Previous studies have suggested the benefits of physical exercise for patients on dialysis. We conducted the Exercise Introduction to Enhance Performance in Dialysis trial, a 6-month randomized, multicenter trial to test whether a simple, personalized walking exercise program at home, managed by dialysis staff, improves functional status in adult patients on dialysis. The main study outcomes included change in physical performance at 6 months, assessed by the 6-minute walking test and the five times sit-to-stand test, and in quality of life, assessed by the Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire. We randomized 296 patients to normal physical activity (control; =145) or walking exercise (=151); 227 patients (exercise =104; control=123) repeated the 6-month evaluations. The distance covered during the 6-minute walking test improved in the exercise group (mean distance±SD: baseline, 328±96 m; 6 months, 367±113 m) but not in the control group (baseline, 321±107 m; 6 months, 324±116 m; <0.001 between groups). Similarly, the five times sit-to-stand test time improved in the exercise group (mean time±SD: baseline, 20.5±6.0 seconds; 6 months, 18.2±5.7 seconds) but not in the control group (baseline, 20.9±5.8 seconds; 6 months, 20.2±6.4 seconds; =0.001 between groups). The cognitive function score (=0.04) and quality of social interaction score (=0.01) in the kidney disease component of the KDQOL-SF improved significantly in the exercise arm compared with the control arm. Hence, a simple, personalized, home-based, low-intensity exercise program managed by dialysis staff may improve physical performance and quality of life in patients on dialysis.

Hepatitis C virus (HCV) remains common in patients with end-stage renal disease (ESRD)and is an important cause of liver disease in this population. Acquisition of HCV infection continues to occur in dialysis patients because of nosocomial spread. The natural history of HCV in dialysis patients remains controversial because the course of HCV typically extends over decades, whereas dialysis patients have higher morbidity and mortality rates than those of the general population limiting long-term follow-up. However, recent reports suggest that HCV infection affects the survival of chronic dialysis patients as well as renal transplant ( L iver disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) treated by dialysis or transplantation. 1 Viral hepatitis was suspected to be prevalent in patients with ESRD maintained on chronic hemodialysis (HD) nearly 3 decades ago. Development of diagnostic testing for hepatitis B virus (HBV) confirmed a high incidence and prevalence of HBV infection both in patients and staff in HD units. A number of measures mandated by the Centers for Disease Control, including isolation of hepatitis B surface antigen-positive patients, dedicated dialysis machines, and regular surveillance for HBV infection, dramatically reduced the spread of HBV in this setting by the late 1970s. However, many cases of liver disease in ESRD were unexplained and were ascribed to non-A, non-B hepatitis. Once the hepatitis C virus (HCV) was cloned, 2 it rapidly became evident that HCV was frequent in patients with ESRD on HD and that HCV transmission was occurring within HD units in the absence of the usual parenteral risk factors (i.e., blood transfusion or illicit drug use) ( Table 1). A number of other important facets of HCV infection in ESRD patients have been recognized, including false-negative serologic tests and an absence of biochemical dysfunction despite viremia. However, despite this, progressive liver disease can occur and is a particular concern in the patient who is a renal transplantation (RT) recipient. Epidemiology and Diagnosis of HCV Infection in ESRDWith first-and second-generation serologic testing for HCV available, a number of investigators 3 reported a high prevalence of anti-HCV seropositivity in patients with ESRD on chronic dialysis, most of whom were also viremic by polymerase chain reaction (PCR). A high rate of false-negative serologic testing was also noted. Bukh et al. 4 reported that 2.6% of dialysis patients seronegative by second-generation enzyme-linked immunosorbent assay (ELISA) were viremic by PCR. However, the more recent