Status In End-stage Renal Disease Patients Research Articles

Application of Propofol Target-Controlled Infusion for Optimized Hemodynamic Status in ESRD Patients Receiving Arteriovenous Access Surgery: A Randomized Controlled Trial.

Background and Objectives: End-stage renal disease (ESRD) is associated with increased anesthetic risks such as cardiovascular events resulting in higher perioperative mortality rates. This study investigated the perioperative and postoperative outcomes in ESRD patients receiving propofol target-controlled infusion with brachial plexus block during arteriovenous (AV) access surgery. Materials and Methods: We recruited fifty consecutive patients scheduled to receive AV access surgery. While all patients received general anesthesia combined with ultrasound-guided brachial plexus block, the patients were randomly assigned to one of two general anesthesia maintenance groups, with 23 receiving propofol target-controlled infusion (TCI) and 24 receiving sevoflurane inhalation. We measured perioperative mean arterial pressure (MAP), heart rate, and cardiac output and recorded postoperative pain status and adverse events in both groups. Results: ESRD patients receiving propofol TCI had significantly less reduction in blood pressure than those receiving sevoflurane inhalation (p < 0.05) during AV access surgery. Perioperative cardiac output and heart rate were similar in both groups. Both groups reported relatively low postoperative pain score and a low incidence of adverse events. Conclusions: Propofol TCI with brachial plexus block can be used as an effective anesthesia regimen for ESRD patients receiving AV access surgery. It can be used with less blood pressure fluctuation than inhalational anesthesia.

Assessment of the Nutritional Status of the Hemodialysis Patients by Anthropometric Measurements.

ObjectiveThis study assessed the nutritional status of end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) by utilizing bedside anthropometric measurements.MethodsThis prospective cross-sectional study was done from November 2020 till April 2021 on ESRD patients three times a week MHD at our centre. Anthropometric measurements including body mass index (BMI), triceps skinfold thickness (TSFT), mid-arm circumference (MAC), calf circumference (CC) and handgrip strength (HGS) were measured mid-arm muscle circumference (MAMC) was calculated, and nutritional status was determined.ResultsOut of 195 patients recruited in our study, 127 (65.1%) were male. The mean age was 51.2 ± 14.8 years with a minimum of 20 and a maximum of 90 years, while the mean duration of HD was 4.6 ± 4.1 years. The majority of our patients had TSFT of 60 % to 90% 93 (47.7%), indicating mild to moderate depletion of fat stores and MAMC of >90 % 128 (65.6%), indicating good protein stores. Among all anthropometric measures, BMI was strongly associated with age (<0.001), while gender and duration of MHD were associated with TSFT (p <0.001).ConclusionAnthropometric measurements are easy and inexpensive bedside methods for assessing the nutritional status of ESRD patients on MHD. Our study concluded that our MHD patients have overall good nutritional status, though our young patients have low BMI and old have obesity. Male patients have weaker HGS. With the increased number of years on MHD, malnutrition increases. Our study will help to treat physicians and nutritionists for proper nutritional planning and implementation to prevent malnutrition.

The effect of hemodialysis, peritoneal dialysis and renal transplantation on nutritional status and serum micronutrient levels in patients with end-stage renal disease; Multicenter, 6-month period, longitudinal study

PurposeNutritional status and micronutrient levels of end stage renal disease (ESRD) patients may vary depending on the mode of renal replacement therapy (RRT). We aimed to compare the effects of hemodialysis, peritoneal dialysis (PD) and renal transplantation (RT) on micronutrient levels and nutritional status in ESRD patients. Patients and MethodsA total of 77 ESRD patients who had not received RRT were included in this prospective longitudinal study. All ESRD patients underwent a blood serum analysis that assessed the micronutrients such as selenium, copper, zinc, chromium, retinol, thiamine and vitamin B6 as well as a nutritional status assessment. After the baseline assessments and the initiation of RRT was accomplished, all patients were followed for 6 months. ResultsThe study showed significant improvements in subjective global assessment scores (percentage increases in score A were 26.6 and 36.6; p = 0.039 and p = 0.001; respectively), mid-arm circumference and the skin-fold thicknesses (p < 0.001, p < 0.001; respectively) in the RT and hemodialysis groups. The examinations at sixth month revealed a significant increase in body weight (4.8 kg; p = 0.002) and albumin levels (0.6 g/dL; p < 0.001) in only RT group. Zinc, thiamin and vitamin B6 were the most deficient micronutrients (44.1 %, 24.7 % and 35.1 %; respectively) in ESRD patients. There was a significant increase in selenium and retinol levels (p = 0.020 and p < 0.001; respectively) but a significant decrease in thiamin levels (p = 0.041) in RT patients. A significant increase in retinol levels (p = 0.028) and a significant decrease in thiamin levels (p = 0.022) was observed in the hemodialysis patients. However, no significant change in micronutrient levels was observed in the PD patients. ConclusionThe results support the recommendation that ESRD patients should be supplemented with water-soluble vitamins, especially thiamine and vitamin B6, and trace elements, especially zinc. RT appears to be superior to other modes of RRT when examining SGA score, anthropometric measurements, albumin and micronutrient levels.

MON-315 PLASMA OSTEOPONTIN LEVELS DIRECTLY CORRELATE WITH INTACT PARATHYROID HORMONE AND ALKALINE PHOSPHATE LEVELS IN END STAGE RENAL DISEASE

The kidney has a critical role in calcium homeostasis and bone turnover, thus mineral disorders, bone turnover diseases, and reduction in bone mineral density are commonly observed in end stage renal disease (ESRD) patients. Evaluation and management of bone turnover and mineral status in ESRD patients are typically accomplished by monitoring levels of intact parathyroid hormone (iPTH) and alkaline phosphatase to limit the development of dysfunctional bone turnover and mineral homeostasis. It is therefore crucial to identify factors that both influence circulating levels of iPTH/alkaline phosphatase and impact the downstream physiological effects of iPTH in ESRD patients.

Adropin and irisin: New biomarkers of cardiac status in patients with end-stage renal disease? A preliminary study.

The new polypeptide hormones adropin and irisin have a broad impact on human metabolism and energy homeostasis. They could be potential biomarkers of cardiac injury. In end-stage renal disease (ESRD), the clinical importance of adropin and irisin is yet to be investigated. The aim of this study was to determine the relationship between these peptides and cardiac status in ESRD patients. Seventy-nine ESRD patients on hemodialysis (HD), peritoneal dialysis (PD) or after renal transplantation (Tx), and 40 healthy, ageand sex-matched controls (CON) were included in this study. Serum concentrations of adropin and irisin were measured with enzyme-linked immunosorbent assay (ELISA). Cardiac status was estimated by transthoracic echocardiography and the plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT). The levels of irisin were significantly lower in HD patients as compared to CON. During HD sessions, the concentrations of adropin did not change significantly, whereas the concentrations of irisin increased with borderline significance. Positive correlations were evident between adropin concentration and cTnT as well as NT-proBNP. Adropin was also correlated with left ventricular systolic internal diameter (LVIDs) (r = 0.375, p = 0.045) and relative wall thickness (RWT) (r = -0.382, p = 0.034). Irisin was correlated with right ventricular diameter (RVd) (r = -0.363, p = 0.045). No correlations were found between irisin and adropin, and blood pressure (BP) measurements. Adropin could be a new candidate marker of cardiac dysfunction in HD patients. The cause of low levels of irisin found in HD patients is still unclear. These 2 myokines should be further investigated as potential prognostic markers of cardiac status in HD patients.

Functional Assessment in End-Stage Renal Disease: Enhancing Quality of Life.

Why do functional assessments in patients with end-stage renal disease (ESRD) matter? Multiple studies show that new dialysis patients undergo a substantial decline among activities of daily living. Moreover, poor functional status in ESRD patients is associated with early morality. That is why CMS has developed new criteria to assess ESRD patients in regards to their functional, psychologic, and cognitive capabilities. Functional assessments by health providers have been used in field of Rehabilitation Medicine for over 50 years; rehabilitation physicians have found them effective in establishing goals and monitoring improvement. Assessments can provide guidance by identifying the needs and types of intervention most suited for patients. Impairments can be addressed with referrals to physical therapy for gross motor issues, occupational therapy for self-care problems, psychiatry for mental disorders, and neurology for cognitive deficits. The more accurate the assessments over time, the more targeted and effective the therapies become. We believe that the new CMS goals to assess functionality will improve ESRD patient's quality of life, longevity, and long-term healthcare costs.

Dyspepsia is Associated with Low Protein and Caloric Intake among End-Stage Renal Disease Patients.

Dyspepsia is highly prevalent and easily assessed in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) and is not a traditional predictor of malnutrition. We sought to establish an association between dyspeptic symptoms and nutritional status in ESRD patients undergoing maintenance HD. We studied 106 ESRD patients on HD. Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ). Scores equal to or greater than 6 classified patients as dyspeptic. Nutritional status was evaluated using serum chemistry, total body mass, muscle mass, and dietary intake. Nutritional status was compared between dyspeptic and non-dyspeptic patients. The association of PADYQ scores and the presence of dyspepsia with nutritional variables were tested. Multivariate analysis was performed to test dyspepsia as an independent predictor for dietary intake. There were 41 (38.7 %) dyspeptics. Protein intake (g/kg/day) and calorie intake (kcal/kg/day) were lower among dyspeptics compared to non-dyspeptics, 1.0 ± 0.5 vs 1.3 ± 0.5 (p = 0.01) and 23.0 ± 9.2 vs 27.4 ± 10.0 (p = 0.02), respectively. More dyspeptics than non-dyspeptics presenting protein-energy wasting based on protein and calorie intake, 41.4 vs 15.3 % (p = 0.01) and 68.2 vs 38.4 % (p = 0.02), respectively. PAQYQ score was negatively correlated with protein intake (r = - 0.20; p = 0.03) and calorie intake (r = - 0.19; p = 0.04). Dyspepsia was able to predict protein (b = - 0.26; p = 0.01) and calorie (b = - 4.42; p = 0.02) intake. Dyspepsia is associated with low protein and calorie intake. Screening of dyspeptic symptoms can be routinely performed aiming to improve HD patients' nutritional status.

Abstract 19931: Echocardiographic Assessment of Volume Status in Hemodialysis Patients: a Study Based on Inferior Vena Cava Diameter and Ventricular Interdependence

Background: It is difficult to assess volume status in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). The euvolemic state (dry weight) in ESRD patients is determined clinically but has limitations. We hypothesized that a combination of ventricular interdependence (VI)_the physiologic phenomenon whereby filling of one ventricle is affected by filling of the contralateral ventricle during different phases of the respiratory cycle_and inferior vena cava diameter (IVCd) predicts volume status in ESRD patients undergoing HD. Methods: Echocardiograms were performed in 20 patients immediately pre- and post-HD. Clinical assessment of volume status was performed by a single nephrologist blinded to echocardiographic data. VI was defined as peak expiratory to inspiratory mitral inflow E velocity ratio. Hypovolemia was defined as IVCd 20 mm and VI &gt;15%. Results: 65% of patients were men, and 60% had a history of heart failure. A total of 40 volume clinical assessments were performed (20 pre- and 20 post-HD): 23 were categorized as hypovolemic, 5 euvolemic, and 12 hypervolemic. 21 of 23 (91%) hypovolemic assessments met echo definition for hypovolemia. None of 5 (0%) euvolemic assessments met echo definition of euvolemia. 12 of 12 (100%) hypervolemic assessments met echo definition of hypervolemia. (Figure. Columns and error bars represent mean +/- standard error of mean. P=0.007, Kruskal-Wallis equality-of-populations rank test.) Conclusions: In ESRD patients undergoing HD, echocardiographic definition of volume status using IVCd and VI accurately predicts hypo- and hypervolemia. There was poor correlation between echo and clinical volume assessment for euvolemia. This is the first study to examine volume status in HD patients with concomitant cardiac disease using IVCd, and VI. Further studies are needed to determine whether clinical or echo assessment of euvolemia is accurate.

Abstract 18286: Relative Prognostic Impact of Various Measures of Right Atrial Pressures on Survival in Patients With End Stage Renal Disease on Hemodialysis: Results From a Prospective Cohort of 442 Patients

Background: End stage renal disease (ESRD) patients on hemodialysis (HD) are prone to heart failure (HF) because of volume excess leading to poor functioning, atrial remodeling, pulmonary hypertension (PHTN) and high mortality. Right atrial pressure (RAP) estimate helps in achieving euvolemic status or optimal dry weight. There is limited data on the best measure of RAP in this population. We compared relative prognostic values of clinically assessed jugular venous pressure (RAP-JVP), RAP estimate recommended by ASE (RAP-ASE) and a visual estimate by an expert reader from combination of inferior vena caval (IVC) and hepatic vein size, hepatic congestion and hepatic vein flow (RAP-EXP). Methods: 442 patients who underwent pre-renal transplant evaluation at our cardiology clinic were prospectively followed. Assessment of RAP by CE as elevated JVP, echo evaluation of RAP-ASE and RAP-EXP were performed on same pre or post dialysis day within a hour of each other. Quantitative evaluation of minimum (IVC min), maximum (IVC max) IVC diameters along with collapse (IV max-IVC min/IVC max) was computed following ASE guidelines independently. Logistic regression and Cox proportional hazard ratio were performed for outcomes assessment. Results: Baseline patient characteristics: age 57± 11 years, men 64%, DM in 68 %, CAD 30%, EF 61± 11%. Elevated RAP-JVP was noticed in 15% and RAP-EXP was high in 30% of the patients. Quantitatively, IVC max was 1.39± 0.55 cm, IVC min 0.87± 0.62 cm and mean IVC collapse 44± 29%. 14% patients had IV max of ≥ 2cm. IVC size, collapse or RAP-ASE group were not predictive of survival. However RAP-JVP (HR 2.15, 95 % CI 1.09-4.12, P = 0.03) and RAP-EXP (HR 2.25, 95 % CI of 1.21- 4.20, P = 0.01) were significant predictors of higher mortality on univariable analysis and after adjusting for age, gender, smoking, HTN, DM, LVEF and duration of dialysis. RAP-JVP and RAP-EXP better correlated with each other and HF by, left atrial pressure and PHTN than RAP-ASE. Conclusions: 1) Clinically estimated JVP and an expert assessment of RAP are equally predictive of survival in patients on HD. 2) Echo assessment of RAP by ASE guidelines is twice as sensitive as CE and its use may help achieve euvolemic status in ESRD patients.

Validation of Mini Nutritional Assessment Scale in peritoneal dialysis patients

IntroductionMalnutrition is a negative predictive factor for survival in end stage renal disease (ESRD) patients. Coincidence of malnutrition, inflammation and atherosclerosis (MIA syndrome) in the dialysis population is an exceptionally poor outcome event. Due to flexibility, ease of performance and reproducibility, clinical scales are of particular value in assessment of nutritional status in ESRD patients. The aim of the present study was to evaluate the clinical value of Mini Nutritional Assessment (MNA) in peritoneal dialysis (PD) patients.Material and methodsNutritional status was assessed in 41 peritoneal dialysis patients by means of the MNA scale and malnutrition inflammation score (MIS). Some other clinical and laboratory parameters associated with nutritional status were analyzed. Patients were followed up for 30 months.ResultsIn the analyzed group of patients a good nutritional state was diagnosed in 22 patients (54%), risk of malnutrition in 17 (41%) and malnutrition in 2 patients (5%) based on the MNA scale. A strong correlation between MNA based nutritional status and MIS was found (r = –0.85, p < 0.01, ANOVA, p < 0.01). Differences in time on dialysis, body mass index, concentration of albumin, cholesterol and triglycerides were noted between at risk/malnourished and well-nourished (according to MNA) patients. Statistically significant factors determining survival of patients by Cox proportional hazard analysis were age (HR 1.07), being at risk/malnourished according to MNA (HR 5.7), MIS (HR 1.2), and albumin (HR 0.13).ConclusionsThe MNA scale is a valuable, clinically suitable tool for assessment of nutritional status in peritoneal dialysis patients. Risk of malnutrition and malnutrition diagnosed by MNA identifies patients at high mortality risk.

Salivary testosterone for the diagnosis of androgen deficiency in end-stage renal disease

Hypogonadism is frequent in patients with end-stage renal disease (ESRD). Salivary testosterone (Sal-T) is a non-invasive tool to screen androgen deficiency in adult male with normal renal function. However, available data on its utility in ESRD are not conclusive. The objectives of the study were: (i) to compare free testosterone fractions in saliva (SAL-T) and serum (Free-T); (ii) to establish the correlation of Sal-T with circulating total (TT) and bioavailable testosterone (Bio-T); (iii) to detect androgen deficiency through Sal-T; (iv) to determine the correlation of Sal-T with clinical parameters. The study included: 60 adult ESRD men on haemodialysis (20-60 years old) with decreased libido referred from two dialysis centres; 112 eugonadic and 40 hypogonadic adult men with normal renal function as controls. Simultaneous morning saliva and serum samples were obtained for testosterone measurements by liquid RIA (SAL-T; TT). Free-T and Bio-T were calculated by the Vermeulen equation. Sal-T (0.338±0.177 nM) and Free-T (0.338±0.165 nM) did not differ (P>0.900) in ESRD as well as in control (0.337±0.182 and 0.337±0.172 nM, respectively; P>0.900). Sal-T levels correlated positively (P<0.0001) with Free-T (r=0.95), TT (r=0.80) and Bio-T (r=0.76) in ESRD. Sal-T negatively correlated with age and years on dialytic therapy. Sal-T showed 100% sensitivity and specificity to differentiate patients with androgen deficiency (22%) from those with normal androgen levels (78%). Hypogonadism was hypergonadotrophic in 69% cases and hypogonadotrophic in 31%. These data demonstrate the value of morning Sal-T testing as a non-invasive approach to screen androgen status in ESRD patients.

Homocysteinemia Correlates with Plasma Thiol Redox Status in Patients with End-Stage Renal Disease

Background/Aims: In end-stage renal disease (ESRD), hyperhomocysteinemia is a common finding associated with increased cardiovascular risk. However, the pathogenic role of homocysteine is still unclear. In vitro studies show that thiol redox status affects endothelial cell functions. We therefore investigated the possible association between homocysteinemia and plasma thiol redox status in ESRD patients. Methods: Total plasma homocysteine (Hcy), cysteine (Cys) and free thiols (SH) were measured both before and after a dialytic session in 54 ESRD patients receiving (n = 15) or not receiving (n = 39) folate supplementation, and 17 control subjects. Results: High predialysis levels of both Hcy and Cys were found to be negatively correlated with low SH levels both in supplemented (r = –0.680, p < 0.01 and r = –0.624, p < 0.02, respectively) and unsupplemented (r = –0.698, p < 0.001 and r = –0.445, p < 0.01, respectively) patients. Following dialysis, SH values returned to normal and the above correlations were no longer appreciable. Conclusion: A strong, folate therapy-insensitive association between homocysteinemia and plasma free thiol levels was found in ESRD patients. These results support a role for oxidative stress in ESRD-related hyperhomocysteinemia and suggest the plasma thiol redox status alteration as a possible pathogenic mechanism underlying the cardiovascular toxicity of hyperhomocysteinemia in these patients.

Excellent agreement between C-reactive protein measurement methods in end-stage renal disease patients no additional power for mortality prediction with high-sensitivity CRP

The conventional method for C-reactive protein (CRP) measurement is an immunoturbidimetric assay (imCRP, detection limit > or =3 mg/l). However, high-sensitivity CRP (hsCRP, detection limit >0.1 mg/l) has been advocated as preferable biomarker for cardiovascular risk assessment. The aim of this study was to determine agreement between imCRP and hsCRP in end-stage renal disease (ESRD) patients, and to examine whether the association between CRP and mortality is comparable when using imCRP or hsCRP. Patients from a prospective follow-up study among incident ESRD patients (NECOSAD) with serum CRP available at 3 months of follow-up were included [n = 840, 60% male, mean (SD) age 59 (15) years]. Agreement between imCRP and hsCRP was determined by intraclass correlation coefficient (ICC) and by Cohen's kappa (kappa) for CRP dichotomized to the presence (CRP >10 mg/l) or absence of systemic inflammation. The association between CRP and mortality was determined by Cox regression analysis and c-statistic. ICC between imCRP and hsCRP was 0.78, which improved to 0.86 after correction for systematic differences between measurement methods. Systemic inflammation was present in 28.2% and absent in 67.6% of patients according to both methods (discordant in 4.2%), resulting in good agreement between the two methods (kappa = 0.90). Patients with systemic inflammation had a significantly increased mortality risk compared with patients without systemic inflammation [HR(im,adj) = 1.49 (95%CI 1.14-1.93) and HR(hs,adj) = 1.53 (1.18-2.0)]. Predictive capacity of mortality was similar for both CRP methods [c-statistic(adj) 0.83 (0.79-0.86)]. The agreement between imCRP and hsCRP in patients with ESRD is very good. Furthermore, the association between CRP and mortality in ESRD patients is similar when using imCRP and hsCRP. These data suggest that there is no need to use a high-sensitivity method for the determination of inflammatory status in ESRD patients.

Osteoporosis in the elderly with chronic kidney disease

Considering the aging dialysis population of today, increasing our knowledge about the nature, diagnosis and the treatment of bone mineral density (BMD) problems in end-stage renal disease (ESRD) patients deserves more attention. Osteoporosis is basicly defined as a decrease in bone mass. Large epidemiological studies in general population have identified several risk factors for osteoporosis including advancing age, female gender, white race, decreased calcium intake, gastric acid suppression therapy, sedentary lifestyle, premature loss of gonadal function, decreased estrogen secretion, thin body habitus, decreased physical activity, cigarette smoking, alcohol abuse, excess glucocorticoid exposure, and possibly some genetic factors. Osteoporosis in ESRD patients is only a part of a wider spectrum of metabolic bone problems, namely uremic osteodystrophy. Therefore, its diagnosis, management and follow-up may differ from the general population and an individualization of diagnosis and definition for dialysis population may be necessary. However, standard diagnostic tools such as dual energy X-ray absorptiometry (DEXA) have been widely used for the assessment of bone mineral deficiency status in ESRD patients. Regardless of the methods, most of the studies are in concordance with a reduced BMD in HD and PD patients. Dialysis patients are known to be at increased risk for low-trauma fractures. Thinning of cortical bone, which is responsible for the largest contribution toward reduced bone mineral content in chronic renal failure results in increased fracture risk. In either normal population and dialysis patients, fracture risk is increased with age. But in dialysis patients, besides age, several other factors may also affect the degree of bone mineral deficiency, and age-BMD relationship may be blunted. Female sex, in hemodialysis patients is negatively associated with total hip BMD. While several studies have been unable to demonstrate any association between BMD and PTH levels, larger body size has been shown to have a significant positive effect on BMD in both hemodialysis and peritoneal dialysis patients. Although they have been used in small groups of chronic kidney disease (CKD) and ESRD patients, because of their potential nephrotoxicity and hypocalcemic effects, use of biphosphonates in renal patients is questionable. Currently, bone biopsy, in order to exclude adynamic bone disease is recommended before beginning treatment with bisphosphonates in chronic kidney disease and dialysis patients.

Adjustment for Comorbidity in Studies on Health Status in ESRD Patients

Health status can be an important outcome in studies on patients with end-stage renal disease (ESRD). In these studies, adjustment for prognostic factors, such as comorbidity, often has to be made. None of the comorbidity indices that are commonly used in research on ESRD patients has been validated for studies on health status. This study evaluated three existing indices (Khan, Davies, and Charlson) and four indices specifically developed for use in studies on health status. In a large prospective multi-center study (NECOSAD-2), new ESRD patients were included (n = 1041). Comorbidity was assessed at the start of dialysis. Health status was assessed with the physical and mental component summary score of the SF-36 (PCS and MCS), the symptoms dimension of the KDQOL-SF, and the Karnofsky Scale. Patient data were randomly allocated to a modeling or a testing set. The new indices were developed in the modeling set. The three existing indices explained about the same percentage of variance in the PCS (7 to 8%), MCS (1 to 3%), symptoms (2 to 4%), and Karnofsky (10 to 12%). The new indices performed better than the existing indices in the modeling population (13% PCS, 10% MCS, 10% symptoms, 18% Karnofsky), but not in the testing population (8% PCS, 1% MCS, 3% symptoms, 8% Karnofsky). Individual comorbidities explained more variance in PCS (10 to 15%), MCS (1 to 7%), symptoms (6 to 11%), and Karnofsky (11 to 18%) than comorbidity indices. The Khan, Davies, and the Charlson indices will adjust to the same extent for the potential confounding effect of comorbidity in studies with health status as an outcome. Separate comorbidity diagnoses will adjust best for comorbidity.

EFFECTS OF SELF-MONITORED EXERCISE ON SELECTED BLOOD CHEMISTRY PARAMETERS OF END-STAGE RENAL DISEASE PATIENTS

The effects of exercise on patients with end-stage renal disease (ESRD) is relatively unexplored. Of the complications associated with kidney failure, anemia and abnormal blood lipids profiles are among those that exercise may alter. Thus, the purpose of this study was to determine the effects of a self-monitored exercise program on the blood chemistry status in ESRD patients. The program consisted of aerobic activity maintained for a minimum of 15 min at least three times per week at an intensity of 10.8 +/- 2.13 on the Borg rating of perceived exertion scale (this scale correlates with heart rate and is used in cases where heart rate is not a reliable predictor of exercise intensity such as hemodialysis patients). Monthly blood samples were taken to assess the patients status regarding anemia and blood lipids. Results indicate no significant differences (P greater than 0.05) were seen from the beginning of the program until the end of the eighth month as seen below: [table; see text] Values are X +/- SEM. These data indicate that a self-monitored exercise program of moderate intensity may not be beneficial in helping regulate the anemia and altered blood lipid status of ESRD patients. Thus, since no physiological benefits are apparent with a self-monitored exercise program of low intensity, it is important to realize the potential risk involved with patients undertaking an unsupervised exercise program. These data illustrate that ESRD patients need supervised exercise programs in order to elicit a physiological training response.