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Background Hypermetabolism is theorized in patients diagnosed with chronic kidney disease (CKD) on maintenance hemodialysis (MHD). We aimed to distinguish key disease-specific determinants of resting energy expenditure that can be used to create a predictive energy equation that more precisely establishes energy needs with the intent of preventing protein-energy wasting. Materials and Methods For this three-year, multi-site, cross-sectional study (N=116), eligible participants were diagnosed with CKD and on MHD for at least three months. Predictors for the model included weight, sex, age, c-reactive protein (CRP), glycosylated hemoglobin (A1C), and serum creatinine (SCr). The outcome variable was measured resting energy expenditure (mREE). Regression modeling was used to generate predictive formulas and Bland-Altman analyses to evaluate accuracy. Results The majority were male (60.3%), black (81.0%), non-Hispanic (76.7%) and 23% were 65 years or older. After screening for multi-collinearity, the best predictive model of mREE (R2=0.67) included weight, age, sex, and CRP. Two alternative models with acceptable predictability (R2=0.66) were derived with A1C or SCr. Using Bland-Altman analyses, the Maintenance Hemodialysis Equation with CRP included had the best precision with the highest proportion of participants’ predicted energy expenditure classified as accurate (61.2%) and the lowest number of individuals with under- or over-estimation. Conclusions This study confirms disease-specific factors as key determinants of mREE in patients on MHD and provides a preliminary predictive energy equation. Further prospective research is necessary in order to test the reliability and validity of this equation across diverse populations of patients on MHD.

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Background: This pilot study determined the feasibility of a specifically designed 8-week yoga program for people with moderate multiple sclerosis (MS)-related disability. We explored the program's effect on quality of life (QOL) and physical and mental performance. Methods:We used a single-group design with repeated measurements at baseline, postintervention, and 8-week follow-up. Feasibility was examined through cost, recruitment, retention, attendance, and safety. Maximizing physical function and quality of life (QOL) is of paramount importance for the person with multiple sclerosis (MS). Disease progression, severity, and signs and symptoms are unpredictable and vary between people. 1 People with MS may experience fatigue, asthenia, balance and mobility loss, depression, and decreased cognitive function. 2 The QOL is impaired in individuals with MS owing International Journal of MS Care 31Yoga for MS vention models. In general, yoga activities vary widely between types and between instructors within types. More importantly, there is a lack of programs tailored to the needs of people with MS that are scalable to accommodate differing levels and types of disability. Recognizing this limitation, we created a standardized, integrative yoga program for people with moderate MS-related disability through a modified Delphi process. 13 Delphi panel participants included people with MS, certified yoga instructors with experience teaching people with MS, and health-care professionals and researchers with experience and expertise in MS care or yoga. This resulted in a comprehensive program specifically designed to address the needs of people with moderate MS-related disability. Details of this process have been presented elsewhere. 14 The program was designed with scalable difficulty to meet the heterogeneous capabilities of a sample of people with moderate MS-related disability while maximizing program standardization. The first objective of this study was to examine the feasibility of the specifically designed yoga program in people with moderate MS-related disability. The second objective was to examine the immediate and lasting effects of the program on function, activity, and participation. Methods DesignWe conducted a single-group pilot study, approved by the Rutgers University-Newark institutional review board, to assess the safety, feasibility, and effects of a specifically designed yoga program on QOL, physical performance, and mental performance in people with moderate MS-related disability. Repeated measures were obtained at three time points: baseline, after 8 weeks of yoga classes (postintervention), and again 8 weeks later (follow-up). Weekly home practice tracking forms were completed throughout the study.