RESUMO
Purpose: Evaluating the effects of interdialytic daily inspiratory muscle training (IMT) on respiratory muscle strength, chest wall regional volumes, diaphragmatic mobility and thickness, pulmonary function, functional capacity, and quality of life (QoL) in haemodialysis (HD) patients.Method: A randomised, and double-blind clinical trial composed of 24 chronic kidney disease patients undergoing HD. Patients were allocated into the IMT group (n = 12) or sham group (n = 12) and performed daily IMT twice per day with a load of 50% inspiratory muscle strength for the IMT group and 5 cmH2O for the sham group during 8 weeks. Respiratory muscle strength, diaphragm thickness and mobility, chest wall regional volumes, functional capacity, and QoL were measured.Results: At the end of the study, an increase in inspiratory and expiratory muscle strength was observed for both groups, but no significant difference was found between them. Changed volume distribution was also observed in the IMT group, with significantly increased inspiratory capacity in the pulmonary compartment compared to the sham group.Conclusions: Daily interdialytic IMT promoted a change in chest wall regional volumes, with an increase in the inspiratory capacity of the pulmonary rib cage. Both groups had increased inspiratory and expiratory muscle strength with daily respiratory exercise.Trial registration: www.ClinicalTrials.gov; study number: NCT02599987; name of trial registry: IMT in Patients with End-stage Renal Disease.Implications for rehabilitationMuscular impairment in chronic kidney disease patients results from a series of common alterations, affecting respiratory muscles.Patients with chronic kidney disease have low values of diaphragmatic thickness.The daily inspiratory muscle training (IMT) or breathing exercise over a period of 8 weeks provided increased respiratory muscle strength.The daily inspiratory muscle training presented a change in tri-compartment distribution of lung volume compared to the sham group, with increased inspiratory capacity of the pulmonary rib cage.
Assuntos
Inalação/fisiologia , Músculos Respiratórios/fisiopatologia , Terapia Respiratória/métodos , Adulto , Diafragma/diagnóstico por imagem , Método Duplo-Cego , Expiração/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Pletismografia , Qualidade de Vida , Diálise Renal , Espirometria , Ultrassonografia , Teste de CaminhadaRESUMO
Abstract Introduction: Quality of life (QoL) of hemodialysis patients is a major evaluative marker currently measured, while treatment time is a clinical determinant associated with impaired QOL. Objective: To evaluate QOL in individuals undergoing hemodialysis (HD) considering treatment time and the presence of comorbidities. Methods: A cross-sectional study conducted in the hemodialysis unit of the Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE). We studied patients with Chronic Kidney Disease (CKD) of both genders over the age of 18 years, at any level of education and undergoing HD for at least 6 months. We evaluated the demographic/socioeconomic and clinical data, followed by application of the quality of life questionnaire (KDQOL-SF). Results: Participants were 47 patients with a mean age of 50.94 ± 13.33 years, 55.3% were male and average treatment time of 57.35 ± 61.46 months. Hypertension (59.6%) was the most frequent underlying disease. According to the responses obtained through the KDQOL-SF, the situation at work and physical limitation scored worse. Sexual function (85.83) and encouragement by the team had the best performance. There were no differences in dimensions of questionnaire and treatment time. Conclusion: The presence of comorbidities and HD duration were not found to be possible factors for changing QoL in this study. However, we suggest that future studies evaluate other factors such as laboratory, emotional and functional data to check for changes in QoL in these patients related to HD duration.
Resumo Introdução: A qualidade de vida (QV) dos pacientes hemodialíticos é um dos principais marcadores avaliativos atualmente e o tempo de tratamento é um determinante clínico associado à QV prejudicada. Objetivo: Avaliar a QV em indivíduos submetidos à hemodiálise (HD) considerando o tempo de tratamento e a presença de comorbidades. Métodos: Estudo transversal desenvolvido no setor de hemodiálise do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), realizado em pacientes com Doença Renal Crônica (DRC) de ambos os sexos, maiores de 18 anos, em qualquer nível de escolaridade e em HD a pelo menos seis meses. Foram avaliados os dados demográfico/socioeconômico e clínico, seguidos da aplicação do questionário de QV (KDQOL-SF). Resultado: Participaram do estudo 47 pacientes, com média de idade de 50,94 ± 13,33 anos, sendo 55,3% do sexo masculino e média do tempo de tratamento de 57,35 ± 61,46 meses. A Hipertensão Arterial Sistêmica (HAS) (59,6%) foi a patologia de base mais frequente. De acordo com as respostas obtidas através do KDQOL-SF, a situação no trabalho e a limitação física apresentaram piores resultados. A função sexual (85,83) e o encorajamento da equipe apresentaram o melhor desempenho. Não se observou diferenças no comportamento das dimensões do questionário com o tempo de tratamento. Conclusão: A presença de comorbidades e o tempo de HD não se apresentaram como possíveis fatores para alteração da QV em nosso estudo. No entanto, sugerimos que estudos futuros possam avaliar outros fatores como dados laboratoriais, emocionais e funcionais para verificar a existência de alterações na QV nesses pacientes relacionadas ao tempo de HD.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diálise Renal , Insuficiência Renal Crônica , Pacientes , Qualidade de Vida , Estudos Transversais , HipertensãoRESUMO
Abstract Introduction: Hypertension (HT) and diabetes mellitus (DM) lead to functional and structural changes in target organs such as the kidneys, characterizing the need for preventive actions to avoid Chronic Kidney Disease (CKD). Objective: To verify cardiologists' and endocrinologists' knowledge, indications and practices regarding prevention of CKD in patients with HT and DM. Methods: A cross-sectional study with 14 cardiologists and 5 endocrinologists applying a questionnaire about the conduct of these professionals regarding the prevention of CKD in hypertensive and diabetic patients. Results: One hundred percent of the cardiologists and endocrinologists did not request specific tests for CKD screening (albuminuria and glomerular filtration rate (GFR), although 92.9% of the cardiologists and 60.0% of the endocrinologists report referring hypertensive and diabetic patients with impaired renal function to nephrologists. One hundred percent of the interviewees recognize the importance of physical exercise for their patients; however, only 68.6% of cardiologists and 60% of endocrinologists indicated a physiotherapist and/or physical trainer to implement these exercises. Conclusion: The professionals evaluated in this study do not request microalbuminuria and GFR examinations for hypertensive and diabetic patients as a follow-up routine, despite having found cases of renal function impairment in these patients; in contrast to what is proposed in the guidelines for hypertension and diabetes mellitus. They recognize the importance of physical exercise and report indicating their patients to a physiotherapist and/or physical trainer. We suggest continuing the study in order to ascertain the reasons for their not complying with the respective guidelines.
Resumo Introdução: A hipertensão arterial (HAS) e o diabetes mellitus (DM) ocasionam alterações funcionais e estruturais de órgãos alvo como os rins, caracterizando a necessidade de ações preventivas para evitar a Doença Renal Crônica (DRC). Objetivo: Verificar o conhecimento, indicação e prática de condutas dos cardiologistas e endocrinologistas quanto a prevenção de DRC em pacientes com HAS e DM. Métodos: Estudo transversal realizado com 14 cardiologistas e 5 endocrinologistas, através de questionário referente a conduta desses profissionais quanto a prevenção da DRC entre hipertensos e diabéticos. Resultados: Cem por cento dos cardiologistas e endocrinologistas não solicitam os exames específicos para o rastreamento da DRC (albuminúria e estimativa da taxa de filtração glomerular - TGF), embora 92,9% dos cardiologistas e 60,0% dos endocrinologistas relatem encaminhar pacientes hipertensos e diabéticos com comprometimento da função renal ao nefrologista. Cem por cento dos entrevistados reconhecem a importância do exercício físico para seus pacientes, no entanto, apenas 68,6% dos cardiologistas e 60% dos endocrinologistas indicam o fisioterapeuta e ou educador físico para a realização dos mesmos. Conclusão: Os profissionais avaliados neste estudo não solicitam exames microalbuminúria e de TFG para pacientes hipertensos e diabéticos como rotina de acompanhamento, embora tenham encontrado casos de comprometimento da função renal nesses pacientes, diferentemente do proposto nas diretrizes para hipertensão arterial e diabetes mellitus. Reconhecem a importância do exercício físico e referem indicar seus pacientes ao fisioterapeuta e ou educador físico. Sugerimos continuidade do estudo a fim de averiguar as razões para o não cumprimento das respectivas diretrizes.