Physical Function and Physical Activity in Peritoneal Dialysis Patients.

Background: Physical functioning (PF) and physical activity (PA) are low in patients treated with maintenance hemodialysis (MHD). Little information exists on this topic in patients treated with peritoneal dialysis (PD). The objective of this study was to compare PF and PA in patients with Stage-5 chronic kidney disease (CKD) treated with PD and in-center MHD.

Low Physical Function in Maintenance Hemodialysis Patients Is Independent of Muscle Mass and Comorbidity.

Objectives: It is unknown whether muscle wasting accounts for impaired physical function in adults on maintenance hemodialysis (MHD).

Design: Observational study.

Setting: Outpatient dialysis units and a fall clinic.

Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study.

Background: Slow walk (gait) speed predicts functional decline, institutionalization, and mortality risks in the geriatric population. A gait speed evidence base for dialysis patient outcomes is needed.

Study Design: Prospective cohort study.

The BASES expert statement on exercise therapy for people with chronic kidney disease.

Chronic kidney disease (CKD) is becoming a serious health problem throughout the world and is one of the most potent known risk factors for cardiovascular disease, which is the leading cause of morbidity and mortality in this patient population. Physical inactivity has emerged as a significant and independent risk factor for accelerated deterioration of kidney function, physical function, cardiovascular function and quality of life in people in all stages of CKD. CKD specific research evidence, combined with the strong evidence on the multiple health benefits of regular and adequate amounts of PA in other cardiometabolic conditions, has resulted in physical inactivity being identified by national and international CKD clinical practice guidelines as one of the multiple risk factors that require simultaneous and early intervention for optimum prevention/management of CKD.

Association of physical function with predialysis blood pressure in patients on hemodialysis.

Background: New information from various clinical settings suggests that tight blood pressure control may not reduce mortality and may be associated with more side effects.

Methods: We performed cross-sectional multivariable ordered logistic regression to examine the association between predialysis blood pressure and the short physical performance battery (SPPB) in a cohort of 749 prevalent hemodialysis patients in the San Francisco and Atlanta areas recruited from July 2009 to August 2011 to study the relationship between systolic blood pressure and objective measures of physical function. Mean blood pressure for three hemodialysis sessions was analyzed in the following categories: <110 mmHg, 110-129 mmHg (reference), 130-159 mmHg, and ≥160 mmHg.

Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS.

Background And Objectives: Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined.

Design, Setting, Participants, & Measurements: In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009-2011) were classified into five aerobic physical activity categories (never/rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire.

Characterization of physical activity and sitting time among patients on hemodialysis using a new physical activity instrument.

Objectives: Physical activity questionnaires usually focus on moderate to vigorous activities and may not accurately capture physical activity or variation in levels of activity among extremely inactive groups like dialysis patients.

Design: Cross-sectional study.

Setting: Three dialysis facilities in the San Francisco Bay Area.

Physical function and physical activity assessment and promotion in the hemodialysis clinic: a qualitative study.

Background: Despite practice guidelines (KDOQI [Kidney Disease Outcomes Quality Initiative]) recommending regular assessment of physical function and encouragement of physical activity, few clinics in the United States objectively assess physical function/physical activity or provide recommendations for physical activity in their patient care.

Study Design: Qualitative methods were used to develop an understanding of practice patterns related to physical function assessment and physical activity encouragement by dialysis staff.

Setting & Participants: Data were collected in one outpatient university-based hemodialysis clinic.

Physical function and gait speed in patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) who are treated with dialysis have impaired physical functioning that is associated with poor outcomes. Gait speed is an important measure of mobility that predicts adverse events and mortality in older people. Gait speed is low in patients with CKD, and those treated with hemodialysis average below cut-points known to indicate increased risk of reduced survival and adverse health events.

The association of physical activity and physical function with clinical outcomes in adults with chronic kidney disease.

Purpose Of Review: Despite guidelines supporting the regular assessment of physical functioning and encouragement of physical activity in management of the patient with chronic kidney disease (CKD), implementation has been undermined by a lack of understanding of the evidence for this recommendation. The purpose of this review is to present a summary of emerging data from larger epidemiologic cohorts that report associations between low levels of physical functioning and/or low physical activity and clinical outcomes in patients with CKD.

Recent Findings: Low levels of physical activity and poor physical functioning are strongly associated with mortality and poor clinical outcomes in adult patients with CKD, regardless of treatment modality.

Assessing physical function and physical activity in patients with CKD.

Patients with CKD are characterized by low levels of physical functioning, which, along with low physical activity, predict poor outcomes in those treated with dialysis. The hallmark of clinical care in geriatric practice and geriatric research is the orientation to and assessment of physical function and functional limitations. Although there is increasing interest in physical function and physical activity in patients with CKD, the nephrology field has not focused on this aspect of care.

Effects of the left ventricular assist device on the compliance and distensibility of the carotid artery.

We investigated the impact of continuous-flow left ventricular assist devices (LVAD) on the carotid elastic properties. Carotid artery parameters (diameter distensibility (DD), cross-sectional distensibility (CSD), diameter compliance (DC), cross-sectional compliance (CSC), and incremental elastic modulus (IEM)) were measured in a cross-sectional study using a standard ultrasound with a 10-MHz linear array probe. Measurements (mean ± SEM) were made in separate groups at various clinical time points: prior to LVAD surgery (baseline; 13 male/3 female; age 48 ± 3 years), 1 week following LVAD placement (acute; 12 male/2 female; age 47 ± 3 years), approximately 24 weeks following LVAD surgery (chronic; 13 male/2 female; age 52 ± 3 years), and in a group of healthy subjects (controls; 9 male/1 female; age 51 ± 4 years).

A closer look at frailty in ESRD: getting the measure right.

Patients treated with dialysis have low levels of physical functioning and activity. Whether this translates into frailty or not may depend on how the frailty phenotype is operationalized. This is a secondary analysis of data from the Renal Exercise Demonstration Project to evaluate two methods of operationalizing the Fried phenotype for frailty: Using measured walking speed and muscle weakness (FRAILmeas) and using substitution of the Physical Function Scale (PF) from the SF-36 questionnaire for walking speed and muscle weakness (FRAILsubst).

Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials.

Background And Objectives: Relatively little is known about the effects of hemodialysis frequency on the disability of patients with ESRD.

Design, Setting, Participants, & Measurements: This study examined changes in physical performance and self-reported physical health and functioning among subjects randomized to frequent (six times per week) compared with conventional (three times per week) hemodialysis in both the Frequent Hemodialysis Network daily (n=245) and nocturnal (n=87) trials. The main outcome measures were adjusted change in scores over 12 months on the short physical performance battery (SPPB), RAND 36-item health survey physical health composite (PHC), and physical functioning subscale (PF) based on the intention to treat principle.

Effects of modality change on health-related quality of life.

Patients with end-stage renal disease (ESRD) requiring renal replacement have impaired health-related quality of life (HRQoL), and there is general consensus that HRQoL improves with successful transplant and evidence of improvement with frequent hemodialysis. This study reports changes in HRQoL associated with changes in treatment modality to daily hemodialysis (DHD) and transplant among patients requiring renal replacement. This cohort study had assessments at baseline and 6-month following modality change.

Exercise in individuals with CKD.

There are few studies evaluating exercise in the nondialysis chronic kidney disease (CKD) population. This review covers the rationale for exercise in patients with CKD not requiring dialysis and the effects of exercise training on physical functioning, progression of kidney disease, and cardiovascular risk factors. In addition, we address the issue of the risk of exercise and make recommendations for implementation of exercise in this population.

Bioimpedance spectroscopy for the estimation of fat-free mass in end-stage renal disease.

BACKGROUND #ENTITYSTARTX00026; AIMS: Bioimpedance spectroscopy may provide reliable estimates of fat-free mass in end-stage renal disease patients. We aimed to evaluate the ability of bioimpedance spectroscopy to estimate fat-free mass in end-stage renal disease patients using dual-energy X-ray absorptiometry as a reference. METHODS: Fat-free mass measured by bioimpedance spectroscopy was compared to fat-free mass measured by dual-energy X-ray absorptiometry in 16 end-stage renal disease patients on hemodialysis, 12 undialysed end-stage renal disease patients and 23 control subjects.

Self-reported physical activity in patients with end stage renal disease.

Patients served by ESRD Network 11 were surveyed on participation in regular physical activity (physical activity). National recommendations (3 days/week, 30 minutes/session, and intensity of "moderate level") were used to categorize respondents into three physical activity categories: no physical activity, some physical activity, and recommended levels of physical activity. Analysis of 1323 returned questionnaires indicated that 57% of respondents reported participation in regular physical activity; however, only 13.

Baseline physical performance, health, and functioning of participants in the Frequent Hemodialysis Network (FHN) trial.

Background: Self-reported physical health and functioning and direct measures of physical performance are decreased in hemodialysis patients and are associated with mortality and hospitalization.

Study Design: We determined baseline cross-sectional associations of physical performance, health, and functioning with demographics, clinical characteristics, nutritional indexes, laboratory benchmarks, and measures of body composition in participants in the Frequent Hemodialysis Network (FHN) trial.

Setting & Participants: 375 persons enrolled in the FHN with data for physical performance, health, and functioning.

Effects of modality change and transplant on peak oxygen uptake in patients with kidney failure.

Background: Exercise capacity as measured by peak oxygen uptake (Vo₂(peak)) is low in hemodialysis patients. The present study assesses determinants of VO₂(peak) in patients with chronic kidney failure who either changed kidney replacement modality to frequent hemodialysis therapy or received a kidney transplant.

Study Design: Cohort study with assessment at baseline and 6 months after modality change.

A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy.

Background: Few studies have evaluated an individualized home-based exercise prescription during and after cancer treatment.

Objective: The purpose of this study was to evaluate the effectiveness of a home-based exercise training intervention, the Pro-self Fatigue Control Program on the management of cancer-related fatigue.

Interventions/methods: Participants (N = 119) were randomized into 1 of 3 groups: group 1 received the exercise prescription throughout the study; group 2 received their exercise prescription after completing cancer treatment; and group 3 received usual care.

Implementing exercise: what do we know? Where do we go?

Exercise capacity, physical functioning, and physical activity are all low in patients with CKD treated with dialysis. Although there is robust evidence that these patients benefit from regular exercise training and/or increasing physical activity, the nephrology community has not adopted recommendations and encouragement for physical activity as a part of the routine care plan. This article reviews what is known regarding the implementation of exercise and provides suggestions as to how exercise counseling might become a routine part of the care of patients with CKD.

Determinants of exercise capacity in CKD patients treated with hemodialysis.

There are many ways to measure physical functioning. Oxygen uptake at peak exercise is considered to be the most objective or 'gold-standard' measure and is determined by the integrated functioning of multiple physiological systems. Renal failure can affect the functioning of several of these systems which results in low levels of peak oxygen uptake.