The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM).

BACKGROUND: Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD. METHODS: This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM. RESULTS: 340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively. CONCLUSION: Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD. TRIAL REGISTRATION: NCT04872933. Registered 5th May 2021.

Nutritional status, functional capacity and exercise rehabilitation in end-stage renal disease.

A significant percentage of patients with end-stage renal disease are malnourished and/or muscle wasted. Uremia is associated with decreased protein synthesis and increased protein degradation. Fortunately, nutritional status has been shown to be a modifiable risk factor in the dialysis population. It has long been proposed that exercise could positively alter the protein synthesis-degradation balance. Resistance training had been considered as the only form of exercise likely to induce anabolism in renal failure patients. However, a small, but growing, body of evidence indicates that for some dialysis patients, favourable improvements in muscle atrophy and fibre hypertrophy can be achieved via predominantly aerobic exercise training. Moreover, some studies tentatively suggest that nutritional status, as measured by SGA, can also be modestly improved by modes and patterns of exercise training that have been shown to also increase muscle fibre cross-sectional area and improve functional capacity. Functional capacity tests can augment the information content of basic nutritional status assessments of dialysis patients and as such are recommended for routine inclusion as a feature of all nutritional status assessments.

Improvement in quality of life of dialysis patients during six months of exercise.

Quality of life (QOL) assessment has rapidly become an integral variable of outcome in clinical research; over 1,000 new articles each year are indexed under "quality of life" (1). Despite the proliferation of instruments and the burgeoning theoretical literature devoted to QOL evaluation, no unified approach has been derived for its measurement, and little agreement has been attained on what it means (2). Lack of clarity regarding the definition of QOL has led to several related concepts, namely functional status, life-satisfaction, well-being, and health status, being used interchangeably with QOL (3), further contributing to ambiguity. Compared to the general population, patients with end-stage renal disease (ESRD) experience a poorer QOL (4). Questionnaire-based QOL measurement in ESRD has demonstrated that QOL is best in renal transplantation and worst in unit-based haemodialysis. The main determinants of difference are the physical function domains. QOL in ESRD has traditionally been measured by a number of disease-specific, domain-specific and generic instruments, all exhibiting a fixed design. However, the fixed nature of the aforementioned instruments, is problematic in that what is measured is predetermined and hence may not represent the free choice of the individual whose QOL is assessed (5). Questionnaire-based instruments may not reflect individual priorities.

Reproducibility of exercise tolerance in patients with end-stage renal disease.

OBJECTIVE: To determine the interday reproducibility of peak and submaximal exercise tolerance of patients with end-stage renal disease (ESRD). DESIGN: Repeated measures. SETTING: Day-patient rehabilitation center. PARTICIPANTS: Twelve consecutively presenting, self-selected patients with ESRD. INTERVENTIONS: All patients performed peak exercise tolerance assessments on a cycle ergometer up to the point of volitional fatigue, with a 1-week interval between the 2 tests. MAIN OUTCOME MEASURES: Cardiopulmonary, hemodynamic, and physical performance parameters were assessed at peak exercise and at the lactate threshold. Standard error of measurement, percentage coefficient of variation (CV%), intraclass correlation coefficient (ICC), and limits of agreement (LOA) were calculated to determine the reproducibility of all variables. RESULTS: CV% (range, 5%-7%) and ICCs (range, .94 - .98) for oxygen uptake and heart rate at peak exercise and lactate threshold indicated highly acceptable levels of group mean reproducibility. LOA analysis revealed satisfactory levels of reproducibility for individual patients. CONCLUSION: Taken together, these reproducibility data may be applied to clinical work, requiring the quantification of changes in the exercise tolerance of patients with ESRD after short-term interventions (eg, exercise training, therapeutic use of recombinant erythropoietin).