Nutritional status of patients starting on peritoneal dialysis: A comparison between planned and unplanned dialysis initiation.

BACKGROUND: A suboptimal dialysis initiation with insufficient or no planning before urgent start of dialysis remains a common problem associated with increased morbimortality. Whether nutritional markers differ between patients starting peritoneal dialysis (PD) in unplanned and planned modes has not yet been explored. Therefore, we aimed to evaluate whether the nutritional status at the start of dialysis differed between patients with unplanned and planned PD initiation. METHODS: In this observational study comprising 47 adult patients starting PD (age 58±15 years, 51% female), 29 patients had unplanned (starting dialysis up to 72 hours after peritoneal catheter implantation) and 18 planned (follow-up pre-dialysis >90 days) dialysis initiation. Within 30 days of PD initiation, nutritional status was evaluated using anthropometric measurements, multifrequency bioelectrical impedance analysis, appetite assessment, handgrip strength, laboratory markers, and the malnutrition-inflammation score (MIS). Physical activity and performance were also evaluated. RESULTS: Patients with an unplanned PD initiation had a higher frequency of diabetes, higher blood glucose, urea, and glycated hemoglobin levels, and lower hemoglobin and albumin levels. Furthermore, they had a lower calf circumference, slower gait speed, higher protein intake, and greater MIS, while their physical activity level and appetite did not differ. CONCLUSION: Patients with an unplanned PD had unfavorable clinical and nutritional markers compared with those with planned PD. These findings indicate that a lack of follow-up prior to dialysis initiation can influence the clinical and nutritional statuses of patients, reinforcing the importance of conservative treatment prior to dialysis initiation.

Serum myostatin levels are associated with physical function and hospitalization in peritoneal dialysis patients.

BACKGROUND: Myostatin functions as a negative regulator of skeletal muscle growth. The association of myostatin with muscle parameters in dialysis patients is inconsistent, and there are no studies associating myostatin with physical function and outcomes in peritoneal dialysis (PD) patients. Therefore, we assessed the association of serum myostatin with lean mass, physical function, and hospitalization in a prospective cohort of PD patients. METHODS: Lean mass, physical function, and serum myostatin were assessed at baseline. Patients were followed up for at least 24 months and hospitalization was recorded. RESULTS: Serum myostatin levels were positively correlated with handgrip strength and Appendicular Lean Mass Index among male patients. Binary logistic regression models were performed including myostatin levels and physical function parameters as independent variables. Serum myostatin, handgrip strength, gait speed, and Short Physical Performance Battery were associated with hospitalization. CONCLUSION: Lower serum myostatin and physical function were associated with hospitalization in PD patients.

Handgrip Strength Thresholds are Associated With Malnutrition Inflammation Score (MIS) in Maintenance Hemodialysis Patients.

OBJECTIVE: The aim is to verify the association between nutritional status and muscle strength, considering handgrip strength (HGS) cutoffs associated with sarcopenia and mortality. METHODS: Cross-sectional analysis, including hemodialysis patients. Malnutrition Inflammation Score (MIS) was used to assess nutritional status. Muscle function was assessed by HGS, and the considered cutoffs were established by other studies. Cutoffs for sarcopenia diagnosis were 27 and 16 kg for males and females, respectively; cutoffs associated with mortality were 22 and 7 kg for males and females, respectively. Two binary logistic regression models were built, with HGS categorized according to the cutoff for sarcopenia and mortality as dependent variables. RESULTS: Of the 218 patients who were included, 56.9% were male, the mean age was 58.3 years, and 44.7% diabetic; 132 patients (60.6%) had HGS <27 or 16 kg. Age, prevalence of diabetes, and MIS were higher, creatinine and albumin were lower in patients with HGS below these values; 77 patients (35.2%) had HGS <22 or 7 kg. Age, male, and diabetes prevalence, CRP and MIS were higher, midarm muscle circumference (MAMC), creatinine, albumin, and urea were lower in patients with HGS below these values. In the logistic regression MIS (OR 1.202; 95% CI 1.073-1.347; P < .01), age, male, diabetes, and MAMC were associated with the risk of HGS below the cutoffs for sarcopenia. MIS (OR 1.322; 95% CI 1.192-1.467; P < .01), age, male, and diabetes were associated with the risk of HGS below the cutoffs associated with mortality. CONCLUSION: Worse nutritional status increases the risk of HGS below the cutoffs associated with sarcopenia and mortality in hemodialysis patients.

Sarcopenia diagnosis in patients receiving hemodialysis: Agreement among different consensuses.

BACKGROUND: There are many consensuses to diagnose sarcopenia, and their agreement in patients receiving hemodialysis (HD) is not clear. We described the sarcopenia prevalence in patients receiving HD using different consensuses and analyzed their level of agreement. METHODS: Sixty-seven patients (43 men, 55 ± 14.6 years) were evaluated for appendicular skeletal muscle mass using dual-energy x-ray absorptiometry and muscle strength using handgrip strength. Patients were classified according to different sarcopenia consensuses (European Working Group on Sarcopenia in Older People [EWGSOP], Revised EWGSOP [EWGSOP2], Foundation for the National Institutes of Health Project [FNIH], and Asian Working Group for Sarcopenia 2019 [AWGS2]). Kappa analysis identified the level of agreement. RESULTS: The prevalence of sarcopenia ranged from 1.5% to 11.9% depending on the sarcopenia consensus. The agreement between the different consensuses ranged from poor to almost perfect. FNIH and EWGSOP showed the lowest agreement (κ = 0.20; 95% CI, -0.14 to 0.54; P < 0.05), whereas EWGSOP2 and AWGS2 had the largest κ = 0.90 (95% CI, 0.71 to 1.00; P < 0.001). When stratified by age (≥60 years), the sarcopenia prevalence was higher in the older group (27% vs 2%; P = 0.004). In addition, male participants seemed to be more prone to sarcopenia compared with female counterparts, but this difference was not statistically confirmed (16% vs 4%; P = 0.242). CONCLUSION: The sarcopenia consensuses showed from poor to almost perfect agreement, which varied the sarcopenia prevalence rates in patients receiving HD. EWGSOP2 and AWGS2 showed the largest agreement.

A Comparison of Dietary Intake Between Individuals Undergoing Maintenance Hemodialysis in the United Kingdom and China.

OBJECTIVE: Protein-energy wasting is highly prevalent in people with end-stage kidney disease receiving regular hemodialysis. Currently, it is unclear what the optimal nutritional recommendations are, which is further complicated by differences in dietary patterns between countries. The aim of the study was to understand and compare dietary intake between individuals receiving hemodialysis in Leicester, UK and Nantong, China. METHODS: The study assessed 40 UK and 44 Chinese participants' dietary intake over a period of 14 days using 24-hour diet recall interviews. Nutritional blood parameters were obtained from medical records. Food consumed by participants in the UK and China was analyzed using the Nutritics and Nutrition calculator to quantify nutritional intake. RESULTS: Energy and protein intake were comparable between UK and Chinese participants, but with both below the recommended daily intake. Potassium intake was higher in UK participants compared to Chinese participants (2,115 [888] versus 1,159 [861] mg/d; P < .001), as was calcium (618 [257] versus 360 [312] mg/d; P < .001) and phosphate intake (927 [485] versus 697 [434] mg/d; P = .007). Vitamin C intake was lower in UK participants compared to their Chinese counterparts (39 [51] versus 64 [42] mg/d; P = .024). Data are reported here as median (interquartile range). CONCLUSION: Both UK and Chinese hemodialysis participants have insufficient protein and energy in their diet. New strategies are required to increase protein and energy intakes. All participants had inadequate daily intake of vitamins C and D; there may well be a role in the oral supplementation of these vitamins, and further studies are urgently needed.

According to Revised EWGSOP Sarcopenia Consensus Cut-Off Points, Low Physical Function Is Associated With Nutritional Status and Quality of Life in Maintenance Hemodialysis Patients.

OBJECTIVE: The aim of this study is to assess the association of nutritional status and quality of life with low physical function, according to the revised European Working Group on Sarcopenia in Older People (EWGSOP) - sarcopenia consensus cut-offs in maintenance hemodialysis patients. DESIGN AND METHODS: This is a cross-sectional study including patients on maintenance hemodialysis. Participants were submitted to a single evaluation of physical function, nutritional status, and quality of life. Handgrip strength, Short Physical Performance Battery (SPPB), sit-to-stand test, and gait speed were performed to evaluate physical function. Cut-offs proposed by the revised EWGSOP consensus were considered. Malnutrition Inflammation Score was used to assess nutritional status. Quality of life was assessed by the 36-Item Short Form Health Survey. RESULTS: Seventy-seven patients were enrolled, 64.9% male, mean age 55 ± 14 years. According to the cut-offs proposed by the most recent EWGSOP consensus, 55.8% of patients presented SPPB <8, 48.1% gait speed test ≤0.8 m/seconds, sit-to-stand test >15 seconds, and 39.0% handgrip strength <27 kg and <16 kg for men and women, respectively. Malnutrition Inflammation Score was significantly associated with all physical function parameters, except gait speed, in receiver operating characteristic curve and logistic regression. The 36-Item Short Form Health Survey domains or component summary were associated with SSPB, gait speed, and handgrip strength in logistic regression. CONCLUSION: Poor nutritional status and quality of life are associated with low physical function (according to the cut-offs proposed by EWGSOP) in hemodialysis patients.

Spatial Ventilation Inhomogeneity Determined by Electrical Impedance Tomography in Patients With Chronic Obstructive Lung Disease.

The aim of this study was to examine whether electrical impedance tomography (EIT) could determine the presence of ventilation inhomogeneity in patients with chronic obstructive lung disease (COPD) from measurements carried out not only during conventional forced full expiration maneuvers but also from forced inspiration maneuvers and quiet tidal breathing and whether the inhomogeneity levels were comparable among the phases and higher than in healthy subjects. EIT data were acquired in 52 patients with exacerbated COPD (11 women, 41 men, 68 ± 11 years) and 14 healthy subjects (6 women, 8 men, 38 ± 8 years). Regional lung function parameters of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced inspiratory vital capacity (FIVC), forced inspiratory volume in 1 s (FIV1), and tidal volume (V T ) were determined in 912 image pixels. The spatial inhomogeneity of the pixel parameters was characterized by the coefficients of variation (CV) and the global inhomogeneity (GI) index. CV and GI values of pixel FVC, FEV1, FIVC, FIV1, and VT were significantly higher in patients than in healthy subjects (p ≤ 0.0001). The ventilation distribution was affected by the analyzed lung function parameter in patients (CV: p = 0.0024, GI: p = 0.006) but not in healthy subjects. Receiver operating characteristic curves showed that CV and GI discriminated patients from healthy subjects with an area under the curve (AUC) of 0.835 and 0.852 (FVC), 0.845 and 0.867 (FEV1), 0.903 and 0.903 (FIVC), 0.891 and 0.882 (FIV1), and 0.821 and 0.843 (VT), respectively. These findings confirm the ability of EIT to identify increased ventilation inhomogeneity in patients with COPD.

Association of Phase Angle, but Not Inflammation and Overhydration, With Physical Function in Peritoneal Dialysis Patients.

Introduction: Muscle mass depletion, overhydration, and inflammatory state have been related to impaired physical function in chronic kidney disease patients. The relationship between bioelectrical impedance analysis (BIA) parameters, such as hydration status and phase angle (PhA), with physical function in peritoneal dialysis (PD), is still not well-established. Therefore, the objective was to evaluate the association of BIA parameters (overhydration index and PhA) and inflammatory markers with physical function in patients on PD. Methods: The present cross-sectional study enrolled PD patients. Multifrequency BIA was performed to obtain overhydration index and PhA. The Short Physical Performance Battery (SPPB) test battery was applied to assess physical function. The time to complete the 4-m gait test and sit-to-stand test was also considered for physical function assessment. The inflammatory markers tumor necrosis factor-alpha and C-reactive protein levels were determined. Multiple linear regression models were performed, with the physical function variables as dependent variables, adjusted for age, diabetes, and sex. Results: Forty-nine PD patients were enrolled, 53.1% (n = 26) women; mean age, 55.5 ± 16.3 years. There were significant correlations between PhA and SPPB (r = 0.550, p < 0.001), time of 4-m gait test (r = -0.613, p < 0.001) and sit-to-stand test and (r = -0.547, p < 0.001). Overhydration index was significantly correlated with SPPB, 4-m gait test (r = 0.339, p = 0.017), and sit-to-stand test (r = 0.335, p = 0.019). Inflammatory markers were not significantly correlated with physical function parameters. In the multiple linear regression analysis, PhA was associated with physical function parameters, even after adjustments. Overhydration index was associated with all physical function tests only in the models with no adjustments. Conclusion: PhA was independently associated with physical function in PD patients. Inflammatory markers and overhydration index were not associated with physical function.

Age, diabetes mellitus, and dialysis modality are associated with risk of poor muscle strength and physical function in hemodialysis and peritoneal dialysis patients.

BACKGROUND: Due to the poor outcomes associated with the impairment of physical function and muscle strength in patients on maintenance dialysis, it is important to understand the factors that may influence physical function and muscle strength. The aim of this study was to explore the factors associated with physical function in hemodialysis and peritoneal dialysis patients. METHODS: Patients with chronic kidney disease on dialysis for at least 3 months, aged 18 years old or above, were enrolled. Physical function was assessed by handgrip strength, gait and sit-to-stand tests, and the Short Physical Performance Battery (SPPB). Clinical and laboratory data were collected to verify the association with physical function parameters through binary logistic regression. RESULTS: One-hundred ninety patients on maintenance dialysis were included; 140 patients (73.7%) on hemodialysis and 50 (26.3%) on peritoneal dialysis. The mean age was 57.3 ± 14.9 years, 109 (57.4%) were male, and 87 (45.8%) were older than 60 years. The median SPPB was 8.0 points (6.0-10.0 points) and the mean ± standard deviation of handgrip strength was 24.7 ± 12.2 kg. Binary logistic regression showed that age, type of renal replacement therapy, diabetes mellitus, and serum creatinine were significantly associated with both higher 4-meter gait test times and lower SPPB scores. Only age and diabetes mellitus were associated with higher sit-to-stand test times, while age and ferritin were associated with lower handgrip strength. CONCLUSION: Age, diabetes mellitus, serum creatinine, and hemodialysis modality are factors related to physical function in dialysis patients.

Vitamin D and skeletal muscle: A narrative review focusing on chronic kidney disease and dialysis.

Morphological, molecular, and physiological effects of vitamin D on skeletal muscle have been analyzed both in animals and humans. Vitamin D may be a potential therapeutic for increasing muscle mass and function. The presence of vitamin D receptors in skeletal muscle cells is already established. However, there is still need for more evidence about the effect of vitamin D on muscle. Some studies have associated vitamin D and skeletal muscle in chronic kidney disease (CKD) patients; most of these studies enrolled hemodialysis patients. FGF-23 and Klotho were recently described in mineral and bone disorders in CKD, resulting in reductions in calcitriol levels. Therefore, both Klotho and FGF-23 may play a role in muscle loss in CKD, which is related to morbidity and mortality risk. Therefore, this article presents a narrative review, aiming to discuss the available information associating skeletal muscle and vitamin D, highlighting the results in CKD and dialysis patients.

Which Method Should Be Used to Assess Protein Intake in Peritoneal Dialysis Patients? Assessment of Agreement Between Protein Equivalent of Total Nitrogen Appearance and 24-Hour Dietary Recall.

OBJECTIVES: After dialysis initiation, a high protein diet is recommended due to significant nutrient losses through dialysate and increased risk of protein energy wasting. In peritoneal dialysis (PD) patients, protein intake can be assessed through different methods that have some advantages and limitations, which affect its use on routine care. The aim of this study is to evaluate the agreement between 2 different methods (24-hour dietary recall and PNA-protein equivalent of total nitrogen appearance) on estimating protein intake in PD patients. DESIGN AND METHODS: Patients on PD for at least 3 months, aged 18 years old or more, were enrolled. To estimate protein intake, 24-hour dietary recall and PNA was used. PNA was calculated from 24-hour urine on the same day of the 24-hour dietary recall. RESULTS: Fifty individuals on PD were included, mean age 55.7 ± 16.2 years, and body mass index 26.0 ± 4.5 kg/m2. The average energy consumption was 1788.79 ± 504.40 kcal/day, which corresponds to 26.81 ± 9.11 kcal/kg current body weight (BW)/day and 29.82 ± 8.39 kcal/kg ideal body weight (IBW)/day. The median of total daily and normalized protein intake estimated using dietary recall was 61.43 (45.28-87.40) g/day, 0.90 (0.58-1.22) g/kg current BW/day, and 1.04 (0.77-1.32) g/kg IBW/day, respectively. Daily protein intake estimated by PNA was 55.75 (48.27-67.74) g/day, protein intake normalized by current BW was 0.81 (0.72-0.99) g/kg and 0.92 (0.83-1.06) g/kg IBW/day. Bland-Altman analysis indicates no systematic bias for the assessment of total protein intake and normalized protein intake for current and ideal BW. Significant proportionality bias was observed for both evaluations, showing there is a dispersion of the values. CONCLUSIONS: Despite the absence of systematic bias in the Bland-Altman analysis, there is no agreement in the assessment of protein intake by dietary recall and PNA, due to the existence of proportionality bias. Thus, values can be influenced biased by the magnitude of the measures.

Multimodal remote chest monitoring system with wearable sensors: a validation study in healthy subjects.

OBJECTIVE: Development of wearable medical technology for remote monitoring of patients suffering from chronic lung diseases may improve the care, therapy and outcome of these patients. APPROACH: A multimodal system using wearable sensors for the acquisition of multiple biosignals (electrical bioimpedance of the chest for electrical impedance tomography and respiratory rate assessment, peripheral oxygen saturation, chest sounds, electrocardiography for heart rate measurement, body activity, and posture) was developed and validated in a prospective, monocentric study on 50 healthy subjects. The subjects were studied under different types of ventilation (tidal and deep breathing, forced full expiration maneuver) and during increased body activity and posture changes. The major goals were to assess the functionality by determining the presence and plausibility of the signals, comfort of wearing and safety of the vest. MAIN RESULTS: All intended signals were recorded. Streaming of selected signals and wireless download of complete data sets were functional. Electrical impedance tomography recordings revealed good to excellent quality of detection of ventilation-related impedance changes in 34 out of 50 participants. Respiratory and heart rates were reliably detected and generally in physiological ranges. Peripheral oxygen saturation values were unphysiologically low. The chest sound recordings did not show waveforms allowing meaningful analysis of lung sounds. Body activity and posture were correctly identified. The comfort of wearing and the vest properties were positively rated. No adverse events occurred. SIGNIFICANCE: Albeit the full functionality of the current vest design was not established, the study confirmed the feasibility of remote functional chest monitoring with a marked increase in clinically relevant information compared to existing systems.

Correction: Update of the European consensus on sarcopenia: what has changed in diagnosis and prevalence in peritoneal dialysis?

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Role of parathyroid hormone in anorexia on maintenance hemodialysis patients.

BACKGROUND AND AIM: Anorexia, which is a common condition in patients on hemodialysis (HD), is characterized by impaired appetite, a subjective condition that hinders anorexia diagnosis. Anorexia is frequently associated with protein energy wasting and inflammation, increasing morbidity and mortality risk. The aim of the study was to evaluate the association between appetite and nutritional, inflammatory, hormonal, and dietary intake parameters in patients on maintenance HD. METHODS: Cross-sectional study with clinical, laboratory, and anthropometric parameters, body composition, muscle function, and dietary intake assessment. To evaluate appetite, a three simple questions questionnaire previously validated was used. After appetite classification, the sample was dichotomized in "normal appetite" and "impaired appetite" and compared. Multiple logistic regression was used to identify association between variables and outcome. RESULTS: 125 patients on HD were included, aged 60.6 ± 14.12 years old, median HD vintage 35.5 months. In dichotomized sample, 78.4% patients showed "normal appetite", and 21.6% "impaired appetite". "Impaired appetite" was independently associated with increased serum PTH (OR 1.001; 95% CI 1.000-1.002; p = 0.03), low zinc intake (OR 0.860; 95% CI 0.746-0.991; p = 0.03) and lower urea serum (OR 0.982; 95% CI 0.965-0.999; p = 0.04). Both groups showed insufficient dietary intake. CONCLUSIONS: Appetite was independently associated with increased serum of PTH, low serum concentration of urea, and low zinc intake which may infer association of appetite with mineral bone disease, protein intake and zinc deficiency.

Aerobic Exercise Training and Nontraditional Cardiovascular Risk Factors in Hemodialysis Patients: Results from a Prospective Randomized Trial.

INTRODUCTION: Chronic kidney disease (CKD) patients have a high incidence of cardiovascular diseases (CVD) which increases their morbidity and mortality. A sedentary lifestyle in CKD is directly linked to the onset of CVD. Physical activity can bring beneficial effects to CKD patients. AIMS: The aim of this study was assess the impact of aerobic training on nontraditional cardiovascular risk factors in CKD patients on hemodialysis. MATERIALS AND METHODS: This is a prospective, controlled, and randomized clinical trial with analysis of intention to treat. Thirty patients underwent an exercise treadmill test, an arterial stiffness evaluation, echocardiography and analysis of endothelial reactivity, and carotid ultrasound and laboratorial tests, including analysis of serum aldosterone. The intervention group (IG) (n =15) underwent aerobic exercise during hemodialysis 3 times a week for 4 months. The control group (CG) (n =15) had no intervention. All of the patients were reassessed after 4 months. RESULTS: In the IG, there was a statistically significant improvement in flow-mediated vasodilation (FMV; p = 0.002) and a reduction in left ventricular hypertrophy (p = 0.006) and serum aldosterone (p = 0.016). There was an increase in C-reactive protein in the CG (p = 0.002). CONCLUSION: This aerobic training protocol was able to improve endothelial function with enhanced FMV and reduce left ventricular hypertrophy and serum aldosterone, which could have a positive impact on the reduction of nontraditional cardiovascular risk factors in CKD patients on hemodialysis.

Update of the European consensus on sarcopenia: what has changed in diagnosis and prevalence in peritoneal dialysis?

Patients on peritoneal dialysis (PD) may be affected by sarcopenia, which is a progressive and generalized skeletal muscle disorder characterized by muscle mass atrophy with decline of muscle strength and function. The aim was to evaluate differences in the diagnosis and prevalence of sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP). The screening for sarcopenia was performed in PD patients older than 18 years, with evaluation of appendicular skeletal muscle mass index (ASMMI), handgrip strength (HGS) and gait speed (GS). The diagnosis was according to the 2010 and 2019 versions of EWGSOP consensus on sarcopenia. Fifty subjects on PD were included, mean age 55.74 ± 16.22 years old, 52% female. The prevalence of sarcopenia ranged from 4 to 10% according to cut points and references used.

Regional lung function in nonsmokers and asymptomatic current and former smokers.

Electrical impedance tomography (EIT) is able to detect rapid lung volume changes during breathing. The aim of our observational study was to characterise the heterogeneity of regional ventilation distribution in lung-healthy adults by EIT and to detect the possible impact of tobacco consumption. A total of 219 nonsmokers, asymptomatic ex-smokers and current smokers were examined during forced full expiration using EIT. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC were determined in 836 EIT image pixels for the analysis of spatial and temporal ventilation distribution. Coefficients of variation (CVs) of these pixel values were calculated. Histograms and medians of FEV1/FVCEIT and times required to exhale 50%, 75%, 90% of FVCEIT (t50, t75 and t90) were generated. CV of FEV1/FVCEIT distinguished among all groups (mean±sd: nonsmokers 0.43±0.05, ex-smokers 0.52±0.09, smokers 0.62±0.16). Histograms of FEV1/FVCEIT differentiated between nonsmokers and the other groups (p<0.0001). Medians of t50, t75 and t90 showed the lowest values in nonsmokers. Median t90 separated all groups (median (interquartile range): nonsmokers 0.82 (0.67-1.15), ex-smokers 1.41 (1.03-2.21), smokers 1.91 (1.33-3.53)). EIT detects regional ventilation heterogeneity during forced expiration in healthy nonsmokers and its increase in asymptomatic former and current smokers. Therefore, EIT-derived reference values should only be collected from nonsmoking lung-healthy adults.

Twelve weeks of supervised exercise improves self-reported symptom burden and fatigue in chronic kidney disease: a secondary analysis of the 'ExTra CKD' trial.

BACKGROUND: Chronic kidney disease (CKD) patients experience a high symptom burden including fatigue, sleep difficulties, muscle weakness and pain. These symptoms reduce levels of physical function (PF) and activity, and contribute to poor health-related quality of life (HRQoL). Despite the gathering evidence of positive physiological changes following exercise in CKD, there is limited evidence on its effect on self-reported symptom burden, fatigue, HRQoL and physical activity. METHODS: Thirty-six patients [mean ± SD 61.6 ± 11.8 years, 22 (61%) females, estimated glomerular filtration rate: 25.5 ± 7.8 mL/min/1.73 m2] not requiring renal replacement therapy underwent 12 weeks (3 times/week) of supervised aerobic exercise (AE), or a combination (CE) of AE plus resistance training. Outcomes included self-reported symptom burden, fatigue, HRQoL and physical activity. RESULTS: Exercise reduced the total number of symptoms reported by 17% and had favourable effects on fatigue in both groups. AE reduced the frequency of 'itching', 'impotence' and 'shortness of breath' symptoms, and the intrusiveness for symptoms of 'sleep disturbance', 'loss of muscular strength/power', 'muscle spasm/stiffness' and 'restless legs'. The addition of resistance exercise in the CE group saw a reduction in 'loss of muscular strength/power'. No changes were seen in subjective PF or physical activity levels. AE increased self-efficacy for physical activity. CONCLUSIONS: Supervised exercise had favourable effects on symptom frequency and intrusiveness, including substantial improvements in fatigue. Although the intervention did not improve self-reported physical activity levels, AE increased patients' self-efficacy for physical activity. These favourable changes in self-reported outcomes support the important role of exercise in CKD.