Physical performance in patients treated with nocturnal hemodialysis - a systematic review of the evidence

Abstract

Background Patients treated with conventional hemodialysis have poor physical performance, explained by insufficient metabolic clearance and shortage of time by time-consuming dialysis. Nocturnal hemodialysis improves metabolic control and results in increased spare time. Our aim is to investigate whether physical performance in nocturnal hemodialysis is superior to conventional hemodialysis. Methods A systematic search was conducted in MEDLINE, Embase, CINAHL, PhycInfo and Web of Science until January 2018. Primary outcomes were physical performance, activity, strength and muscle mass in home or in-center nocturnal hemodialysis. Methodological quality was assessed with the Newcastle-Ottawa scale. Results Ten studies met the inclusion criteria, including 2 RCTs, evaluating 526 nocturnal hemodialysis patients with a mean follow-up of 15, 3 months. The methodological quality of 4 studies was limited. Physical capacity tests were done in 3 studies with different methodology: short-physical performance battery, exercise spirometry and 6-min walk test. The latter 2 showed significant improvements in physical performance. Four studies assessed lean mass using dual-energy X-ray absorptiometry (2×) and bioelectrical impedance analysis (2×), of which 1 demonstrated increased lean body and skeletal muscle mass. In 5 studies a Quality of Life questionnaire was used, of which 2 showed improved physical component score. Conclusions The evidence on the effect of nocturnal hemodialysis on physical performance is either of insufficient methodological quality or only measures isolated aspects of physical performance. As literature emphasizes the importance of physical activity on clinical outcomes, it is necessary to conduct larger studies of high methodological quality using capacity tests for answering the question whether nocturnal hemodialysis can improve physical performance of patients with end-stage renal disease. Trial registration NTR4715, Netherlands Trial Register. Registered 30 July 2014. Electronic supplementary material The online version of this article (10.1186/s12882-019-1518-4) contains supplementary material, which is available to authorized users.

Association of physical performance with cognitive impairment in middle-aged to older haemodialysis patients: a multicentre cross-sectional observational study

“… 7 Poor physical performance is associated with worse clinical outcomes and poor quality of life. 8 Current physical activity guidelines for Americans advocate for engaging in multicomponent physical activities, such as balance training, aerobic exercises and muscle strengthening, as these activities have been demonstrated to enhance cognition and reduce the risk of dementia. 9 Despite this, the relationship between physical performance and CI remains unexplored among MHD patients.…”

Nocturnal Hemodialysis Leads to Improvement in Physical Performance in Comparison with Conventional Hemodialysis

“…For example, improvements are found in left ventricular hypertrophy, hypertension, hyperphosphatemia, use of erythropoiesis-stimulating agents, hospitalization rates and survival, when comparing NHD to CHD [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. However, limited studies have investigated the effect of NHD on physical performance and showed contradictory results [ 22 ]. The frequent hemodialysis network (FHN) trial reported no improvement in physical performance in NHD patients [ 23 ].…”