Physical Activity in End-Stage Renal Disease Patients: The Effects of Starting Dialysis in the First 6 Months after the Transition Period

Abstract

Objectives: Physical inactivity in end-stage renal disease (ESRD) patients is associated with increased mortality, and might be related to abnormalities in body composition (BC) and physical performance. It is uncertain to what extent starting dialysis influences the effects of ESRD on physical activity (PA). This study aimed to compare PA and physical performance between stage 5 chronic kidney disease (CKD-5) non-dialysis and dialysis patients, and healthy controls, to assess alterations in PA during the transition from CKD-5 non-dialysis to dialysis, and to relate PA to BC. Methods: For the cross-sectional analyses 44 CKD-5 non-dialysis patients, 29 dialysis patients, and 20 healthy controls were included. PA was measured by the SenseWear™ pro3. Also, the walking speed and handgrip strength (HGS) were measured. BC was measured by the Body Composition Monitor©. Longitudinally, these parameters were assessed in 42 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before the start of dialysis and 6 months thereafter. Results: PA was significantly lower in CKD-5 non-dialysis patients as compared to that in healthy controls but not as compared to that in dialysis patients. HGS was significantly lower in dialysis patients as compared to that in healthy controls. Walking speed was significantly lower in CKD-5 non-dialysis patients as compared to that in healthy controls but not as compared to that in dialysis patients. Six months after starting dialysis, activity related energy expenditure (AEE) and walking speed significantly increased. Conclusions: PA is already lower in CKD-5 non-dialysis patients as compared to that in healthy controls and does not differ from that of dialysis patients. However, the transition phase from CKD-5 non-dialysis to dialysis is associated only with a modest improvement in AEE.

Patients receiving dialysis do not have increased energy needs compared with healthy adults

“…Three of these studies found no significant difference in REE between patients receiving dialysis and healthy controls (p > 0.05) as shown in Figure . One study mentioned in Table , found TEE to be significantly lower (p < 0.05) in both patients with chronic kidney disease (CKD) stage 5 not on dialysis and patients receiving dialysis compared with healthy adults (Broers et al ). The studies in Table assessed REE once in all subjects.…”

“…Fatigue is often accompanied by long‐term dialysis treatment, but it is unclear from the studies in Table as to why patients receiving dialysis are not engaging in more physical activity (Broers et al . ).…”

Three compartment bioimpedance spectroscopy in the nutritional assessment and the outcome of patients with advanced or end stage kidney disease: What have we learned so far?

“…In addition, a study of Chen et al already showed the added value of measuring LTI with the BCM as a screening tool for nutritional status, given the fact that low LTI as a marker of protein wasting, is seen as the primary component of PEW . It is of importance to realize that abnormalities in body composition are part of a wider, but only partly overlapping spectrum, including physical inactivity, a reduction in muscle strength, and a reduction in health‐related quality of life in which the latter may surpass a reduction of muscle mass in the prediction of outcome . Indeed, recent guidelines on sarcopenia recommend to include combined assessments of muscle mass, muscle strength, and physical performance .…”

Actividad física y calidad de vida en personas con enfermedad renal crónica

“…Qiu y cols 27 reportaron que la AF tiene beneficios entre las personas enfermas y mejora el consumo máximo de oxígeno, por lo tanto, el ejercicio físico puede ayudar a los pacientes en su función física y capacidad aeróbica restaurando su funcionamiento. Broers y cols 28 indicaron que los parámetros de AF fueron más bajos en pacientes con tiempo de diálisis menor o igual a 6 meses, lo cual es un rango distintivo de inactividad física; observaron cambios en el gasto energético relacionado con la actividad en los primeros seis meses de haber iniciado el tratamiento de diálisis y la velocidad para caminar aumentó de manera significativa con el paso del tiempo. Esto permite indicar la necesidad de intervenciones de entrenamiento físico conjuntas al tratamiento sustitutivo, para incrementar los parámetros de AF antes y después de iniciar la diálisis.…”