Physical Activity In Hemodialysis Patients Research Articles

WCN24-1057 Enhancing Gait and Physical Activity in Hemodialysis Patients: A Randomized Trial of Intradialytic Electrical Stimulation

WCN24-1057 Enhancing Gait and Physical Activity in Hemodialysis Patients: A Randomized Trial of Intradialytic Electrical Stimulation

The Impact of a Wearable Activity Tracker and Structured Feedback Program on Physical Activity in Hemodialysis Patients: The Step4Life Pilot Randomized Controlled Trial

People with end-stage kidney disease (ESKD) have very low physical activity, and the degree of inactivity is strongly associated with morbidity and mortality. We assessed the feasibility and effectiveness of a 12-week intervention coupling a wearable activity tracker (FitBit) and structured feedback coaching versus wearable activity tracker alone on changes in physical activity in hemodialysis patients. Randomized controlled trial. 55 participants with ESKD receiving hemodialysis who were able to walk with or without assistive devices recruited from a single academic hemodialysis unit between January 2019 and April2020. All participants wore a Fitbit Charge 2 tracker for a minimum of 12 weeks. Participants were randomly assigned 1:1 to a wearable activity tracker plus a structured feedback intervention versus the wearable activity tracker alone. The structured feedback group was counseled weekly on steps achieved after randomization. The outcome was step count, and the main parameter of interest was the absolute change in daily step count, averaged per week, from baseline to completion of 12 weeks intervention. In the intention-to-treat analysis, mixed-effect linear regression analysis was used to evaluate change in daily step count from baseline to 12-weeks in both arms. Out of 55 participants, 46 participants completed the 12-week intervention (23 per arm). The mean age was 62 (± 14 SD) years; 44% were Black, and 36% were Hispanic. At baseline, step count (structured feedback intervention: 3,704 [1,594] vs wearable activity tracker alone: 3,808 [1,890]) and other participant characteristics were balanced between the arms. We observed a larger change in daily step count in the structured feedback arm at 12 weeks relative to use of the wearable activity tracker alone arm (Δ 920 [±580 SD] versus Δ 281 [±186 SD] steps; between-group difference Δ 639 [±538 SD] steps; P<0.05). Single-center study and small sample size. This pilot randomized controlled trial demonstrated that structured feedback coupled with a wearable activity tracker led to a greater daily step count that was sustained over 12 weeks relative to a wearable activity tracker alone. Future studies are required to determine longer-term sustainability of the intervention and potential health benefits in hemodialysis patients. Grants from industry (Satellite Healthcare) and government (National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK). Registered at ClinicalTrials.gov with study number NCT05241171.

Mediterranean Diet: A Dietary Pattern Related to Nutritional Benefits for Hemodialysis Patients

In adults with CKD, not on dialysis, there is a recent recommendation suggesting the prescription of a Mediterranean Diet pattern but there is still no evidence to suggest a specific dietary pattern for hemodialysis (HD) patients. The aim of this study was to identify dietary patterns in HD patients and analyze their relationship with nutritional status, physical activity, and survival. This was a longitudinal prospective multicenter study with 12 months of follow-up that included 582 HD patients from 37 dialysis centers. Clinical parameters, dietary intake and physical activity were assessed. Dietary patterns were derived from principal component analysis. A p-value lower than 0.05 was considered statistically significant. Three different dietary patterns were identified: "Mediterranean", "Western" and "Low animal protein". Patients in the Mediterranean pattern group showed higher intakes of protein (p=0.040), omega 3 fatty acids (p< 0.001), vitamins B12 (p< 0.001), B6 (p< 0.001), C (p< 0.001), D (p< 0.001), folic acid (p< 0.001) and presented a higher practice of moderate physical activity (p=0.010). Despite the lower number of deaths that occurred in the Mediterranean dietary pattern group, we did not observe a statistically significant lower mortality risk (p=0.096). The Mediterranean style pattern was associated with a better nutritional intake profile and in lifestyle related factors such as a higher practice of moderate physical activity in HD patients.

Physical function and physical activity in hemodialysis patients with peripheral artery disease.

Peripheral artery disease (PAD) is commonly observed in patients undergoing hemodialysis. PAD impairs the vasculature and leads to pathophysiologic changes in the skeletal muscles, causing physical function impairment and physical inactivity in general. However, it is unclear whether PAD adversely affects physical function and physical activity in patients on hemodialysis. We performed a cross-sectional study with a retrospective review of the data to determine whether PAD is associated with impaired physical function and physical activity in patients undergoing hemodialysis. The study population comprised 310 patients and 88 healthy subjects. PAD was diagnosed based on an ankle-brachial index of <1.00 in patients on hemodialysis. Measurements of physical function included maximum walking speed, muscle strength in the lower extremities, and balance while standing. Of the 310 patients, 84 (27.1%) had PAD. When patients undergoing hemodialysis were divided into those without PAD and those with PAD, both groups had poorer physical function and physical activity than the healthy control subjects. After adjustments for potential confounders, it was found that patients on hemodialysis with PAD had slower walking speed, poorer standing balance, and less physical activity than those without PAD. However, there was no significant difference in lower extremity muscle strength between the two groups. PAD diagnosed based on an ankle-brachial index of <1.00 was independently associated with impaired physical function and reduced physical activity in patients undergoing hemodialysis.

MO835: Physical Activity Measured by Pedometer And Human Activity Profile in Hemodialysis Patients

Abstract BACKGROUND AND AIMS Physical inactivity is associated with increased mortality in hemodialysis patients and the level is still unclear. Several studies have surveyed physical activity in hemodialysis patients with subjective methods by questionnaires, and some have used objective methods based on accelerometers or pedometers in small population. This study aimed to investigate the level of physical activity of hemodialysis patients with a combination of pedometer and questionnaire and explore the influencing factors limiting the physical activity. METHOD A multi-center cross-sectional survey using pedometer and Human Activity Profile (HAP) was performed in 505 hemodialysis patients. The pedometer (Omron, HJ-321) measured daily steps by continuously wearing for a week. HAP can provide a maximum activity score (MAS) reflecting the most taxing activity the patient is still doing, and an adjusted activity score (AAS) reflecting the level of daily activity. Linear regression was performed to explore factors related to the physical activity. RESULTS A total of 505 patients were included in this study. The average age (means ± SE) was 49.69 ± 13.96 years with 141 (27.92%) patients were elderly (≥60 years old), and 339 (67.13%) were male. Patients walked 4585.84 ± 2887.40 steps/day, 94.65% of patients had physical activity levels below the guideline recommended level (10 000 steps/day), and 60% were in sedentary lifestyle (&amp;lt;5000 steps/day). The AAS score was 63.85 ± 13.99, 112 patients were impaired (&amp;lt;53 points), and 275 were moderately active (≥53 and &amp;lt;74 points). The univariate linear regression showed that the elderly, unemployed, diabetic nephropathy and patients with diabetes or &amp;gt;3 complications had fewer steps and lower MAS and AAS scores (P &amp;lt; 0.05). Besides, the number of steps in patients undergoing hemodialysis 5 times every 2 weeks was significantly lower than that of patients 3 times/week (P = 0.020). And for MAS and AAS, the ability to perform daily activities was significantly impaired in females and patients over 36 months of hemodialysis (P &amp;lt; 0.05). In multivariate linear regression, elderly patients with &amp;gt;3 complications were associated with lower levels of physical activity (P &amp;lt; 0.05). Females [–2.72 (–5.21 to –0.24); P = 0.032] with hypertension [6.14 (1.89–10.40); P = 0.005), congestive heart failure [5.24 (0.94–9.53); P = 0.017] and ischemic heart disease [6.48 (1.01–11.94); P = 0.020] were more likely to have impaired daily physical activity. CONCLUSION This survey demonstrates that hemodialysis patients are engage in physical inactivity. Elderly hemodialysis patients with more complications are prone to physical inactivity. Patients undergoing hemodialysis 5 times every 2 weeks are more likely to be live with sedentary lifestyle, while female patients with hypertension, congestive heart failure and ischemic heart disease are more impaired in daily physical activity. We should pay attention to the physical inactivity of hemodialysis patients.

Glittre activities of daily living test is reliable and valid in hemodialysis patients

Purpose To examine the validity, and the relative and absolute within-day reliability of the TGlittre in chronic kidney disease patients undergoing hemodialysis (HD). Materials and methods Thirty HD patients (52 ± 12 years) undertook the TGlittre twice on a single day, in a cross-sectional design. For validation purposes, participants TGlittre performance and accelerometry-based physical activity were correlated. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were determined to assess within-day reliability. Results There was a moderate correlation between TGlittre performance and moderate to vigorous physical activity (r= −0.587; p= 0.001). The relative reliability of the test showed an ICC of 0.96. For the absolute reliability, the SEM was 13.05 s (0.22 min), and the MDC was 36.17 s (0.60 min). Conclusions TGlittre performance is associated with moderate to vigorous physical activity in HD patients, highlighting that those with higher levels of physical activity are likely to perform better on the TGlittre. Additionally, TGlittre shows a good to excellent intra-rater reliability and a low SEM. An MDC value was established. Implications for rehabilitation Patients on hemodialysis have a low physical capacity and often struggle to simply complete their physical activities of daily living. The TGlittre is a tool for assessing functional capacity through completion of multiple physical activities of daily living and can be easily applied in a clinical setting. TGlittre is a valid test that elicit reliable physiological, hemodynamic, and physical performance responses in HD patients.

Accelerometry Correlates in Body Composition, Physical Fitness, and Disease Symptom Burden: A Pilot Study in End-Stage Renal Disease

There is strong evidence that hemodialysis (HD) patients with a sedentary lifestyle have a higher risk of death compared to peers who engage in regular physical activity. Therefore, monitoring physical activity is of utmost importance. However, there is a lack of data on objectively measured physical activity behaviors in HD patients. Therefore, this study aimed to objectively measure physical activity in HD patients throughout the week, with particular attention to dialysis and non-dialysis days. We also examined how objectively measured physical activity correlated with physical fitness, body composition, and disease burden. Daily physical activity, body composition, serum parameters, comorbidity index, sit-to-stand, and hand-grip strength tests were measured in 14 HD patients. Daily physical activity was measured using the Actigraph GT9X accelerometer. The Dialysis Symptom Index questionnaire was also used. We found significant differences in anthropometric variables (weight, body mass index, overhydration, lean tissue index, and fat tissue index, all p < 0.05) and phase angle (p < 0.01) between HD patients reaching and patients not reaching physical activity guidelines for patients with chronic diseases. HD patients showed to be less active during dialysis days compared to non-dialysis days as indicated in sedentary time (–11.7%; p = 0.001), light (–47.3%; p = 0.003), moderate (–51.5%; p = 0.001), moderate to vigorous (–49.3%; p = 0.001), and vigorous (–34.3%; p = 0.067) physical activity. No significant correlations were found among serum parameters, symptom burden, and comorbidity burden, but a very large and positive correlation was found between phase angle and total moderate to vigorous physical activity (p < 0.01). Our findings support the need to implement physical activity on dialysis days in HD units to mitigate the effects of sedentary behavior. Prospective, long-term studies evaluating the use of accelerometers in HD patients and their effects on physical activity are needed.

Fear of falling and physical activity in hemodialysis patients: a pilot study

BackgroundHemodialysis (HD) patients are at a high risk of falls and fractures. The amount of physical activity (PA) they perform may be limited by psychosomatic factors associated with fear of falling, leading to frailty progression. This study aimed to clarify the relationship between fear of falling and PA in patients undergoing HD.MethodsThis cross-sectional study included 46 HD patients. Fear of falling was evaluated using the Modified Falls Efficacy Scale (MFES). A 3-axis accelerometer was used to measure PA, including number of steps; 1 to 1.9 METs = static PA, 2 to 2.9 = light PA, and 3 or more = moderate to vigorous PA (MVPA). We examined correlation of MFES with each type of PA. Factors affecting fear of falling were determined using multiple regression analysis.ResultsThe median MFES was 9.2 (7.4, 10.0). MFES was associated with the number of steps (r = 0.608, p < 0.001), light PA (r = 0.421, p = 0.004), and MVPA (r = 0.546, p < 0.001). Eighteen participants (39.1%) experienced at least one fall in a year and had lower MFES than the non-fall group (fall group: 7.4 [5.1, 9.0] vs. non-fall group: 9.7 [8.5, 10.0], p < 0.001). Multiple regression analysis showed that MFES was independently associated with the number of steps (B = 279.7, 95% confidence interval [CI] = 90.5–469.0, p = 0.005) and MVPA (B = 3.52, 95% CI = 1.14–5.90, p = 0.005), respectively.ConclusionsFear of falling was associated with amount of PA among patients undergoing HD. Interventions that target the fear of falling may be effective in reducing HD patients’ fall risk by enhancing PA.

Dietary Intake, Body Composition, and Clinical Parameters: Associations Between the Level and Type of Physical Activity in Hemodialysis Patients.

Physical inactivity and muscle wasting potentiate each other and are highly prevalent among hemodialysis (HD) patients. The authors evaluated the association between physical activity (PA), clinical, nutritional, and body composition parameters in HD patients. Multicenter cross-sectional study with 581 HD patients. Clinical, body composition, dietary intake, and PA data were recorded. For the analysis, patients were divided into active (follow World Health Organization recommendations) and inactive groups. A total of 20% of the patients followed World Health Organization recommendations on PA. Differences between physically active and physically inactive patients were observed in age, biochemical parameters and total body water, intracellular water, lean tissue index (LTI), body cell mass, energy, and protein intake. PA was a predictor of higher LTI, body cell mass, and energy intake independently of age, gender, presence of diabetes, dialysis adequacy, and dialysis vintage. Controlling for the effect of age, walking and vigorous PA were positively correlated with energy and protein intake. Vigorous PA was also positively correlated with LTI. The PA is a predictor of higher LTI, body cell mass, and energy intake. Vigorous PA is associated with an improved body composition and dietary pattern, whereas walking seems to be also associated with a favorable nutritional status.

Physical activity in hemodialysis patients on nondialysis and dialysis days: Prospective observational study

The physical decline in patients with end-stage kidney disease (ESKD) is associated with morbidity and mortality. Prior studies have attempted to promote physical activity at the time of dialysis; however, physical activity patterns on the nondialysis days are unknown. This study aimed to quantify physical activity on dialysis and nondialysis days in hemodialysis patients using a wearable actigraph. In this prospective study, subjects receiving hemodialysis were recruited from two outpatient dialysis units in urban San Diego and rural Imperial County, CA, between March 2018 and April 2019. Key inclusion criteria included: (1) receiving thrice weekly hemodialysis for ≥3 months, (2) age ≥ 18 years, and (3) able to walk with or without assistive devices. All participants wore a Fitbit Charge 2 tracker for a minimum of 4 weeks. The primary outcome was the number of steps per day. Each participant completed the Physical Activity Questionnaire, the Patient Health Questionnaire (PHQ)-9, the PROMIS Short form Fatigue Questionnaire at baseline, and the Participant Technology Experience Questionnaire at day 7 after study enrolment. Of the 52 recruited, 45 participants (urban = 25; rural = 20) completed the study. The mean age was 61 ± 15 years, 42% were women, 64% were Hispanic, and the mean dialysis vintage was 4.4 ± 3.0 years. For those with valid Fitbit data (defined as ≥10 hours of wear per day) for 28 days (n = 45), participants walked an average of 3688 steps per day, and 73% of participants were sedentary (<5000 steps/day). Participants aged >80 years were less active than younger (age < 65 years) participants (1232 vs. 4529 steps, P = 0.01). There were no statistical differences between the groups when stratified by gender (women vs. men [2817 vs. 4324 steps, respectively]), urbanicity (rural vs. urban dialysis unit [3141 vs. 4123 steps, respectively]), and dialysis/nondialysis day (3177 vs. 4133 steps, respectively). Due to the small sample size, we also calculated effect sizes. The effect size was medium for the gender differences (cohen's d = 0.57) and small to medium for urbanicity and dialysis/nondialysis day (d = 0.37 and d = 0.33, respectively). We found no association between physical activity and self-reported depression and fatigue scale. The majority of participants (62%, 28/45) found the Fitbit tracker easy to wear and comfortable. ESKD participants receiving hemodialysis are frequently sedentary, and differences appear more pronounced in older patients. These findings may assist in designing patient-centered interventions to increase physical activity among hemodialysis patients.

Effects of Ingressed Physical Activity in Hemodialysis Patients on Health-related Quality of Life and Nutritional Intake

Effects of Ingressed Physical Activity in Hemodialysis Patients on Health-related Quality of Life and Nutritional Intake

Association of nutrient intakes with physical activity in patients on chronic hemodialysis

Rationale: Nutritional management of hemodialysis patients is important because protein-energy wasting worsens their prognosis of life. It is reported that appetite of elderly and frail patients is promoted when daily physical activity is high. The purpose of this study was to clarify the relationship between nutrient intake and daily physical activity in hemodialysis patients.

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.&#x0D; 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).&#x0D; 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 &lt; 8 g/dL with 8.1–12 g/dL (**p=0.01) and hemoglobin levels &lt; 8 g/dL with &gt; 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).&#x0D; Conclusion: We found that hemoglobin levels &gt; 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.

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.

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.

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.

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.