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1.
Int Urol Nephrol ; 51(7): 1249-1260, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31161521

RESUMO

PURPOSE: Patients with end-stage renal disease (ESRD) seem to have a negative attitude towards physical activity, which is mainly favored by the lack of counseling provided by the medical and nursing staff. The aim of this study was to investigate the attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity and identify the obstacles that discourage patients' involvement in intervention programs. STUDY DESIGN: Subjective assessment questionnaires and the International Physical Activity Questionnaire were administrated to hemodialysis patients and medical staff, to investigate the association between patient's barriers to physical activity, the total intensity level of physical activity, and attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity. RESULTS: A total of 103 ESRD patients (61 men, 59.2%), 20 nephrologists (12 men, 60.0%), and 72 nurses (61 women, 84.7%) participated in the study. Most commonly reported patient's barriers were fatigue on dialysis (97.4%) and non-dialysis days (55.1%). Healthcare staff showed positive attitude towards renal rehabilitation exercise programs. However, most of physicians (85.0%) and nurses (83.3%) did not have previous experience with interventional exercise rehabilitation programs. Binary logistic regression revealed significant association between patients' inactivity, demographic data, and barriers towards physical activity, such as fatigue and pain in dialysis and non-dialysis days (p < 0.05), family's and physician's concern (p < 0.05), too many medical problems (p < 0.05), the fear of getting hurt (p = 0.01), and unwillingness for exercise (p < 0.05). Interestingly, healthcare staff's negative attitudes toward patient's physical activity seem to be strongly associated with patient's inactivity status. CONCLUSION: Healthcare staff negative attitudes and multiple related barriers especially fatigue on dialysis and non-dialysis days, towards ESRD patient's physical activity, suppress desire for exercise and active patients' status, leading them to abstain from it.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Terapia por Exercício , Exercício Físico , Falência Renal Crônica , Participação do Paciente/psicologia , Diálise Renal , Adulto , Aconselhamento , Exercício Físico/fisiologia , Exercício Físico/psicologia , Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Falência Renal Crônica/psicologia , Falência Renal Crônica/reabilitação , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Nefrologistas/psicologia , Recursos Humanos de Enfermagem/psicologia , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Diálise Renal/psicologia , Comportamento Sedentário
2.
Nephron ; 142(2): 114-116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943504

RESUMO

Maintenance haemodialysis is the most common form of renal replacement therapy treatment in Sub-Saharan Africa. In spite of this, there is a general inadequacy for patients receiving this form of therapy due to lack of materials, human resources and funding from the governments. This form of treatment is relatively new in the Gambia compared to many West African countries, but there is also an enormous challenge on the part of the government to ensure that the citizens benefit from this form of therapy. Inadequate finances and human resources are making it difficult for the Gambia government to achieve this objective. It is therefore imperative for the state to invest more efforts on preventive strategies, which until today continue to remain inadequate.


Assuntos
Hospitais de Ensino/organização & administração , Falência Renal Crônica/reabilitação , Diálise Renal , Gâmbia , Humanos
3.
Clin Rehabil ; 33(2): 147-156, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30789077

RESUMO

OBJECTIVE:: This study aimed to conduct an up-to-date systematic review of the literature to evaluate the effects of exercise on fatigue, anxiety, depression, physical activity, and quality of life (QOL) in patients with end-stage renal disease. DATA SOURCES:: We searched PubMed (October 2018), Embase (from 1966 to October 2018), Web of Science (from 1900 to October 2018), The Cochrane Library (October 2018), and references of papers. METHODS:: This study includes randomized controlled trials that analyzed the combined effects of exercise intervention on patients with end-stage renal disease. Two reviewers independently screened the retrieved records, extracted data, and assessed the risk of bias for inclusion in the study. The effects of exercise intervention were conducted in the meta-analysis using RevMan 5.3 software. RESULTS:: A total of 614 participants were included in 13 randomized controlled studies. The study revealed that exercise can improve fatigue, anxiety, depression, physical activity, and QOL. The effect value results were as follows: (1) fatigue, -0.97 (95% confidence interval (CI) -1.32 to -0.62, P < 0.00001); (2) anxiety, -0.78 (95% CI -1.17 to -0.39, P < 0.0001); (3) depression, -0.85 (95% CI -1.13 to -0.56, P < 0.00001) (4) physical activity, 38.15 (95% CI 21.20 to 55.10, P < 0.0001); (5) QOL, the physical component of the 36-item Short-Form Health Survey (SF-36), 4.73 (95% CI 1.92 to 7.54, P = 0.0010); and (6) the mental component of the SF-36, 3.42 (95% CI 0.27 to 6.56, P = 0.03). CONCLUSION:: Exercise intervention is more effective in fatigue, anxiety, depression, physical activity, and QOL. However, large-scale randomized controlled trials are needed to confirm the appropriate types of exercise and optimal time for patients with end-stage renal disease.


Assuntos
Terapia por Exercício , Falência Renal Crônica/psicologia , Falência Renal Crônica/reabilitação , Ansiedade , Depressão , Exercício Físico , Fadiga , Humanos , Qualidade de Vida
4.
J Ren Care ; 45(1): 9-19, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30648345

RESUMO

INTRODUCTION: End-stage kidney disease (ESKD) is characterised by several complications, leading to reduced functional ability and quality of life during transition to dialysis. This study aimed to establish the feasibility and effectiveness of a patient-centred programme of exercise, nutritional intervention and multidisciplinary education for persons approaching dialysis. METHODS: Patients with eGFR <15 ml/min/1.73 m2 and anticipated to start dialysis within 6-12 months were invited to participate. The 10-week pre-dialysis intervention included a weekly 1-hour gym-based exercise circuit and an education programme. Feasibility and acceptability were assessed through recruitment and retention rates, adherence to the intervention, and from patient feedback following the intervention. Physical function, nutritional status, and anxiety and depression, were assessed at baseline, after intervention, and as dialysis commenced. RESULTS: Thirty patients agreed to participate, with 22 completing the pre-dialysis intervention. Thirteen (59%) participants achieved 100% attendance at the exercise and education sessions, with only two participants attending less than 8/10 sessions. The intervention also led to improved physical function, demonstrated by significant increase in both incremental shuttle walk distance (330 vs. 385 m, p = 0.006) and quadriceps one repetition maximum (p = 0.007), and a trend towards increased sit-to-stand repetitions (20-23, p = 0.11). There was a trend for improved patient perception of activity (Duke Activity Status Index score 31.55 vs. 33.75, p = 0.09). Hand grip strength (29.1 vs. 29.8 kg), body mass index (30.4 vs. 30.5 kg/m2 ) and nutritional status assessed by subjective global assessment (73% well-nourished) were maintained. CONCLUSION: This study demonstrated the feasibility and effectiveness of a patient-centred exercise and education programme in those approaching dialysis. Further research is therefore required to evaluate the impact of this programme on clinical outcomes.


Assuntos
Diálise/métodos , Falência Renal Crônica/reabilitação , Adulto , Índice de Massa Corporal , Terapia por Exercício/métodos , Feminino , Força da Mão , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Educação de Pacientes como Assunto/métodos , Qualidade de Vida/psicologia
5.
Clin Transplant ; 33(1): e13450, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30462375

RESUMO

Prehabilitation is the process of enhancing preoperative functional capacity to improve tolerance for the upcoming stressor; it was associated with improved postoperative outcomes in a handful of studies, but never evaluated in transplantation. Kidney transplant (KT) candidates may be uniquely suited for prehabilitation because they experience a profound loss of functional capacity while waiting years on dialysis. To better understand the feasibility and effectiveness of prehabilitation in KT, we conducted a pilot study of center-based prehabilitation for candidates; this intervention consisted of weekly physical therapy sessions at an outpatient center with at-home exercises. We enrolled 24 participants; 18 participated in prehabilitation (75% of enrolled; 17% of eligible). 61% were male, 72% were African American, and mean age = 52 (SD = 12.9); 71% of participants had lower-extremity impairment, and 31% were frail. By 2 months of prehabilitation, participants improved their physical activity by 64% (P = 0.004) based on accelerometry. Participants reported high satisfaction. Among 5 prehabilitation participants who received KT during the study, length of stay was shorter than for age-, sex-, and race-matched control (5 vs 10 days; RR = 0.69; 95% CI:0.50-0.94; P = 0.02). These pilot study findings suggest that prehabilitation is feasible in pretransplant patients and may potentially be a strategy to improve post-KT outcomes.


Assuntos
Exercício Físico , Falência Renal Crônica/reabilitação , Transplante de Rim/reabilitação , Tempo de Internação/estatística & dados numéricos , Cuidados Pré-Operatórios/métodos , Recuperação de Função Fisiológica , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias , Prognóstico , Adulto Jovem
6.
Am J Kidney Dis ; 71(5): 677-689, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29398178

RESUMO

BACKGROUND: Half of surgically created arteriovenous fistulas (AVFs) require additional intervention to effectively support hemodialysis. Postoperative care and complications may affect clinical maturation. STUDY DESIGN: Hemodialysis Fistula Maturation (HFM) Study, a 7-center prospective cohort study. SETTING & PARTICIPANTS: 491 patients with single-stage AVFs who had neither thrombosis nor AVF intervention before a 6-week postoperative ultrasonographic examination and who required maintenance hemodialysis. PREDICTORS: Postoperative care processes and complications. OUTCOMES: Attempted cannulation, successful cannulation, and unassisted and overall clinical maturation as defined by the HFM Study criteria. RESULTS: AVF cannulation was attempted in 443 of 491 (90.2%) participants and was eventually successful in 430 of these 443 (97.1%) participants. 263 of these 430 (61.2%) reached unassisted and 118 (27.4%) reached assisted AVF maturation (overall maturation, 381/430 [88.6%]). Attempted cannulation was less likely in patients of surgeons with policies for routine 2-week versus later-than-2-week first postoperative visits (OR, 0.21; 95% CI, 0.06-0.70), routine second postoperative follow-up visits (OR, 0.39; 95% CI, 0.15-0.97), and a routine clinical postoperative ultrasound (OR, 0.28; 95% CI, 0.14-0.55). Attempted cannulation was also less likely among patients undergoing procedures to assist maturation (OR, 0.51; 95% CI, 0.27-0.98). Unassisted maturation was more likely for patients treated in facilities with access coordinators (OR, 1.91; 95% CI, 1.17-3.12), but less likely after precannulation nonstudy ultrasounds (OR per ultrasound, 0.42 [95% CI, 0.26-0.68]) and initial unsuccessful cannulation attempts (OR per each additional attempt, 0.90 [95% CI, 0.83-0.98]). Overall maturation was less likely with infiltration before successful cannulation (OR, 0.44; 95% CI, 0.22-0.89). Among participants receiving maintenance hemodialysis before AVF surgery, unassisted and overall maturation were less likely with longer intervals from surgery to initial cannulation (ORs for each additional month of 0.81 [95% CI, 0.76-0.88] and 0.93 [95% CI, 0.89-0.98], respectively) and from initial to successful cannulation (ORs for each additional week of 0.87 [95% CI, 0.81-0.94] and 0.88 [95% CI, 0.83-0.94], respectively). LIMITATIONS: Surgeons' management policies were assessed only by questionnaire at study onset. Most participants received upper-arm AVFs, planned 2-stage AVFs were excluded, and maturation time windows were imposed. Some care processes may have been missed and the observational design limits causal attribution. CONCLUSIONS: Multiple processes of care and complications are associated with AVF maturation outcomes.


Assuntos
Fístula Arteriovenosa/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateterismo/métodos , Falência Renal Crônica/reabilitação , Diálise Renal/efeitos adversos , Dispositivos de Acesso Vascular/efeitos adversos , Adulto , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Estudos de Coortes , Remoção de Dispositivo/métodos , Feminino , Seguimentos , Humanos , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Diálise Renal/métodos , Reoperação/métodos , Medição de Risco , Resultado do Tratamento , Ultrassonografia Doppler/métodos
7.
Disabil Rehabil ; 40(26): 3171-3176, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-28886676

RESUMO

PURPOSE: This study determined the validity, test-retest reliability and minimal detectable change of the balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) in patients with end-stage renal disease. METHODS: A cross-sectional study with 74 patients with end-stage renal disease (male 66.2%; 63.9 ± 15.1 years old) was conducted. Participants were asked to report the number of falls during the previous 12 months and to complete the activity-specific balance confidence (ABC) scale. The BESTest was administered, and the Mini-BESTest and Brief-BESTest scores were computed based on the BESTest performance. Validity was assessed by correlating balance tests with each other and with the ABC scale. Test-retest relative reliability and agreement were explored with the intraclass correlation coefficient (ICC) equation (2,1) and the Bland and Altman method. Minimal detectable changes at the 95% confidence level were established. RESULTS: Balance test scores were significantly correlated with each other (spearman's correlation = 0.89-0.92) and with the ABC scale (spearman's correlation = 0.49-0.59). Balance tests presented high test-retest reliability (ICC = 0.84-0.94), with no evidence of bias. Minimal detectable change values were 10.8 (expressed as a percentage 13.5%), 5.3 (23.7%) and 5.6 (34%) points for the BESTest, Mini-BESTest and Brief-BESTest, respectively. CONCLUSIONS: All tests are valid and reliable to assess balance in patients with end-stage renal disease. Nevertheless, based on the minimal detectable changes found, BESTest and Mini-BESTest may be the most recommended tests for this specific population. Implications for Rehabilitation Balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) are reliable and valid in patients with end stage renal disease (ESRD). The minimal detectable changes of 10.8 for the BESTest, 5.3 for the Mini-BESTest and 5.6 for the Brief-BESTest can be used by clinicians to identify a true change in balance over time or in response to interventions. Based on the minimal detectable changes found, BESTest and Mini-BESTest may be the most recommended; and the selection of one of them may be based on time and equipment availability.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação da Deficiência , Equilíbrio Postural/fisiologia , Idoso , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/reabilitação , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Psicometria , Reprodutibilidade dos Testes , Medição de Risco
8.
Clin Transplant ; 31(8)2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28564126

RESUMO

Many patients become frail with diminished cardiorespiratory fitness while awaiting kidney transplantation. Frailty and poor fitness powerfully predict mortality, transplant graft survival, and healthcare utilization after kidney transplantation. Efforts to intervene with post-transplant physical therapy have been met with limited success, in large part due to high study dropout. We reviewed the literature on chronic kidney disease and exercise to propose a clinical framework for physical therapy interventions to improve fitness, scheduled for before the transplant. This framework may lead to better patient retention and compliance, and thus demonstrate better efficacy in mitigating the effects of frailty and poor fitness after kidney transplantation.


Assuntos
Falência Renal Crônica/reabilitação , Transplante de Rim , Modalidades de Fisioterapia , Cuidados Pré-Operatórios/métodos , Teste de Esforço , Fragilidade , Humanos , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/cirurgia , Aptidão Física
9.
BMC Nephrol ; 18(1): 144, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28460640

RESUMO

BACKGROUND: Poor physical performance and protein-energy wasting (PEW) are health issues of major concern in haemodialysis patients. The conventional haemodialysis (CHD) regime, three times per week 3-5 h, is subject of discussion because of high morbidity and mortality rates. When patients switch from CHD to longer dialysis sessions, i.e. nocturnal haemodialysis (NHD), improvement in protein intake and increase in body weight is seen. However, it is unclear whether physical performance and more important aspects of PEW, such as body composition, improve as well. Therefore, the aim of this study is to investigate whether physical performance improves and PEW decreases, when patients switch from CHD to NHD. A second aim is to assess the influence of NHD on the biomarkers fibroblast growth factor-23 and sclerostin which are thought to be associated with malnutrition and mortality in patients on haemodialysis. METHODS: This study is a prospective multicentre cohort study with an inclusion aim of 50 patients: 25 patients in a control group (three times per week, 3-5 h CHD) and 25 patients in a nocturnal group (three times per week, 7-9 h NHD). Primary outcome is change in physical performance, measured by the Short Physical Performance Battery. Additional measurements are a 6-min walk test, handgrip strength, a physical activity questionnaire and physical activity monitoring. The secondary outcome of the study is PEW, which will be evaluated by body weight, dual-energy X-ray absorptiometry, bio-electrical impedance spectroscopy, mid-upper arm muscle circumference, subjective global assessment, visual analogue scale for appetite and dietary records. Laboratory measurements including fibroblast growth factor-23 and sclerostin, and quality of life assessed with the Kidney Disease Quality of Life-Short Form are also studied. In every patient, four repeated measurements will be performed during one year of follow-up. DISCUSSION: This study will investigate whether physical performance improves and PEW decreases when patients switch from CHD to NHD, compared to a control group who continue treatment with CHD. Strengths of this study are the comparison with a conventional haemodialysis cohort, and the broad variety of objective measurements combined with patient-reported outcomes of physical performance and PEW. TRIAL REGISTRATION: NTR4715 , Netherlands Trial Register. Registered 30 July 2014.


Assuntos
Falência Renal Crônica/complicações , Falência Renal Crônica/reabilitação , Aptidão Física , Desnutrição Proteico-Calórica/etiologia , Desnutrição Proteico-Calórica/prevenção & controle , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Resultado do Tratamento , Adulto Jovem
10.
BMC Nephrol ; 18(1): 145, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28460645

RESUMO

BACKGROUND: Basic and translational research supports beneficial effects of statins on bone metabolism. Clinical studies suggest that statin use may reduce the risk of hip fractures in the general population. Whether statin use is associated with hip fracture risk in kidney transplant recipients, a particularly high-risk group for this outcome, is unknown. METHODS: From the U.S. Renal Data System (2007-2011), we identified all hip fracture events recorded in Medicare billing claims of first-time kidney transplant recipients. We then matched all cases to an unlimited number of controls on age (±3 years), sex, race (black vs. non-black), and time since transplant. Cases and controls were required to have >1 year of Medicare Parts A + B + D coverage and be without a recorded history of hip fracture. We ascertained any statin use in the previous year and defined adherent statin use as those who had filled prescriptions for statins to cover >80% of days in that year (proportion of days covered, PDC). We ascertained several potential confounders (demographics, comorbidities, BMI, transplant-related factors) and applied conditional logistic regression with multiple imputation for missing data to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: We identified 231 hip fracture cases (mean age 51.8 years; 53% female; 11.3% black; 6.9 years from transplant, and 9.9 years from ESRD) and 15,575 matched controls. Any prior statin use was present in 64.1% of cases and 60.3% of controls with 37.2% of cases and 33.9% of controls being found adherent. Unadjusted conditional logistic regression showed an OR of 1.17 (0.89-1.54) for any statin use, and a fully-adjusted OR of 0.89 (0.67-1.19). Compared with statin non-users, the adjusted OR for patients with lesser adherence (PDC ≤80%) and those with greater adherence (PDC >80%) were 0.93 (0.66-1.31) and 0.87 (0.63-1.20), respectively. CONCLUSION: Statin use was not associated with hip fracture risk in first-time kidney transplant recipients.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/reabilitação , Transplante de Rim/estatística & dados numéricos , Conservadores da Densidade Óssea/uso terapêutico , Causalidade , Comorbidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Feminino , Fraturas do Quadril/diagnóstico , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
11.
BMC Nephrol ; 18(1): 37, 2017 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-28122510

RESUMO

BACKGROUND: Evidence suggests that exercise training for hemodialysis patients positively improves morbidity and mortality outcomes, yet exercise programs remain rare and are not systematically incorporated into care. We developed a research-based film, Fit for Dialysis, designed to introduce, motivate, and sustain exercise for wellness amongst older hemodialysis patients, and exercise counseling and support by nephrologists, nurses, and family caregivers. The objective of this clinical trial is to determine whether and in what ways Fit for Dialysis improves outcomes and influences knowledge/attitudes regarding the importance of exercise for wellness in the context of end-stage renal disease. METHODS/DESIGN: This 2-site parallel intervention trial will recruit 60 older hemodialysis patients from two urban hospitals. The trial will compare the film + a 16-week exercise program in one hospital, with a 16-week exercise-only program in another hospital. Physical fitness and activity measures will be performed at baseline, 8 and 16 weeks, and 12 weeks after the end of the program. These include the 2-min Walk Test, Grip Strength, Duke Activity Status Index, and the Timed Up-and-Go Test, as well as wearing a pedometer for one week. Throughout the 16-week exercise program, and at 12 weeks after, we will record patients' exercise using the Godin Leisure-time Exercise Questionnaire. Patients will also keep a diary of the exercise that they do at home on non-dialysis days. Qualitative interviews, conducted at baseline, 8, and 16 weeks, will explore the impact of Fit for Dialysis on the knowledge/attitudes of patients, family caregivers, and nephrology staff regarding exercise for wellness, and in what ways the film is effective in educating, motivating, or sustaining patient exercise during dialysis, at home, and in the community. DISCUSSION: This research will determine for whom Fit for Dialysis is effective, why, and under what conditions. If Fit for Dialysis is proven beneficial to patients, nephrology staff and family caregivers, research-based film as a model to support exercise promotion and adherence could be used to support the National Kidney Foundation's guideline recommendation (NKF-KDOQI) that exercise be incorporated into the care and treatment of dialysis patients. TRIAL REGISTRATION: NCT02754271 (ClinicalTrials.gov), retroactively registered on April 21, 2016.


Assuntos
Terapia por Exercício/métodos , Falência Renal Crônica/reabilitação , Filmes Cinematográficos , Motivação , Educação de Pacientes como Assunto/métodos , Diálise Renal , Idoso , Canadá , Cuidadores , Aconselhamento , Feminino , Força da Mão , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Nefrologistas , Enfermeiras e Enfermeiros , Inquéritos e Questionários , Pesquisa Médica Translacional , Teste de Caminhada
12.
BMC Nephrol ; 18(1): 4, 2017 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-28056851

RESUMO

BACKGROUND: The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis. Dialysis should not only be aimed at prolonging lives but also improve quality of life (QOL). Using mixed methods, we investigated the QOL of patients on chronic haemodialysis (HD) and peritoneal dialysis (PD). METHODS: We conducted a cross-sectional study at Tygerberg Hospital in Cape Town, South Africa. All the PD patients were being treated with continuous ambulatory peritoneal dialysis. The KDQOL-SF 1.3 questionnaire was used for the quantitative phase of the study. Thereafter, focus-group interviews were conducted by an experienced facilitator in groups of HD and PD patients. Electronic recordings were transcribed verbatim and analysed manually to identify emerging themes. RESULTS: A total of 106 patients completed questionnaires and 36 of them participated in the focus group interviews. There was no difference between PD and HD patients in the overall KDQOL-SF scores. PD patients scored lower with regard to symptoms (P = 0.005), energy/fatigue (P = 0.025) and sleep (P = 0.023) but scored higher for work status (P = 0.005) and dialysis staff encouragement (P = 0.019) than those on HD. Symptoms and complications were verbalised more in the PD patients, with fear of peritonitis keeping some housebound. PD patients were more limited by their treatment modality which impacted on body image, sexual function and social interaction but there were less dietary and occupational limitations. Patients on each modality acknowledged the support received from family and dialysis staff but highlighted the lack of support from government. PD patients had little opportunity for interaction with one another and therefore enjoyed less support from fellow patients. CONCLUSIONS: PD patients experienced a heavier symptom burden and greater limitations related to their dialysis modality, especially with regards to social functioning. The mixed-methods approach helped to identify several issues affecting quality of life which are amenable to intervention.


Assuntos
Relações Interpessoais , Falência Renal Crônica/psicologia , Falência Renal Crônica/reabilitação , Diálise Peritoneal Ambulatorial Contínua/psicologia , Diálise Peritoneal Ambulatorial Contínua/estatística & dados numéricos , Qualidade de Vida/psicologia , Adulto , Idoso , Efeitos Psicossociais da Doença , Estudos Transversais , Emprego , Feminino , Nível de Saúde , Humanos , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , África do Sul/epidemiologia , Inquéritos e Questionários , Resultado do Tratamento
13.
Hemodial Int ; 21(3): 422-429, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-27766736

RESUMO

INTRODUCTION: The use of administrative data to capture 30-day readmission rates in end-stage renal disease is challenging since Medicare combines claims from acute care, inpatient rehabilitation (IRF), and long-term care hospital stays into a single "Inpatient" file. For data prior to 2012, the United States Renal Data System does not contain the variables necessary to easily identify different facility types, making it likely that prior studies have inaccurately estimated 30-day readmission rates. METHODS: For this report, we developed two methods (a "simple method" and a "rehabilitation-adjusted method") to identify acute care, IRF, and long-term care hospital stays from United States Renal Data System claims data, and compared them to methods used in previously published reports. FINDINGS: We found that prior methods overestimated 30-day readmission rates by up to 12.3% and overestimated average 30-day readmission costs by up to 11%. In contrast, the simple and rehabilitation-adjusted methods overestimated 30-day readmission rates by 0.1% and average 30-day readmission costs by 1.8%. The rehabilitation-adjusted method also accurately identified 96.8% of IRF stays. DISCUSSION: Prior research has likely provided inaccurate estimates of 30-day readmissions in patients undergoing dialysis. In the absence of data on specific facility types particularly when using data prior to 2012, future researchers could employ our method to more accurately characterize 30-day readmission rates and associated outcomes in patients with end-stage renal disease.


Assuntos
Hospitalização/estatística & dados numéricos , Falência Renal Crônica/reabilitação , Readmissão do Paciente/estatística & dados numéricos , Diálise Renal/métodos , Estudos de Coortes , Humanos
14.
Curr Sports Med Rep ; 15(4): 269-75, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27399824

RESUMO

When a person's kidneys fail, hemodialysis (HD) is the most common treatment modality. With a growing number of patients requiring this life-sustaining treatment, and with evidence illustrating the significant physical dysfunction of this population, encouraging exercise is essential. The use of intradialytic exercise, as a novel and efficient use of time during HD, is well established in Australia and some European nations; however, it is slower to start in North America. While a large number of small studies have demonstrated numerous benefits and safe delivery of intradialytic exercise training for patients with end-stage kidney disease, intradialytic exercise is rarely delivered as standard of care. It is of utmost importance for health care staff to overcome barriers and bring theory into practice. Included in this report are current recommendations from governing bodies, expert opinion, as well as established policies and procedures from a successful intradialytic exercise program in Canada.


Assuntos
Terapia por Exercício/métodos , Terapia por Exercício/normas , Falência Renal Crônica/reabilitação , Guias de Prática Clínica como Assunto , Diálise Renal/métodos , Diálise Renal/normas , Terapia Combinada/métodos , Terapia Combinada/normas , Medicina Baseada em Evidências , Humanos , Falência Renal Crônica/diagnóstico , Nefrologia/normas , Resultado do Tratamento
15.
Perit Dial Int ; 35(6): 630-4, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26702003

RESUMO

Individuals aged over 70 years at the time of starting dialysis have a varied and often challenging existence on dialysis. Canadian data suggest those starting dialysis between the ages of 75 and 79 years will have an average life expectancy of 3.2 years, while based on US data, patients can expect an average life expectancy of 25 months. A substantial proportion of these patients will, however, experience transient or permanent loss of personal independence within the first few months to years on dialysis. Preliminary data from patients recently started on peritoneal dialysis (PD) suggest patients and families adapt, but that the adaptation often involves limiting activities and altering the social role the patient has within the family. As data emerge, it will be possible to hypothesize whether this adaptation is beneficial in the long term, or whether these adaptations are permissive, allowing the patient to play a sick role leading to an accelerated transition to frailty and possibly death. Future research will hopefully inform us whether the functional dependency can be identified early and whether it is preventable. In the interim, repair rather than prevention is possible through rehabilitation. We therefore advocate that programs providing PD care consider the integration of protocols whereby patients may undergo formal evaluation to identify those who would benefit from walking or personal care aids, rehabilitation interventions, and, when needed, personal support.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Avaliação Geriátrica/métodos , Falência Renal Crônica/reabilitação , Falência Renal Crônica/terapia , Diálise Peritoneal/métodos , Qualidade de Vida , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Canadá , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Masculino , Diálise Peritoneal/efeitos adversos , Prognóstico , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento
16.
Ter Arkh ; 87(6): 62-67, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26281198

RESUMO

AIM: To make an integrated assessment of the sociomedical status of patients receiving continuous renal replacement therapy (RRT) with hemodialysis (HD), by using the Charlson comorbidity index (CCI) and the Barthel disability index (BI) and to analyze the compliance of these indices with the disability severity estimated according to disability group (DG). SUBJECTS AND METHODS: The medical records of 605 HD patients (323 men, 282 women) whose mean age was 56.4 ± 13.9 years and mean RRT duration was 65.6 ± 62.8 months, were analyzed. The patients were grouped according to DG, CCI, BI, employment, and a history of diabetes mellitus. Data on basic laboratory parameters were collected. RESULTS: According to DG, the patients were grouped as follows: 1) 292 (51%); 2) 212 (37%); 3) 15 (3%) and 4) 48 (9%) without DG. The disability severity estimated according to DG was found to be correlated with RRT duration (r = -0.35; p < 0.001) and employment (r = 0.36; p < 0.001). CCI averaged 6.3 ± 3.1 scores (n = 486). The mean BI was 86 ± 14 scores (n = 224). Among the respondents completing the BI questionnaire, 26 (20%) patients with DG 1 showed an uncomplicated comorbid background (CCI, 2-5 scores), no significant disability (BI, 90-100 scores), while 33 (48%) patients with DG 2 exhibited a high comorbidity index (ICC, more than 5 scores) and obvious disability (BI, less than 90 scores). The indicators relating to restricted self-movement in some BI scales were of the most importance. CONCLUSION: The disability severity estimated in view of DG does not correspond to the severity of comorbidities (CCI) and the magnitude of functional limitations (BI) in some patients with CKD 5D. While determining DG, it is advisable to take into account CCI as an indicator of the severity of physical disorders to objectify the estimate of the sociomedical status of patients with CKD 5D, as well as BI to determine the degree of disability.


Assuntos
Diabetes Mellitus/epidemiologia , Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Falência Renal Crônica/epidemiologia , Terapia de Substituição Renal/métodos , Comorbidade , Diabetes Mellitus/terapia , Feminino , Seguimentos , Humanos , Falência Renal Crônica/reabilitação , Masculino , Pessoa de Meia-Idade , Diálise Renal , Estudos Retrospectivos , Federação Russa/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários
17.
Pediatr Nephrol ; 30(7): 1181-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25877914

RESUMO

BACKGROUND: Peritoneal dialysis (PD) or conventional hemodialysis (HD) are considered to be equally efficient dialysis methods in children and adolescents. The aim of our study was to analyze whether an intensified, nocturnal HD program (NHD) is superior to PD in an adolescent cohort. METHODS: Thirteen patients were prospectively enrolled in a NHD program. We measured uremia-associated parameters, parameters for nutrition, medication and blood pressure and analyzed the data. These data were compared to those of 13 PD controls, matched for gender, age and weight at the beginning the respective dialysis program and after 6 months of treatment. RESULTS: Serum phosphate levels decreased significantly in the NHD group and remained unchanged in the PD group. Arterial blood pressure in the NHD was significantly lower despite the reduction of antihypertensive treatment, whereas blood pressure levels remained unchanged in the PD controls. Preexisting left ventricular hypertrophy resolved and albumin levels improved with NHD. Dietary restrictions could be lifted for those on NHD, whereas they remained in place for the patients on PD treatment. Residual diuresis remained unchanged after 6 months of either NHD or PD. NHD patients experienced fewer days of hospitalization than the PD controls. CONCLUSIONS: Based on our results, NHD results in significantly improved parameters of uremia and nutrition. If individually and logistically possible, NHD should be the treatment modality of preference for older children and adolescents.


Assuntos
Falência Renal Crônica/terapia , Diálise Peritoneal/métodos , Adolescente , Albuminúria/complicações , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Criança , Colesterol/sangue , Dieta , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão Renal/tratamento farmacológico , Hipertensão Renal/terapia , Hipertrofia Ventricular Esquerda/complicações , Falência Renal Crônica/patologia , Falência Renal Crônica/reabilitação , Masculino , Estado Nutricional , Fosfatos/sangue , Ureia/metabolismo
18.
Rehabil Nurs ; 40(2): 111-26, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24729123

RESUMO

PURPOSE: Few studies have examined the role of resistance training (RT) in chronic kidney patients on hemodialysis (HD). This study reviews the literature about resistance exercise for patients on HD and describes protocols and clinical outcomes. METHODS: A search of the MEDLINE database found 21 eligible publications, of which 14 studies applied only RT and 7 combined RT and aerobic training. FINDINGS: Regarding the period of exercise training, 14 studies applied intradialytic exercise. The main outcome reported was muscle strength, which was assessed through knee strength and handgrip measures. CONCLUSIONS: All studies reviewed presented at least one significant result in relation to biochemical parameters, physical capacity, strength, body composition, or quality of life. CLINICAL RELEVANCE: This review demonstrates that RT improves muscle strength, some biochemical parameters, and quality of life of the HD patients.


Assuntos
Falência Renal Crônica/enfermagem , Falência Renal Crônica/reabilitação , Diálise Renal/enfermagem , Treinamento de Resistência , Humanos , Guias de Prática Clínica como Assunto , Resultado do Tratamento
19.
Nephron Clin Pract ; 128(3-4): 387-93, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25531587

RESUMO

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.


Assuntos
Terapia por Exercício , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/reabilitação , Diálise Renal , Idoso , Feminino , Seguimentos , Força da Mão/fisiologia , Humanos , Masculino , Força Muscular/fisiologia , Resistência Física/fisiologia , Estudos Prospectivos , Resultado do Tratamento , Caminhada/fisiologia
20.
Kidney Blood Press Res ; 39(2-3): 180-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25118006

RESUMO

Chronic kidney disease (CKD) worldwide is rising markedly becoming a priority public health problem. The progression of CKD cause functional limitation and severe disability with poor quality of life. The aim of present review was to highlight the effect of rehabilitation in CKD and ESRD subjects. The rehabilitative process is unique in treating disabled people according to a holistic approach with the aim of supporting a person's independent living and autonomy. CKD are associated with an increased risk of functional impairment, independent of age, gender, and co-morbidities. Clinicians should counsel patients with CKD including frail elder people to increase physical activity levels and target that regular physical activity including aerobic or endurance exercises training benefits health. In old subjects with CKD and multiple functional impairments, the traditional disease based model should be changed to individualized patient-centered approach that prioritizes patient preferences. Patients receiving haemodialysis have a considerably lower exercise tolerance, functional capacity, and more muscle wasting than healthy subjects or patients with less severe CKD. Exercise training or comprehensive multi-dimensional strategy and goal-oriented intervention should be also provided in ESRD older subjects. Structured prevention programs based on reducing the risk factors for CKD and rehabilitative strategies could reduce disability occurrence.


Assuntos
Terapia por Exercício/métodos , Falência Renal Crônica/reabilitação , Insuficiência Renal Crônica/reabilitação , Avaliação da Deficiência , Humanos , Falência Renal Crônica/fisiopatologia , Atividade Motora , Diálise Renal , Insuficiência Renal Crônica/fisiopatologia
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