Complete low-intensity endurance training programme in haemodialysis patients: improving the care of renal patients.

BACKGROUND: Patients on haemodialysis (HD) have a decreased physical and functional capacity. Several studies have reported the beneficial effects of exercise on the physical, functional and psychological functioning of HD patients. Despite these results, exercise programmes on HD are not commonplace. OBJECTIVE: To analyse the effect of an intradialysis endurance training programme on muscular strength and functional capacity in our HD patients. MATERIAL AND METHODS: A 6-month single-centre prospective study. HD patients were non-randomly assigned to an exercise group (group E) or a control group (group C). Exercise training included complete endurance training using balls, weights and elastic bands in the first 2 h of an HD session; group C received standard HD care. Analysed data: (1) biochemical parameters; (2) biceps and quadriceps muscle tone, maximum quadriceps length strength (MQLS) and dominant hand grip (HG); (3) functional capacity tests: sit-to-stand-to-sit (STS10) and 6-min walking test (6MWT). RESULTS: Forty patients were included, 55% were men; their mean age was 68.4 years; the patients were 61.6 months on HD; 16 patients were in group E and 24 in group C. In group E, muscular strength showed a significant improvement in MQLS (15.6 ± 10.7 vs. 17.7 ± 12.5 kg, p < 0.05) and HG (22.1 ± 13.2 vs. 24.1 ± 15.8 kg, p < 0.05) at the end of the programme, while a global decrease was reported in group C (MQLS 20.9 ± 9.3 vs. 16.2 ± 8.4 kg, p < 0.05; HG 25.1 ± 10.3 vs. 24.1 ± 11.1 kg). 6MWT significantly improved in group E (20%, 293.1 vs. 368 m, p < 0.001) and decreased in group C (10%, 350 vs. 315 m, p < 0.004). At the end of the programme, STS10 time was reduced in group E (2.1 ± 18.5 vs. 28.7 ± 20.6 s), while it rose in group C (31.5 ± 17.9 vs. 36.4 ± 19.8 s), though significant differences were not found. CONCLUSIONS: (1) The intradialysis training programme improved muscular strength and functional capacity in our HD patients. (2) These results support the benefits of exercise training for HD patients. (3) Nephrologists should consider exercise training as a standard practice for the care of HD patients.

The search for a new marker of renal function in older patients with chronic kidney disease stages 3-4: usefulness of cystatin C-based equations.

BACKGROUND/AIM: Cystatin C (Cys C) is an endogenous marker of glomerular filtration rate (GFR) unaffected by body composition. The aim of the present study was to assess the utility of Cys C-based GFR prediction equations (Hoek, Larsson and Stevens) and creatinine (modification of diet in renal disease-isotope dilution mass spectrometry--MDRD-IDMS, and Cockcroft-Gault--CG) compared with 51Cr-EDTA. METHODS: This study was carried out in 40 Caucasian older patients with advanced age (> or = 60) and chronic kidney disease stages 3-4. To assess the utility of prediction equations in relation to body composition, we measured lean mass (LM) with densitometry (DXA). Pearson's, Bland-Altman and Lin's coefficient (Rc) were used to study accuracy and precision. RESULTS: 51Cr-EDTA was 36.9 +/- 9.2 ml/min/1.73 m2 (22-60). Cys C levels were 2.2 +/- 0.8 mg/l (r = 0.085; p = 0.662 LM) and creatinine 2.8 +/- 1.1 mg/dl (r = 0.427; p = 0.021 LM). The most accurate equations were the Hoek, Larsson and Stevens formulae, with a bias of -0.2 (Rc 0.48), -2.9 (Rc 0.44) and 2.6 ml/min/1.73 m2 (Rc 0.58). The biases obtained with MDRD-IDMS and CG were -14.6 (Rc 0.35) and -12.5 (Rc 0.40). All correlations among biases obtained with creatinine-based formulae and LM were negative and statistically significant (p < 0.05). CONCLUSIONS: The results show superiority of Cys C-based GFR formulae over the MDRD-IDMS and CG equations. This significant underestimation obtained with conventional prediction equations was directly related to the influence of LM.

Effects of rotigotine on clinical symptoms, quality of life and sleep hygiene adequacy in haemodialysis-associated restless legs syndrome. / Efectos de la rotigotina sobre la sintomatología, calidad de vida e higiene de sueño en el síndrome de piernas inquietas en hemodiálisis.

BACKGROUND: Restless legs syndrome (RLS) is a neurological disorder characterised by bothersome symptoms associated with impaired quality of life and sleep hygiene. Rotigotine is a novel therapeutic alternative, although few studies have been published in patients on haemodialysis (HD) with RLS treated with rotigotine. OBJECTIVES: 1.- To establish the prevalence of RLS in our HD unit. 2.- To evaluate the efficacy and safety profile of rotigotine and its effect on symptoms, quality of life and sleep hygiene in our HD population with RLS. MATERIAL AND METHODS: A single-centre, 12-week prospective study. Two stages (6 weeks): stage 1 (no treatment) and stage 2 (rotigotine). We analysed: 1.- Demographic data, biochemistry data, HD suitability parameters and RLS medical treatment data. 2.- Lower extremity symptoms questionnaire (QS). 3.- RLS severity symptoms scale (SRLSS). 4.- RLS Quality of life: John Hopkins RLS-QoL (JH-QoL). 5.- Sleep hygiene: SCOPA Scale. RESULTS: We included 66 HD patients, 14 with RLS; 44.4% male, 70.2±9.9 years and 111.1±160.8 months on HD. And 22.9% RLS. Exclusively in stage 2, a significant improvement for QS (10±2.4 vs. 5.7±1.0), SRLSS (21±4 vs. 5.7±4.6), JH-QoL (22.1±4.4 vs. 4.3±4.0) and SCOPA (16±5.3 vs. 6.7±1.9) were observed. A 77.7 and 11.1%, showed partial (> 20%) and complete (> 80%) remission, respectively, while 55.5% achieved «zero¼ symptoms. Only one patient had gastrointestinal intolerance and none experienced augmentation effect. No changes in biochemical data, suitability for dialysis or medical treatment were found. The inter-group analysis showed a significant improvement in relation to QS, SRLSS, JH-QoL and SCOPA in stage 2. CONCLUSIONS: RLS showed a considerable prevalence in our HD unit. Rotigotine improved clinical symptoms, quality of life and sleep hygiene in RLS patients on HD and was found to be a safe drug with minimal side effects and total therapeutic compliance. Nevertheless, future studies should be performed to confirm the benefits of rotigotine in RLS patients on haemodialysis.

The effect of neuromuscular electrical stimulation on muscle strength, functional capacity and body composition in haemodialysis patients. / Efecto de la electroestimulación neuromuscular sobre la fuerza muscular, capacidad funcional y composición corporal en los pacientes en hemodiálisis.

INTRODUCTION: Haemodialysis (HD) patients are characterised by significant muscle loss. Recently, neuromuscular electrical stimulation (NMES) has emerged as a new therapeutic alternative to improve these patients' physical condition. To date, no studies on the effects of NMES on body composition in HD patients have been published. OBJECTIVE: To analyse the effect of NMES on muscle strength, functional capacity and body composition in our HD patients. MATERIAL AND METHODS: A 12-week, single-centre, prospective study. The patients were assigned to an electrical stimulation (ES) or control (CO) group. The ES group was subjected to intradialytic electrical stimulation of the quadriceps (Compex® Theta 500i), while the CO group received standard HD care. We analysed the following: 1) nutritional parameters; 2) muscle composition of the quadriceps; 3) maximum quadriceps extension strength (mes) and hand-grip (HG); 4) «sit to stand to sit¼ (STS10) and «six-minute walking test¼ (6MWT); 5) body composition (bioelectrical impedance analysis). RESULTS: Of 20 patients, 55% were men. Mean age 67.7 years, 30.3 months in HD. Main aetiology: DM (35%). In the ES group were 13 patients, and 7 in the CO group. At the end of the study, an improvement was only observed in the ES group (*P<.05): MES* (11.7±7.1 vs. 13.4±7.4kg), STS10 (39.3±15.5 vs. 35.8±13.7s) and 6MWT* (9.9%, 293.2 vs. 325.2m). Furthermore, increased quadriceps muscle area (QMA*: 128.6±30.2 vs. 144.6±22.4cm2) and lowered quadriceps fat area (QFA*: 76.5±26.9 vs. 62.1±20.1cm2) were observed. No relevant changes in body composition, nutritional parameters and dialysis adequacy were found. CONCLUSIONS: 1) NMES improved muscle strength, functional capacity and quadriceps muscle composition in our patients. 2) Based on the results obtained, NMES could be a new therapeutic alternative to prevent muscle atrophy and progressive physical deterioration. 3) However, future studies are necessary to establish the potential beneficial effects of NMES in HD patients.

Acute renal failure secondary to imatinib mesylate treatment in chronic myeloid leukemia.

A 58-year-old woman with chronic myeloid leukemia (CML), and previous intolerance to interferon was treated with the BCR-ABL tyrosine kinase protein inhibitor imatinib mesylate. Coincidentally, with the start of treatment, the patient developed acute renal failure, with acute tubular necrosis being observed on histopathology. Imatinib was stopped and three hemodialysis sessions were performed, which was followed by a progressive improvement of the renal function and normalization of the urine output. One year later the patient still has mild chronic renal failure and remains in chronic phase of CML on hydroxyurea treatment.