observational cross-sectional study. According to the study design, depending on the presence of type 2 diabetes mellitus with kidney injury patients were divided into two groups: the 1st one – without DKD (n=88); the 2nd one – with DKD (n=48). All subjects underwent echocardiographical examination for detection of CVC; the MVC and AVC degree were scored as follows: 1, no calcification; 2, valve thickening without calcification; 3, valve annulus or cusps calcification. Vasomotional function of endothelium was assessed using a test with reactive hyperemia (brachial artery flow-mediated dilatation (FMD)). Plasma content of nitrites (NO2), circulating endothelial cells (СECs) and serum concentration of C-reactive protein (CRP) were measured as markers of ED. Data are expressed as means±SEM. Used nonparametric statistics methods: Mann-Whitney U-test, χ2-test, Spearman’s rank R correlations. Results In group of HD patients with DKD indices of СECs (22.3±1.3 vs. 14.2±0.7 × 104/L, Z=4.98, p<0.001), CRP (9.94±1.12 vs. 7.07±1.09 mg/L, Z=3.47, p<0.001) were higher, and NO2 (4.16±0.41 vs. 9.01±1.37 umol/L, Z=3.15, p=0.002), FMD (2.27±0.66 vs. 5.13±0.52%, Z=3.26, p=0.001) – lower compared to the group without diabetes. CVC was detected in 66.6% of patients with DKD with predominance of calcification of both valves (35.4%) over isolated MVC (20.8%) and AVC (10.4 %). Combined valve calcification in the HD patients of the 2nd group was observed 2.6 times more often (χ2=8.78, p=0.003) than in the 1st one. For the first time it was established that in DKD the presence of CVC closely associated with indices of FMD (Rs=-0.59, p<0.001), NO2– (Rs=-0.56, p<0.001), СECs (Rs=0.63, p<0.001) and СRP (Rs=0.54, p<0.001). The MVC as well as AVC degree were related with the level of FMD (Rs=-0.47, p<0.001; Rs=-0.43, p=0.003), content of NO2– (Rs=-0.40, p=0.005; Rs=-0.62, p<0.001), СECs (Rs=0.47, p<0.001; Rs=0.62, p<0.001) and СRP (Rs=0.48, p<0.001; Rs=0.41, p=0.004) concentrations respectively. Conclusion (1) HD patients with DKD are combined with damaged endothelium, disturbance of vasoreactivity and lack of NO. (2) Type 2 diabetes mellitus with kidney injury is characterized by the large-scale combined MVC and AVC, which in turn are closely associated with the ED markers. (3) Complex estimation of the character of CVC and endothelium activity in HD patients with DKD permits a better identification of their cardiovascular risk.

THE ASSOCIATION OF HEMOGLOBIN LEVELS WITH QUALITY OF LIFE AND PHYSICAL ACTIVITY IN HEMODIALYSIS PATIENT IN WANGAYA REGIONAL GENERAL HOSPITAL, DENPASAR

Objective: Anemia in chronic kidney disease (CKD) contributes in decreasing quality life, but specific hemoglobin associated with quality of life is still in debate. Anemia was thought to be one of contributing factors of low physical activity in CKD, but this finding is inconsistent across studies. This research study aims to investigate the association of hemoglobin levels with quality of life and physical activity in hemodialysis patients in our settings.
 Methods: This study was conducted between March 30, 2020, and April 30, 2020, in hemodialysis unit, Wangaya Regional General Hospital, Bali. The study included 50 subjects on regular hemodialysis. Subject-reported quality of life was evaluated by interview, based on Kidney Disease Quality of Life (KDQOL)-36TM questionnaire. Self-reported physical activity level was assessed by International Physical Activity Questionnaires (IPAQ).
 Results: Quality of life in burden of kidney disease categories is different significantly between hemoglobin levels group (*p=0.034). There is significant difference between hemoglobin levels < 8 g/dL with 8.1–12 g/dL (**p=0.01) and hemoglobin levels < 8 g/dL with > 12 g/dL (*p=0.034). For self-reported physical activity, hemoglobin level was not associated with physical activity in Fisher’s exact test analysis (p=1.000).
 Conclusion: We found that hemoglobin levels > 8 g/dL were associated with higher quality of life in hemodialysis patient. Hemoglobin levels were not associated with physical activity. Recommended hemoglobin levels to support the best quality of life and physical activity without increasing mortality rate are still in need to be further evaluated.

Vitamin e-loaded membrane dialyzers reduce hemodialysis inflammaging

BackgroundInflammaging is a persistent, low−grade, sterile, nonresolving inflammatory state, associated with the senescence of the immune system. Such condition downregulates both innate and adaptive immune responses during chronic disorders as type II diabetes, cancer and hemodialysis, accounting for their susceptibility to infections, malignancy and resistance to vaccination.Aim of this study was to investigate hemodialysis inflammaging, by evaluating changes of several hemodialysis treatments on indoleamine 2,3-dioxygenase-1 activity and nitric oxide formation.MethodsWe conducted a randomized controlled observational crossover trial. Eighteen hemodialysis patients were treated with 3 different hemodialysis procedures respectively: 1) Low−flux bicarbonate hemodialysis, 2) Low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers, and 3) Hemodialfitration. The control group consisted of 14 hospital staff healthy volunteers. Blood samples were collected from all 18 hemodialysis patients just after the long interdialytic interval, at the end of each hemodialysis treatment period.ResultsHemodialysis kynurenine and kynurenine/L − tryptophan blood ratio levels were significantly higher, when compared to the control group, indicating an increased indoleamine 2,3-dioxygenase-1 activity in hemodialysis patients. At the end of the low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers period, L − tryptophan serum levels remained unchanged vs both low−flux bicarbonate hemodialysis and hemodialfitration. Kynurenine levels instead decreased, resulting in a significant reduction of kynurenine/L − tryptophan blood ratio and indoleamine 2,3-dioxygenase-1 activity, when matched to both low−flux bicarbonate hemodialysis and HDF respectively. Serum nitric oxide control group levels, were significantly lower when compared to all hemodialysis patient groups. Interestingly, low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers nitric oxide serum levels from venous line blood samples taken 60 min after starting the hemodialysis session were significantly lower vs serum taken simultaneously from the arterial blood line.ConclusionsThe treatment with more biocompatible hemodialysis procedure as low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers, reduced indoleamine 2,3-dioxygenase-1 activity and nitric oxide formation when compared to both low−flux bicarbonate hemodialysis and hemodialfitration. These data suggest that low−flux bicarbonate hemodialysis with vitamin E − loaded dialyzers lowering hemodialysis inflammaging, could be associated to changes of proinflammatory signalling a regulated molecular level.Trial registrationNCT Number: NCT02981992; Other Study ID Numbers: 20100014090. First submitted: November 26, 2016. First posted: December 5, 2016. Last Update Posted: December 5, 2016.

A cross-sectional study exploring levels of physical activity and motivators and barriers towards physical activity in haemodialysis patients to inform intervention development

Purpose To describe physical activity (PA) levels and motivators and barriers to PA amongst haemodialysis (HD) patients and to identify an appropriate approach to increasing their PA. Methods A cross-sectional mixed methods study conducted in a tertiary and satellite HD unit. One hundred and one participants aged 18 years and over, receiving regular HD for at least four months, were recruited. Patients with recent hospital admission or acute cardiac event were excluded. Participants completed health status (EQ-5D-3L™) and activity (Human Activity Profile (HAP)) questionnaires. A subgroup was invited to wear accelerometers and wearable cameras to measure PA levels and capture PA episodes, to inform subsequent semi-structured interviews on motivators and barriers. Semi-structured interviews were analysed using the framework method informed by constructs of the Health Belief Model. Results 98/101 completed the study (66 males, 32 females). For 68/98 participants, adjusted activity scores from the HAP indicated “impaired” levels of PA; for 67/98 participants, the EQ-5D-3L indicated problems with mobility. Semi-structured interviews identified general (fear of falls, pain) and disease specific barriers (fatigue) to PA. Motivators included tailored exercise programmes and educational support from health care professionals. Conclusions Participants indicated a need for co-development with healthcare professionals of differentiated, targeted exercise interventions. Implications for rehabilitation Healthcare professionals should encourage and motivate haemodialysis patients to participate in physical activity (PA). As part of this approach, there is a need to increase patient knowledge of safe beneficial exercise activities and help individuals identify and overcome barriers. To allow for individualised approaches, clinical interventions should focus on other community activities that patients can do outside the dialysis clinic setting and utilise existing networks such as the British Renal Society Rehabilitation Network. The dialysis clinic provides professionals the opportunity to monitor and motivate patients. Relevant education is needed for staff about the benefits of PA and how to engage patients and their carers in safe and effective approaches.

Physical Activity in Haemodialysis Patients: a Feasibility Study

Physical Activity in Haemodialysis Patients: a Feasibility Study

Carnitine deficiency is associated with decreased exercise activity in hemodialysis patients

Background and aimCarnitine deficiency is common and associated with muscle atrophy in hemodialysis (HD) patients. We investigated whether carnitine levels could be an independent predictor for exercise capacity in these patients.MethodA total of 37 patients (mean age, 55.9 ± 13.4 years) who underwent HD three times a week were enrolled in this study. Carnitine fraction levels were measured by the enzyme cycling method. Univariate and multiple stepwise regression analyses were performed to determine the correlation between free carnitine levels and the value of exercise capacity examined by the time-up-and-go test (TUG), knee extension strength, functional reach test (FRT), and 10-m walk test, and thigh and calf circumferences as markers of muscle mass.ResultsSerum free carnitine levels were significantly decreased in HD patients. Free carnitine levels were associated with TUG (inversely; r2 = 0.120, P = 0.035), knee extension strength (r2 = 0.129, P = 0.029), FRT (r2 = 0.246, P = 0.002), and the 10-m walk test (inversely; r2 = 0.149, P = 0.018). Multiple stepwise regression analysis revealed that free carnitine was an independent predictor for FRT (β = 0.369, P < 0.001). There was no correlation between free carnitine levels and thigh and calf circumferences.ConclusionLow serum free carnitine levels were associated with decreased exercise capacity in HD patients, suggesting that carnitine deficiency may be a promising therapeutic target for HD-associated muscle weakness in HD patients. This study was retrospectively registered.

Attitudes and barriers to physical activity in hemodialysis patients could intradialytic exercise modify these factors

<p class=MsoListParagraph style=margin-left:0in;mso-add-space:auto;text-align: justify;text-justify:inter-ideograph;mso-pagination:widow-orphan no-line-numbers> Abstract <p class=MsoListParagraphCxSpFirst style=margin-left:0in;mso-add-space:auto; text-align:justify;text-justify:inter-ideograph;mso-pagination:widow-orphan no-line-numbers> Introduction: This study pioneers in determining the impact of Intradialytic Exercise (IDE) on attitudes and barriers to Physical Activity (PA) in Hemodialysis (HD) patients in the United Arab Emirates, a non-western country with different cultural backgrounds. <p class=MsoListParagraphCxSpLast style=margin-left:0in;mso-add-space:auto; text-align:justify;text-justify:inter-ideograph;mso-pagination:widow-orphan no-line-numbers> Subjects and Methods: Forty-one adult HD patients from Al-Qassimi Hospital were recruited for a quasi-experimental intervention with pre-post evaluation. IDE patients trained for 45 minutes per HD session, 2-3 times per week, for 6 months on a static bicycle. Exercise intensity was assessed using the Borg Scale. Participants were educated on the importance of exercise. <p class=MsoListParagraph style=margin-left:0in;mso-add-space:auto;text-align: justify;text-justify:inter-ideograph;mso-pagination:widow-orphan no-line-numbers> Results: 30 patients completed the study. The percentage of patients exercising was higher post intervention, but dropped to baseline at the follow up period. At post intervention and follow-up, patient’s knowledge about the benefits and safety of exercise increased, with some patients facing no barrier to PA at the end of the study (p=0.05). There was a significant increase in patients endorsing the “too many medical problems” barrier, and a significant decrease in patients endorsing the “can’t afford to exercise” barrier. Nephrologists and nurses acknowledge the importance of exercise in HD patients, but the former do not prescribe it. <p class=MsoListParagraph style=margin-left:0in;mso-add-space:auto;text-align: justify;text-justify:inter-ideograph;mso-pagination:widow-orphan no-line-numbers> Conclusions: Aerobic IDE and knowledge empowerment programs could help HD patients increase their knowledge about exercise benefits and safety and shed some barriers to exercise, although patients appear to easily fall back into their normal habits. Even after an IDE program was adopted in the unit, the medical team is still concerned about the risks of exercise in HD patients. <p class=MsoListParagraph style=margin-left:0in;mso-add-space:auto;text-align: justify;text-justify:inter-ideograph;mso-pagination:widow-orphan no-line-numbers> Keywords: Attitude; Exercise; Hemodialysis; Nephrologists; Physical activity

Correction: Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment.

[This corrects the article DOI: 10.1371/journal.pone.0196313.].

Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment.

Background and aim of the studyIn hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff’s attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population.MethodsIn this prospective, cross-sectional, multicenter study we recruited 608 adult patients and 330 members of the healthcare staff in 16 hemodialysis units in Italy. We assessed patient-perceived barriers to, and healthcare staff’s attitude towards, exercise by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either barriers or staff’s attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile–Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. We also employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers.ResultsMost barriers were negatively associated with the HAP-AAS (adjusted change attributable to a given barrier ranging between -5.1 [“Feeling too old”, 95% Confidence Interval: -9.4 to -0.8] and -15.6 [“Ulcers on legs and feet”, 95%CI: -24.8 to -6.5]. We found a significant interaction between staff’s attitude and barriers (adjusted P values ranging between 0.03 [“I do not believe that it is physician’s or nurse’s role providing advice on exercise to patients on dialysis”] and 0.001 [“I do not often ask patients about exercise”]). A beneficial effect of a proactive staff’s attitude was evident only in patients not endorsing barriers.ConclusionsBarriers and non-proactive staff’s attitude reduce physical activity in hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive staff’s attitude.

Involvement of p38MAPK in Impaired Neutrophil Bactericidal Activity of Hemodialysis Patients.

Mortality from infections has been reported to be higher in hemodialysis (HD) patients. Although dysfunction of neutrophils against bacterial infection was reported in HD patients, the precise mechanism remains to be clarified. We therefore examined the impacts of neutrophil inflammatory signaling on bactericidal activity in HD patients. Comprehensive analyses of intracellular signalings were performed in whole blood of HD patients and control using a microarray system. To confirm the contribution of the signaling to bactericidal activity in neutrophils, we examined the phosphorylation, bacterial killing function, reactive oxygen species (ROS) production, and myeloperoxidase (MPO) release in neutrophils against Staphylococcus aureus. RNA microarray analysis showed the suppression of p38 mitogen activated protein kinase (MAPK) signaling in HD patients. Neutrophils in HD patients showed the impairment of bactericidal activity against S. aureus compared to healthy subjects. Phosphorylation rate of p38MAPK of neutrophils in response to S. aureus was lower in HD patients than healthy subjects. The levels of ROS produced by neutrophils after co-culture with S. aureus were lower in HD patients, on the other hand, there was no difference of MPO release between HD patients and healthy subjects. A selective pharmacological inhibitor of p38MAPK suppressed bacterial killing function as well as ROS production in neutrophils of healthy subjects. Impairment of p38MAPK signaling pathway might contribute to the suppression of neutrophil bactericidal activity in HD patients through less production of ROS.

Changes in physical activity and risk of all-cause mortality in patients on maintence hemodialysis: a retrospective cohort study

BackgroundA previous cohort study indicated a significant association of lower baseline level of physical activity in hemodialysis patients with elevated risks of mortality. However, there have been no reports regarding the association between changes in physical activity over time and mortality in hemodialysis patients. This study was performed to examine the prognostic significance of physical activity changes in hemodialysis patients.MethodsThis retrospective cohort study was performed in 192 hemodialysis patients with a 7-year follow-up. The average number of steps taken per non-dialysis day was used as a measure of physical activity. Forty (20.8%) patients had died during the follow-up period. The percentage change in physical activity between baseline and 12 months was determined, and patients were divided into three categories according to changes in physical activity. A decrease or increase in physical activity > 30% was defined as becoming less or more active, respectively, while decrease or increase in physical activity < 30% were classified as stable.ResultsForty seven (24.5%), 51 (26.6%), and 94 (49.0%) patients were classified as becoming less active, becoming more active, and stable, respectively. The hazard ratio on multivariate analysis in patients with decreased physical activity was 3.68 (95% confidence interval, 1.55–8.78; P < 0.01) compared to those with increased physical activity.ConclusionsReductions in physical activity were significantly associated with poor prognosis independent of not only patient characteristics but also baseline physical activity. Therefore, improved prognosis in hemodialysis patients requires means of preventing a decline in physical activity over time.

Assessment of the relationship between serum paraoxonase activity and epicardial adipose tissue in hemodialysis patients.

Paraoxonase-1 (PON-1) is a high-density lipoprotein-associated (HDL) enzyme, which has been shown to reduce susceptibility to low-density lipoprotein (LDL) peroxidation. Epicardial adipose tissue (EAT) is a marker of atherosclerosis. The aim of this study was to determine the relationship between PON-1 activity and EAT in hemodialysis (HD) patients. This is a cross-sectional study conducted on 72 (43 males) HD patients with end-stage renal disease. Serum levels for lipid profiles, C-reactive protein, calcium, phosphate, and parathyroid hormone were measured. PON-1 activity was also measured and compared to the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. Echocardiography was used to measure EAT thickness (EATT). The correlation between PON-1 and EATT was assessed, while independent predictors of EATT in HD patients were similarly assessed using multivariate regression analysis. There was a significant low mean value of PON-1 activity in HD patients compared with the control group (82.1±31.6 vs. 164.3±61.5 U/l, p=0.0001) and significant high mean value of EATT in HD patients, compared with controls (6.2±1.7 vs. 3.9±1.1mm, p=0.0001). In addition, there was a significant negative correlation between PON-1 activity and EATT (r=-0.484, p=0.0001) and a significant positive correlation between PON-1 activity and HDL-C (r=0.417, p=0.0003). PON-1, total cholesterol, triglycerides, LDL, HDL, age, and body mass index were found to be independent predictors of EATT. Our study demonstrated that PON-1 activity was significantly lower in HD patients compared with healthy controls and that PON-1 activity was inversely correlated with EATT in this population.

Dog ownership status and self-assessed health, life-style and habitual physical activity in chronic hemodialysis patients.

Introduction The Statement from the American Heart Association has emphasized a need for novel strategies that can reduce the risk of cardiovascular disease (CVD). Taking a dog for a walk forces its owner to take physical activity. Several studies have explored the relationship between pet ownership and CVD and most reported benefits. This issue has not been investigated in dialysis patients. The aim of the study was to analyze the influence of pet ownership on health and physical activity in hemodialysis patients. Methods 270 chronic hemodialysis patients (172 male, 98 female, mean age 62.7 ± 14.0 years, hemodialysis vintage 4 ± 5 years) took part in the survey focused on their general health and physical activity. Findings Two hundred nineteen (81%) patients were mobile. One hundred sixteen participants had dog at home (43%). An additional physical activity was reported by 46 dog owners (40%) compared with 34 (23%) of nonowners (P = 0.002). Patients who often go for a walk were more often pet owners 49 (57%) than nonowners (n = 37, 43%; P = 0.004). Pet owners were younger (58.3 ± 13.6 vs. 66 ± 13.5 years). Body mass index (BMI) was similar. Patients with BMI from upper tertile (>27.5 kg/m(2) ) and from lower (<23.9) were more often dog owners than from the middle (52.9%, 43.7%, and 31.4%). Dog owners were on dialysis for longer time (5.0 ± 6.5 vs. 3.5 ± 3.7 years; P = 0.02). Discussion Dog ownership appears to positively influence the level of physical activity. Age but not time on dialysis seems to be the most important factor that influences a decision to own a pet and undertake physical activity.

Effects of Pomegranate Extract Supplementation on Cardiovascular Risk Factors and Physical Function in Hemodialysis Patients.

The purpose of this study was to evaluate the effects of oral supplementation with pomegranate extract on cardiovascular risk, physical function, oxidative stress, and inflammation in hemodialysis (HD) patients. Thirty-three HD subjects were randomized to the pomegranate (POM) or placebo (CON) group. Patients in POM ingested a 1000 mg capsule of a purified pomegranate polyphenol extract 7 days/week for 6 months. Individuals in CON ingested a noncaloric placebo capsule using the same protocol. Measurements were conducted at baseline and repeated 6 months following the start of the intervention. Brachial blood pressure (BP) was obtained using an automatic digital BP monitor. Cardiovascular risk was assessed using ultrasound and arterial tonometry. Blood samples were collected for the measurements of circulating markers of inflammation, oxidative stress, and antioxidant capacity. Muscle strength and physical function were assessed by isokinetic dynamometry, a validated shuttle walk test, and a battery of tests to assess functional fitness. Systolic blood pressure and diastolic blood pressure were reduced by 24 ± 13.7 and 10 ± 5.3 mmHg, respectively, in POM (P < .05). However, the BP differences in POM were no longer significant after controlling for baseline BP. The paraoxonase-1 activity increased by 26.6% (P < .05) in POM, compared to no significant change in CON. However, pomegranate supplementation had no effect on other markers of cardiovascular disease risk, inflammation and oxidative stress, or measures of physical function and muscle strength. While pomegranate extract supplementation may reduce BP and increase the antioxidant activity in HD patients, it does not improve other markers of cardiovascular risk, physical function, or muscle strength.

Physical Activity in Hemodialysis Patients Measured by Triaxial Accelerometer.

Different factors can contribute to a sedentary lifestyle among hemodialysis (HD) patients, including the period they spend on dialysis. The aim of this study was to evaluate characteristics of physical activities in daily life in this population by using an accurate triaxial accelerometer and to correlate these characteristics with physiological variables. Nineteen HD patients were evaluated using the DynaPort accelerometer and compared to nineteen control individuals, regarding the time spent in different activities and positions of daily life and the number of steps taken. HD patients were more sedentary than control individuals, spending less time walking or standing and spending more time lying down. The sedentary behavior was more pronounced on dialysis days. According to the number of steps taken per day, 47.4% of hemodialysis patients were classified as sedentary against 10.5% in control group. Hemoglobin level, lower extremity muscle strength, and physical functioning of SF-36 questionnaire correlated significantly with the walking time and active time. Looking accurately at the patterns of activity in daily life, HDs patients are more sedentary, especially on dialysis days. These patients should be motivated to enhance the physical activity.

Quality of Life and Sleep Disorders Among Patients Treated with Hemodialysis in Relation to Dialysis Adequacy

Abstract Introduction. Recent studies in this field are insufficient to determine the relationship between life quality and hemodialy-sis adequacy. The problem, which requires further analysis is the issue of verification of these relationships and the problem of the relationship between sleep disorders and hemodialysis indicators. Aim. The aim of this study is to determine the relationship between quality of life and sleep disorders occurring among patients with end stage renal disease (ESRD) treated with hemodialysis and the dialysis adequacy parameters. Material and methods. The survey was based on two standardized international scales: the Quality of Life Scale (SF-36) and the Pittsburg Sleep Quality Index (PSQI). The study was conducted among 150 patients (67 women and 83 men) treated with hemodialysis at the Fresenius center. All patients participating in the study were undergoing dialysis three times a week. The average value of Kt/V was 1.45 (SD=0.22) and URR ration 71.78 (SD=5.95). Results. The urea level prior to hemodialysis moderately strongly correlates with life energy deficit (r=-0.34, p=-0.049) and that the values of urea reduction ratio URR weakly correlates with the patient's conviction on restricting life's activity (SF-36) (r=0.18, p=0.046). The level of urea prior to dialysis correlates positively with the time of falling asleep in PSQI scale (r=-0.39, p=0.023). Conclusions. Patients with lower urea level before hemodialysis have a significantly higher vitality level. Higher fluctuations of urea concentrations before and after hemodialysis (higher urea reduction ratio URR) are associated with restrictions of physical activity in hemodialysis patients.

Evaluation of the effects of physical activity in hemodialysis patients

Evaluation of the effects of physical activity in hemodialysis patients

The Relationship between Intact Parathyroid Hormone Levels and Daily Physical Activity in Hemodialysis Patients

Poor physical activity and decreased daily activities are commonly seen in hemodialysis (HD) patients. Along with the progression of chronic kidney disease (CKD), various abnormalities of mineral and bone metabolism develop, such as osteitis fibrosa and adynamic bone disease, which are related with intact parathyroid hormone (intact-PTH). Surprisingly, scarce data exists regarding the relationship between intact-PTH and daily physical activity in HD patients. Demographics, clinical parameters, laboratory data were recorded for all patients. Depressive symtoms, quality of life and daily activities of HD patients were measured by Beck Depression Inventory, SF-36, and Nottingham Extended Activities of Daily Living Scale (NEADLS), respectively. In total 114 patients (male/female: 63/51, aged: 53.0 ± 13.8 years) were enrolled. The value of intact-PTH for <25th (Group 1), < 25th-50th (Group 2), 50th-75th (Group 3) and >75th (Group 4) quartiles were <132.5 pg/ml, ≥132.5 <261.0, ≥261.0 <510.4 and ≥510.4, respectively. The NEADLS scores were 25.3 ± 10.8, 35.0 ± 9.4, 27.2 ± 13.9 and 26.4 ± 12.9 as going from Group 1 to Group 4 (p = 0.009). Post-hoc analysis of these four groups revealed that only Group 1 and Group 2 (p = 0.012), and Group 2 and Group 4 (p = 0.034) were different with respect to NEADLS scores. Intact-PTH levels were inversely associated with daily activities in whole group. However, the post hoc analysis demonstrated that the association between intact PTH and daily activity is not linear and daily physical activity was lower only in patients with lowest and highest quartiles of intact-PTH.

Beneficial Effect of Physical Activity in Hemodialysis Patients

Hemodialysis patients are significantly less active than healthy, sedentary individuals and a low intrinsic motivation has been identified as a major barrier to prescribing exercise. Regular physical activity is associated with enhanced health and well being. World Health Organisation (WHO) revealed that regular physical activity is widely recognized as a mean of preventing the occurrence of many chronic diseases and reduced risk of all-cause mortality. Physical activity during illness results in improvement in physical function. Physical activity helps dialysis patients to improve their well-being. The association of decreasing levels of leisure-time physical activity with increased mortality risk is less certain in ESRD patients than in the general population. Studies have shown that hemodialysis patients physically being active had efficient clearance of urea during dialysis compared to physically inactive patients. Yoga and exercise in hemodialysis patient increases the quality of life through reduced stress level. In our country there is lack of awareness of potential benefits of physical activity in hemodialysis patients and there are no facilities available in in-centre hemodialysis centre to implicate the exercise programe during dialysis compared to Western hemodialysis centres. So there is the great need to impart the knowledge among the patients to obtain the complete standard of living with daily physical activity during on and off dialysis days.