Gender Differences in Physical Activity and Health-Related Authorships Between 1950 and 2019.

BACKGROUND: The objective of this study was to investigate gender differences in authorship in physical activity and health research. METHODS: A bibliometric study including 23,399 articles from 105 countries was conducted to estimate the participation of female researchers in physical activity publications from 1950 to 2019. The frequency of female researchers was analyzed and classified by first and last authors and the overall percentage of female authors by region and country. RESULTS: The proportion of female first authors increased from <10% in the 50s and 80s to 55% in the last decade. On the other hand, the proportion of last authors increased from 8.7% to 41.1% in the same period. Most publications with female researchers were from the United States, Canada, Australia, Brazil, the Netherlands, Spain, England, Germany, Sweden, and China. Nine of these countries had over 50% of the articles published by female first authors. However, in all 10 countries, <50% of the articles were published by female last authors. CONCLUSIONS: The proportion of female researchers increased over time. However, regional differences exist and should be addressed in gender equity policies. There is a gap in the participation of female researchers as last authors. By actively addressing the gender gap in research, the global society can harness the full potential of all talented individuals, regardless of gender, leading to more inclusive and impactful scientific advancements.

COVID-19 is more lethal in hemodialysis chronic kidney disease patients with low physical capacity.

INTRODUCTION: The mortality rate in patients on maintenance hemodialysis (HD) is high and is associated with low functional capacity (FC). We analyzed the association of FC and COVID-19 lethality among HD patients. METHODS: A cohort study that included evaluations of FC in patients on HD was underway, and the association between FC and lethality was included as an ad-hoc outcome. RESULTS: One hundred and twelve patients were submitted to a physical, 31 patients contracted symptomatic COVID-19, 20 recovered and 11 died (lethality rate of 35.5%). There was a difference between survivors and non-survivors on six-minutes-walking-test (6MWT) 386.1 ± 112.8 versus 296.9 ± 103.3 meters (p = 0.04), 30 s sit-to-stand test (30CST) score 11.7 ± 3.1 versus 7.7 ± 4.1 (p = 0.006), and timed up and go test (TUG) 9.4 versus 13.6 s (p = 0.009). There was also an association between percentages of predicted 6MWT, 30CST, and TUG with COVID-19 lethality. CONCLUSION: Patients on maintenance HD with poorer physical performance presented the worst prognosis from COVID-19 pandemic.

Medical education on hospital hyperglycemia improving knowledge and outcomes

ABSTRACT Objective: To evaluate the effects of medical education on hospital hyperglycemia on physician's technical knowledge and the quality of medical prescriptions, patient care, and clinical outcomes. Subjects and methods: The intervention included online classes and practical consultations provided by an endocrinologist to medical preceptors and residents of the Department of Internal Medicine. A pretest and a post-test (0 to 10 points) were applied before and after the intervention and patients medical records were reviewed before and after the intervention. The outcomes were improvement in medical knowledge, in the quality of prescriptions for patients in the clinical area, and clinical outcomes. Results: The global mean of correct answers improved with the intervention [before: 6.9 points (±1.7) versus after the intervention: 8.8 points (±1.5) (p < 0.001)]. The number of patients who did not have at least one blood glucose assessment during the entire hospitalization for acute illness decreased from 12.6% before to 2.6% (p < 0.001) after the intervention. There was also a significant reduction in hospital hypoglycemia rates (p < 0.026). The use of sliding-scale insulin as the main treatment was quite low before and after the intervention (2.2% and 0%). After 6 months, medical knowledge did not show significant reduction. Conclusion: Medical education on hospital hyperglycemia can improve medical knowledge and clinical outcomes for patients. The improvement in medical knowledge was maintained after 6 months.

Incidence of hospital admissions in bioimpedance-guided fluid management among maintenance hemodialysis patients-Results of a randomized controlled trial.

INTRODUCTION: Hemodialysis is life-sustaining in kidney failure. However, proper regulation of body fluids depends on an accurate estimate of target weight. This trial aims to compare clinical endpoints between target weight estimation guided by bioimpedance spectroscopy and usual care in hemodialysis patients. METHODS: This is an open-label, parallel-group, controlled trial that randomized, through a table of random numbers, adult patients on maintenance hemodialysis to target weight estimation based on monthly clinical evaluation alone or added to evaluation by bioimpedance twice a year. The primary outcome was survival, and the secondary outcomes were the rate of hospital admissions, change in blood pressure (BP), and antihypertensive drugs load. Participants were followed for 2 years. Survival analysis was performed using Kaplan-Meier estimator and Log-rank test, and hospital admissions were analyzed by the incidence-rate ratio. FINDINGS: One hundred and ten patients were randomized to the usual care (52) or bioimpedance (58) groups, with a mean age of 57.4 (15.4) years, 64 (58%) males. There was no difference between the groups at baseline. Survival was not significantly different between groups (log-rank test p = 0.68), but the trial was underpowered for this outcome. There was also no difference between the groups in the change in systolic or diastolic BP or in the number of antihypertensive drugs being used. The incidence rate of hospital admissions was 3.1 and 2.1 per person-year in usual care and bioimpedance groups, respectively, with a time-adjusted incidence rate ratio of 1.48 (95% CI: 1.20-1.82, p = 0.0001) and attributable fraction of risk among exposed individuals of 0.32 (95% CI: 0.17-0.45). DISCUSSION: The inclusion of bioimpedance data to guide the estimation of target weight in hemodialysis patients had no detectable impact on survival or BP control, but significantly reduced the incidence rate of hospital admissions. The study was registered at ClinicalTrials.gov Identifier: NCT05272800.

Antibiotic resistance pattern in urine cultures from community-dwelling women in southern Brazil - a cross-sectional study short communication.

OBJECTIVE: The increase in antibiotic resistance (AR) is a global phenomenon with regional variation. This survey aims to describe the AR in urine cultures of women from the community in a southern Brazil city. METHODS: A retrospective cross-sectional single-center study in urine cultures of community dwelling individuals. The main outcome was the AR profile of bacterial isolates from women in outpatient care. RESULTS: From 4,011 urine cultures, 524 were positive (91% from women). The most frequently isolated bacteria were Escherichia coli (E. coli) (67.0%) and Klebsiella spp. (19.4%). E. coli presented low resistance to nitrofurantoin (3.7%), moderate to levofloxacin (15.6%), amoxacillin-clavulonate (16.4%) and ciprofloxacin (17.4%), and high to trimethoprim-sulfamethoxazole (26.9%). CONCLUSIONS: Nitrofurantoin seems to be the best choice for the empirical treatment of low urinary tract infections in women, whereas sulfonamides are no longer an option, since E. coli resistance to this drug is above 20%.

Effects of intradialytic exercise on functional capacity in patients with end-stage chronic kidney disease: a systematic review and meta-analysis.

The study aimed to investigate the effect of intradialytic exercise training programmes on the submaximal functional capacity of patients with kidney failure. We searched for randomized clinical trials that assessed submaximal functional capacity using the 6-min walk test (6 MWT) in adult patients on maintenance haemodialysis submitted to intradialytic physical training. The search was performed on 15 October 2021, in different databases. Random-effect, multivariate meta-regression adjusted for multiplicity were performed to examine the relationship between exercise effect and covariates. Intradialytic physical exercise induced greater changes in 6MWT distance (k = 18; n = 1,458; WMD: 37.0; 95% CI 29.3; 50.6 metres) than control groups, with substantial heterogeneity (I2 = 78.3%). Aerobic, strength, and combined exercise promoted an average increase of 48.7 (95%CI 30.9; 66.4 metres), 16.9 (95%CI 7.6; 26.3 metres), and 75.8 (95%CI 55.1; 96.6 metres) metres, respectively. Strength training resulted in inferior gains in 6MWT distance compared to aerobic training (WMD: -25.0; 95%CI: -49.1; -0.9). Intervention length shorter than 11 weeks (WMD: 37.0; 95%CI: -5.4; 79.3 metres) did not induce greater changes in 6MWT compared to control groups. There was a positive response in submaximal functional capacity to intradialytic training in kidney failure patients on maintenance haemodialysis.

Effects of a 16-week physical training on clinical outcomes in patients with hypertension and chronic kidney disease: NEPHROS post-trial follow-up.

The NEPHROS is a randomized controlled trial which applied a 16-week aerobic and resistance training to patients with chronic kidney disease (CKD) and high blood pressure. This report describes a long-term post-trial follow-up, comparing survival, health-related quality of life (HRQoL), and estimated glomerular filtration rate (GFR) change between the intervention and control groups according to in-trial cardiovascular risk factors. Three years after the original trial, NEPHROS participants were re-evaluated. Cox proportional hazards model was used to compare survival time and linear regression for changes in GFR and physical and mental HRQoL summary scores between intervention and control groups according to age, sex, and in-trial GFR, C-reactive protein, glucose, lipids, ankle-brachial index (ABI), functional capacity, and blood pressure. Of the 150 participants of NEPHROS, 128 were included in the long-term analysis. The previous exercise training had no effects on survival, GFR, or HRQoL. Baseline in-trial GFR (HR = 0.95, 95%CI: 0.92; 0.98) and ABI (HR = 0.03, 95%CI: 0.002; 0.43) were positive independent predictors for survival. Lower ABI (coefficient = 9.00, 95%CI: 0.43; 17.5) and higher systolic blood pressure (coefficient = -0.13, 95%CI: -0.24; -0.03) were independent predictors for GFR decline. A 16-week exercise program had no long-term effect on survival, quality of life, or glomerular filtration in patients with CKD stages 2 to 4. Lower GFR and ABI and higher systolic blood pressure were associated with poorer prognosis among CKD patients.

Is It Safe for Hemodialysis Patients to Seek Gains with Less Pain? Acute Hemodynamic Response to Intradialytic Blood Flow Restriction Training.

Considering that the hemodynamic safety is a major concern about intradialytic exercise with blood flow restriction, this analysis was performed to compare the blood pressure (BP) behavior during the first two hours of hemodialysis (HD) between sessions with no exercise (control group, CG), low/moderate intensity aerobic exercise with blood flow restriction (BFRE) and conventional aerobic exercise (AE). Adult patients with chronic kidney disease on HD at a university hospital were randomly assigned and submitted to a 12-week intradialytic training with BFRE or AE compared with the CG group. The main outcomes of this report were the change in systolic (SBP) and diastolic (DBP) BP during HD and the frequency of low BP (LBP) and high BP (HBP) episodes. A total of 6,074 BP measurements of 58 patients were analyzed. There was a larger decrease in BP in the exercise sessions compared with the control sessions, but with a similar magnitude in the BFRE and AE groups (effect size 0.49). There was a higher number of LBP in the BFRE group. The frequency of HBP was similar between the BFRE and the CG groups and lower in the AE group. Despite a greater number of mild LBP in BFRE patients, the BP change during the first two hours of HD was similar to that of patients in AE. Intradialytic aerobic exercise with blood flow restriction does not seem to be associated with a higher hemodynamic burden than conventional aerobic exercise.

Overhydration in acute kidney injury: Is it always a menace to critically ill patients? A survival study using bioimpedance spectroscopy.

INTRODUCTION: The hydration status is a predictor of survival in critically ill patients. However, it is unclear whether this association depends on the patient clinical condition. This study was designed to analyze the impact of hydration status on survival of critically ill patients with acute kidney injury (AKI) with or without sepsis. METHODS: A prospective cohort study following critically ill patients with AKI consecutively admitted over a one-year period to a teaching hospital intensive care unit (ICU). All patients with AKI stage three or higher of the KDIGO score were included. The hydration status was evaluated through the overhydration (OH) parameter of spectroscopy bioimpedance and sepsis was defined according Sepse-3 criteria. The survival analysis used adjusted competing-risks regression. RESULTS: Forty-eight patients were included, 27 (56%) with a sepsis diagnosis. The main negative predictors of survival among sepsis patients, adjusted by SAPS3 score, were higher OH (SHR 1.1, 95% CI 1.0-1.2, p = 0.02), mechanical ventilation (SHR 6.9, 95% CI 1.0-47.8, p = 0.04) and older age (SHR 1.1, 95% CI 1.0-1.1, p = 0.005). The predictors in non-sepsis patients were lower OH (SHR 0.82, 95% CI 0.71-0.95, p = 0.008) and mechanical ventilation (SHR 12, 95% CI 2.4-6.6, p < 0.001). CONCLUSIONS: This finding suggests that extracellular overhydration is an independent predictor of survival in critically ill patients with sepsis, but it seems to have opposite effect in non-sepsis patients.

Sarcopenia diagnosis using different criteria as a predictor of early mortality in patients undergoing hemodialysis.

OBJECTIVES: Chronic kidney disease (CKD) is a public health problem, causing secondary sarcopenia. The aim of this study was to evaluate sarcopenia using the definitions proposed by European Working Group on Sarcopenia in Older People in 2010 (EWGSOP2010) and 2019 (EWGSOP2019) as an independent prognostic factor for worse survival in patients with CKD undergoing hemodialysis. METHODS: Muscle mass, muscle strength, and physical performance were assessed in a cohort of patients with CKD on hemodialysis. The sample consisted of 127 patients (40% >60 y of age) and 36 patients (28.3%) died after a median follow-up length of 23.5 mo (interquartile range= 14.9 - 29). The EWGSOP2010 and EWGSOP2019 definitions were used for diagnosing sarcopenia. Sarcopenia association with mortality by both definitions was investigated using Kaplan-Meier curves and Cox proportional hazard models. The area under the curve, sensitivity, specificity, positive, and negative predictive values for both definitions were also compared. RESULTS: Patients diagnosed with sarcopenia by both criteria had almost three times higher risk for mortality (95% confidence interval,1.45-6.06 and 1.44-6.13, respectively). Patients classified with severe sarcopenia by both definitions had a significantly lower survival, even after the adjusted analysis. The areas under the curve for EWGSOP2010 and EWGSOP2019 did not significantly differ. The sensitivity/specificity analysis was considered similar for both criteria, and around 70% of the patients was correctly classified. CONCLUSION: Sarcopenia, notably severe sarcopenia, diagnosed by EWGSOP2010 or EWGSOP2019 criteria, is an independent prognostic factor for worse survival in this population. Early detection with effective interventions may decrease the higher mortality risk among patients with sarcopenia and CKD.

Effects of a 16-week physical training on clinical outcomes in patients with hypertension and chronic kidney disease: NEPHROS post-trial follow-up / Os efeitos de um treinamento físico de 16 semanas sobre desfechos clínicos em pacientes com hipertensão e doença renal crônica: o estudo NEPHROS de seguimento pós-ensaio / Efectos de un entrenamiento físico durante 16 semanas en los resultados clínicos de pacientes afectados de hipertensión y enfermedad crónica de riñón: NEPHROS seguimiento post ensayo

The NEPHROS is a randomized controlled trial which applied a 16-week aerobic and resistance training to patients with chronic kidney disease (CKD) and high blood pressure. This report describes a long-term post-trial follow-up, comparing survival, health-related quality of life (HRQoL), and estimated glomerular filtration rate (GFR) change between the intervention and control groups according to in-trial cardiovascular risk factors. Three years after the original trial, NEPHROS participants were re-evaluated. Cox proportional hazards model was used to compare survival time and linear regression for changes in GFR and physical and mental HRQoL summary scores between intervention and control groups according to age, sex, and in-trial GFR, C-reactive protein, glucose, lipids, ankle-brachial index (ABI), functional capacity, and blood pressure. Of the 150 participants of NEPHROS, 128 were included in the long-term analysis. The previous exercise training had no effects on survival, GFR, or HRQoL. Baseline in-trial GFR (HR = 0.95, 95%CI: 0.92; 0.98) and ABI (HR = 0.03, 95%CI: 0.002; 0.43) were positive independent predictors for survival. Lower ABI (coefficient = 9.00, 95%CI: 0.43; 17.5) and higher systolic blood pressure (coefficient = -0.13, 95%CI: -0.24; -0.03) were independent predictors for GFR decline. A 16-week exercise program had no long-term effect on survival, quality of life, or glomerular filtration in patients with CKD stages 2 to 4. Lower GFR and ABI and higher systolic blood pressure were associated with poorer prognosis among CKD patients.

O estudo NEPHROS é um ensaio controlado e randomizado que aplicou um programa de treinamento aeróbico e de força com duração de 16 semanas em pacientes com doença renal crônica e hipertensão arterial. O artigo descreve o seguimento pós-ensaio de longo prazo, comparando sobrevida, qualidade de vida relacionada à saúde (HRQoL) e mudança na taxa de filtração glomerular estimada (TFGe) entre o grupo de intervenção e o grupo controle, e de acordo com fatores de risco cardiovascular registrados durante o ensaio. Os participantes do estudo NEPHROS foram reavaliados três anos depois do ensaio original. Foi usada a razão de riscos proporcionais de Cox para comparar o tempo de sobrevida, e a regressão linear para comparar a mudança na TFGe e as pontuações gerais de HRQoL física e mental, entre os grupos de intervenção e controle, de acordo com idade, sexo e níveis durante o ensaio original de TFGe, proteína C-reativa, glicose, lipídios, índice tornozelo-braquial (ITB), capacidade funcional e pressão arterial. Entre os 150 participantes do NEPHROS, 128 foram incluídos na análise de seguimento. Não foi observado nenhum efeito do treinamento na sobrevida, TFGe ou HRQoL. As medidas durante o ensaio original de TFGe (HR = 0,95; IC95%: 0,92; 0,98) e ITB (HR = 0,03; IC95%: 0,002; 0,43) foram preditores positivos independentes de sobrevida. ITB mais baixo (coeficiente = 9,00; IC95%: 0,43; 17,5) e pressão sistólica mais alta (coeficiente = -0,13; IC95% -0,24; -0.03) foram preditores independentes de declínio da TFGe. O programa de exercício de 16 semanas não teve efeito no longo prazo sobre sobrevida, qualidade de vida ou mudança na taxa de filtração glomerular em pacientes com doença renal crônica de estágios 2 a 4. Níveis mais baixos de TFGe e ITB e pressão arterial sistólica mais elevada estiveram associados a prior prognóstico entre pacientes com doença renal crônica.

NEPHROS es un ensayo controlado aleatorio que aplicó un entrenamiento de 16 semanas aeróbico y de resistencia a pacientes con enfermedad crónica de riñón y presión alta. El informe actual describe un seguimiento de largo plazo post ensayo, comparando supervivencia, calidad de vida relacionada con la salud (HRQoL) y el cambio de tasa estimada de filtración glomerular (eGFR) entre los grupos de intervención y control, y según factores de riesgo cardiovascular en el ensayo. Tras tres años del ensayo original, los participantes en NEPHROS fueron reevaluados. Se usó el modelo de Cox de riesgos proporcionales para comparar el tiempo de supervivencia y la regresión lineal para comparar el cambio en los marcadores resumen eGFR, físicos y mentales HRQoL, entre los grupos de intervención y grupos de control, y según edad, sexo, y eGFR en el ensayo, proteína C-reactiva, glucosa, lípidos, índice tobillo-brazo (ABI), capacidad funcional y presión sanguínea. De los 150 participantes de NEPHROS, 128 personas fueron incluidas en el análisis a largo plazo. No se observó un cambio en el efecto del entrenamiento físico previo en la supervivencia, eGFR o HRQoL. La base de referencia en el ensayo eGFR (HR = 0,95; 95%CI: 0,92; 0,98) y ABI (HR = 0,03; 95%CI: 0,002; 0,43) fueron predictores independientes positivos para la supervivencia. Un más bajo ABI (coeficiente = 9,00; 95%CI: 0,43; 17,5) y una presión sistólica sanguínea más alta (coeficiente = -0,13; 95%CI -0,24; -0,03) fueron predictores independientes para la disminución de la eGFR. El programa de ejercicio de dieciséis semanas no tuvo un efecto a largo plazo en la supervivencia, calidad de vida o cambio en la filtración glomerular en pacientes con etapas 2 a 4 enfermedad crónica de riñón. Una eGFR y ABI más bajos, y una presión más alta sistólica de sangre estuvieron asociadas con una prognosis más escasa entre pacientes enfermedad crónica de riñón.

Antibiotic resistance pattern in urine cultures from community-dwelling women in southern Brazil - a cross-sectional study short communication / Patrón de resistencia a los antibióticos en cultivos de orina de mujeres que viven en la comunidad en el sur de Brasil - un estudio transversal comunicación corta / Padrão de resistência antimicrobiana em culturas ambulatoriais de urina em mulheres no sul do Brasil - comunicação breve de um estudo transversal

ABSTRACT Objective The increase in antibiotic resistance (AR) is a global phenomenon with regional variation. This survey aims to describe the AR in urine cultures of women from the community in a southern Brazil city. Methods A retrospective cross-sectional single-center study in urine cultures of community dwelling individuals. The main outcome was the AR profile of bacterial isolates from women in outpatient care. Results From 4,011 urine cultures, 524 were positive (91% from women). The most frequently isolated bacteria were Escherichia coli (E. coli) (67.0%) and Klebsiella spp. (19.4%). E. coli presented low resistance to nitrofurantoin (3.7%), moderate to levofloxacin (15.6%), amoxacillin-clavulonate (16.4%) and ciprofloxacin (17.4%), and high to trimethoprim-sulfamethoxazole (26.9%). Conclusions Nitrofurantoin seems to be the best choice for the empirical treatment of low urinary tract infections in women, whereas sulfonamides are no longer an option, since E. coli resistance to this drug is above 20%.

RESUMEN Objetivo El aumento de la resistencia a los antibióticos (AR) es un fenómeno global con variaciones regionales. Esta investigación tiene como objetivo describir la AR en cultivos de orina de mujeres de la comunidad de una ciudad del sur de Brasil. Métodos Un estudio retrospectivo transversal, de un solo centro, de cultivos de orina de la comunidad. El resultado principal fue el perfil de AR de bacterias aisladas de estos cultivos de orina. Resultados De 4.011 cultivos de orina, 524 fueron positivos (91% de las mujeres). Las bacterias más frecuentemente aisladas en mujeres fueron Escherichia coli (67,0%) y Klebsiella spp. (19,4%). E. coli mostró baja resistencia a nitrofurantoína (3,7%), moderada a levofloxacina (15,6%), amoxacilina-clavulonato (16,4%) y ciprofloxacina (17,4%) y alta a trimetoprima-sulfametoxazol (26,9%) entre las mujeres. Conclusiones La nitrofurantoína parece ser la mejor opción para el tratamiento empírico de la infección de las vías urinarias inferiores en mujeres, mientras que las sulfonamidas ya no son una opción, ya que la resistencia de E. coli a este fármaco es superior al 20%.

RESUMO Objetivo O aumento da resistência aos antibióticos (AR) é um fenômeno global com variações regionais. Esta pesquisa tem como objetivo descrever a AR em culturas de urina de mulheres oriundas da comunidade em uma cidade sul-brasileira. Métodos Um estudo de centro único, transversal e retrospectivo em culturas de urina oriundas da comunidade. O principal desfecho foi o perfil de AR de bactérias isoladas de uroculturas ambulatoriais. Resultados De 4.011 culturas de urina, 524 foram positivas (91% de mulheres). As bactérias mais frequentemente isoladas em mulheres foram Escherichia coli (67,0%) e Klebsiella spp. (19,4%). E. coli apresentou baixa resistência à nitrofurantoína (3,7%), moderada a levofloxacina (15,6%), amoxacilina-clavulonato (16,4%) e ciprofloxacina (17,4%) e alta ao trimetoprim-sulfametoxazol (26,9%) entre mulheres. Conclusões A nitrofurantoína parece ser a melhor escolha para o tratamento empírico das infecções do trato urinário inferior em mulheres, enquanto as sulfonamidas não são mais uma opção, uma vez que a resistência de E. coli a essa droga é superior a 20%.

Intradialytic exercise with blood flow restriction: Something to add to hemodialysis adequacy? Findings from a crossover study.

INTRODUCTION: Hemodialysis (HD) increases the lifespan of chronic kidney disease (CKD) patients. However, HD is only partially effective in replacing renal function. The aim of this study is to compare HD adequacy between sessions with intradialytic exercise with or without blood flow restriction (BFR) with sessions without exercise. METHODS: A crossover study including 22 adult CKD patients on HD. The patients were assigned to BFR (n = 11) or exercise alone group (n = 11). Each patient was submitted to four HD sessions (two with exercise and two control sessions). HD adequacy was assessed by equilibrated Kt/V-urea (eKT/V), single-pool Kt/V-urea (sp-Kt/V), urea and phosphorus rebound, urea reduction ratio (URR) and removal of urea and phosphorus in dialysate. FINDINGS: BFR exercise improved eKt/V and sp-Kt/V (1.32 ± 0.21 vs. 1.10 ± 0.16 for control, P < 0.001; 1.53 ± 0.26 vs. 1.27 ± 0.19 for control, P < 0.001, respectively) and URR (72.5 ± 5.4% vs. 66.1 ± 7.7% for control, P < 0.001). No difference in eKt/V, sp-Kt/V or URR could be detected between exercise alone and control HD sessions. Urea rebound was lower in BFR exercise vs. control sessions (-8.9 ± 9.1% vs. 30.7 ± 12.8%, P < 0.01) and exercise alone vs. control sessions (13.3 ± 29.0% vs. 42.4 ± 15.3%, P < 0.01). Phosphorus rebound was marginally lower in exercise vs. control sessions (14.4 ± 19.1% vs. 28.4 ± 22.1%, P = 0.18). Urea and phosphorus mass removal in dialysate were marginally higher in exercise vs. control sessions (42.2 ± 19.4 g vs. 35.7 ± 12.5 g, P = 0.24; 912.1 ± 360.9 mg vs. 778.6 ± 245.1 mg, P = 0.28). CONCLUSIONS: Intradialytic exercise with BFR was more effective than standard exercise in increasing HD adequacy.

Intradialytic exercise with blood flow restriction is more effective than conventional exercise in improving walking endurance in hemodialysis patients: a randomized controlled trial.

OBJECTIVE: This study aims to compare the effect of intradialytic aerobic exercise with blood flow restriction, without blood flow restriction (conventional) and no exercise (control) on muscle strength and walking endurance among chronic kidney disease patients. DESIGN: Open label and parallel group randomized controlled trial. SUBJECTS: Adult patients with chronic kidney disease on hemodialysis. INTERVENTION: A 12-week intradialytic training with or without blood flow restriction compared with a control group. MAIN MEASURES: Strength and walking endurance were measured using thoracolumbar dynamometry and a 6-minute walk test, respectively, before and after training. RESULTS: A total of 66 patients were randomized into three groups: blood flow restriction group (n = 22), conventional exercise group (n = 22) and control group (n = 22). There were seven dropouts, and 59 patients were included in the analysis. There was a significant increase in the 6-minute walking distance in the blood flow restriction group (from 412.7 (115.9) to 483.0 (131.0) m, P = 0.007) in comparison with the conventional exercise group (from 426.79 (115.00) to 433.2 (120.42) m, not significant) and the control group (from 428.4 (108.1) to 417.3 (100.2) m, not significant). The change in the walking distance over time was significantly different among groups (intervention group/time, P = 0.02). The simple effects test found a significant time effect only in the blood flow restriction group. There was no significant difference in strength change between the groups. CONCLUSION: Among chronic kidney disease patients, intradialytic exercise of low/moderate intensity with blood flow restriction was more effective in improving walking endurance than conventional exercise or no exercise.

Does Intradialytic Exercise Improve Removal of Solutes by Hemodialysis? A Systematic Review and Meta-analysis.

OBJECTIVE: To describe a systematic review and meta-analysis to identify if intradialytic exercise improves the removal of solutes and the hemodialysis adequacy. DATA SOURCES: A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed. The sources were MEDLINE (via PubMed), Web of Science, LILACS, and SciELO, from inception until July 2018. STUDY SELECTION: Clinical trials including patients on chronic hemodialysis submitted to the intervention of aerobic intradialytic exercise. DATA EXTRACTION: Evaluating as outcomes the removal of solutes (creatinine, phosphate, potassium) and/or adequacy parameters (Kt/V-urea). DATA SYNTHESIS: The systematic review included 23 studies (7 evaluating the effect of 1 exercise session and 16 evaluating the effect of training, lasting from 6 to 25 weeks). Eleven RCT were included in the meta-analyses. It was observed that the aerobic intradialytic exercise increased the Kt/V-urea (0.15; 95% confidence interval [95% CI], 0.08-0.21) and decreased creatinine (-1.82 mg/dL; 95% CI, -2.50 to -1.13), despite the high heterogeneity of the analysis. No differences were found in phosphorus and potassium removal. CONCLUSION: The aerobic intradialytic exercise may be suggested to improve the Kt/V-urea and the creatinine removal during the dialysis.

Effects of continuous moderate exercise with partial blood flow restriction during hemodialysis: A protocol for a randomized clinical trial.

Chronic kidney disease (CKD) is associated with physical weakness and increased oxidative stress and inflammation levels. Rehabilitation programs are associated with an improvement in the functional capacity, inflammatory and oxidative stress profile. Exercise associated with blood flow restriction (BFR) has been demonstrating positive effects in training programs, but there is lack information about exercise with BFR in CKD. Therefore, the aim of the present study is to describe a protocol using continuous moderate exercise with blood flow restriction (BFR) applied during hemodialysis (HD) to measures health indicators and immune system and oxidative stress parameters in CKD patients. Methods: A RTC will be conducted with 42 patients in HD. Baseline measures will be compared with final measures (anthropometric, cardiorespiratory, biochemical, muscle fitness, nutritional and behavioral questions). Participants will be randomly allocated to: 1) Continuous moderate exercise group with BFR; 2) Continuous moderate exercise group without BFR; 3) Control group without exercise. The intervention will be 12 weeks long during HD session. Patients will perform 20 min of continuous moderate exercise on a stationary bicycle three times a week. The present study is expected to generate significant information about the role of exercise with BFR in patients with CKD during HD.