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 AE 0.21 vs. 1.10 AE 0.16 for control, P < 0.001; 1.53 AE 0.26 vs. 1.27 AE 0.19 for control, P < 0.001, respectively) and URR (72.5 AE 5.4% vs. 66.1 AE 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 AE 9.1% vs. 30.7 AE 12.8%, P < 0.01) and exercise alone vs. control sessions (13.3 AE 29.0% vs. 42.4 AE 15.3%, P < 0.01). Phosphorus rebound was marginally lower in exercise vs. control sessions (14.4 AE 19.1% vs. 28.4 AE 22.1%, P = 0.18). Urea and phosphorus mass removal in dialysate were marginally higher in exercise vs. control sessions (42.2 AE 19.4 g vs. 35.7 AE 12.5 g, P = 0.24; 912.1 AE 360.9 mg vs. 778.6 AE 245.1 mg, P = 0.28).Conclusions: Intradialytic exercise with BFR was more effective than standard exercise in increasing HD adequacy.

Patients on hemodialysis (HD) are at increased risk for arrhythmias and sudden cardiac death. Autonomic nervous system (ANS) dysfunction seems to participate in the arrhythmogenic process. Genetic factors have an impact on ANS modulation, but the specific role of the insertion/deletion (I/D) polymorphism in the gene for angiotensin-converting enzyme (ACE) has not been investigated. Since the D allele increases gene expression, it is a candidate polymorphism to interact with the ANS. The aim of the present study was to compare the behavior of heart rate variability (HRV) during HD, as a surrogate for ANS response to stressors, between the ACE genotypes. In a sample of patients with chronic kidney disease I/D ACE genotypes were assessed with PCR and HRV was measured before, in the second hour, and after a HD session. HRV parameters in the time and frequency domains were analyzed by repeated-measures mixed models according to the time of measurement and ACE polymorphism. HRV parameters in the frequency domain presented significantly different variations during the HD session between patients with or without the D allele. Only patients with the II genotype presented an increase in low-frequency normalized units and in the low frequency-to-high frequency ratio throughout HD. Patients with the II genotype seemed to have a more physiological response to the volemic and electrolytic changes that occur during HD, with greater sympathetic activation than patients with ID and DD genotypes. NEW & NOTEWORTHY Adding to the effort to understand the complexity of cardiovascular system regulation, we have found that the autonomic nervous system response to the acute volume removal during hemodialysis may be different between angiotensin-converting enzyme insertion/deletion polymorphisms. To our knowledge, this is the first time that this specific interaction was analyzed during a volume removal intervention.

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.

Introduction: An intensive care unit (ICU) provides patients with advanced life support, where they stay from hours to months to stabilise and survive. Early mobilisation has proven to be a safe and viable technique that provides hemodynamic benefits, avoids the effects of immobility and contributes to the best physical and functional outcomes for patients. Objective: The aim of this study is to clarify the importance of early mobilisation (EM) in critically ill patients. Material and Methods: A systematic review of the literature by mobilizing the descriptors: "Critical patient", "Early mobilisation" and "Nursing ". Were selected databases imaginable, between 2014-2020, included for analysis seven articles. Results and Discussion: Results and discussion: In most studies it was found that the general form, this practice provides increased muscle strength, increased maximum inspiratory pressure, shorter duration of mechanical ventilation, shorter hospital stay and better quality of life. The seven studies identified recognized the importance of early mobilization as it can facilitate the functional rehabilitation of these patients by promoting increased muscle strength and greater participation in daily activities, but some studies also identified challenges that need to be addressed. Conclusion: Early mobilization contributes to improve the patient's functional capacity and quality of life, both in the hospital environment and in the post-discharge period. It has been shown that patients who are mobilized early in a safe and practical manner have advantages in the face of the disease. This behavior helps to reduce muscle weakness acquired through immobility in bed and enables faster functional recovery, shorter weaning and shorter hospital and intensive care stays.

No abstract