Six-minute walk test in dialysis population hasn't been consistently evaluated for the isolated impact of renal failure and other predictive factors. We measured six-minute walk distance in patients ...representative for low level of comorbidity and searched for potentially modifiable predictive factors of performance and dyspnea.
This was a cross-sectional study with hemodialysis patients (N = 90) and control subjects (N = 140).
six-minute walk test distance and dyspnea severity using the 10-item Borg scale.
Median distance decreased from 600m below the 6th decade to 420m in the 8th decade of age. Dialysis dependence predicted 101.5m shorter distance in the adjusted model that explained 70% of variability in results. Adjusted for significant covariates of age, height and spontaneous gait speed, fat mass (but not lean body mass) and serum total iron binding capacity were significantly associated with distance (95% CI for B coefficients -4.6 to -1.4 m/kg and 0.1 to 5 m/μmol/l, respectively). Serum total iron binding capacity as an explanatory variable was superior to C-reactive protein and albumin. Dialysis dependence, odds ratio (OR) 2.97 (1.11-7.94), spontaneous gait speed, OR 0.08 (0.02-0.41), rate-pressure product, OR 1.15 (1.08-1.23) and hemoglobin, OR 0.95 (0.92-0.98) predicted dyspnea in the adjusted model.
Renal failure without the confounding effect of comorbidity is a significant negative predictor of performance at six-minute walk test and perceived level of dyspnea. Body fat mass and serum total iron binding capacity are the main potentially modifiable predictors of performance, total iron binding capacity being superior to C-reactive protein and albumin. Although hemoglobin is not associated with test performance, it negatively predicts perceived shortness of breath.
Uric Acid and Plant-Based Nutrition Jakše, Boštjan; Jakše, Barbara; Pajek, Maja ...
Nutrients,
07/2019, Letnik:
11, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Plant-based diets (PBDs) are associated with decreased risk of morbidity and mortality associated with important noncommunicable chronic diseases. Similar to animal-based food sources (e.g
, meat, ...fish, and animal visceral organs), some plant-based food sources (e.g
, certain soy legume products, sea vegetables, and brassica vegetables) also contain a high purine load. Suboptimally designed PBDs might consequently be associated with increased uric acid levels and gout development. Here, we review the available data on this topic, with a great majority of studies showing reduced risk of hyperuricemia and gout with vegetarian (especially lacto-vegetarian) PBDs. Additionally, type of ingested purines, fiber, vitamin C, and certain lifestyle factors work in concordance to reduce uric acid generation in PBDs. Recent limited data show that even with an exclusive PBD, uric acid concentrations remain in the normal range in short- and long-term dieters. The reasonable consumption of plant foods with a higher purine content as a part of PBDs may therefore be safely tolerated in normouricemic individuals, but additional data is needed in hyperuricemic individuals, especially those with chronic kidney disease.
Summary Background & aims Physical performance deficits in kidney failure predict mortality and quality of life. We aimed to quantify deficits in multiple motor abilities, investigate associations of ...lean and fat tissue content with test results and analyzed performance of sarcopenic individuals with adipose tissue excess. Methods Ninety hemodialysis patients and 140 healthy controls performed 6-minute walk test, gait speed measurement, sit-to-stand and time up and go tests, upper extremity handgrip and tapping tests, Stork balance and forward bend flexibility tests. Human Activity Profile questionnaire was used to assess habitual activity. Body composition was measured by bioimpedance analysis. Results Relative performance deficit of dialysis patients in age, sex, height and comorbidity adjusted estimated marginal means was largest for balance and flexibility (−52 and −33%), followed by lower extremity deficits in sit-to-stand, time up and go and 6-minute walk tests (−29, −19 and −15%, respectively), p < 0.05 for all comparisons. Upper extremity performance was less affected. Lean tissue index associated significantly positively with five and fat tissue index associated significantly negatively with two out of nine tests. Sarcopenic overweight and obese individuals exhibited significant deficits mainly in lower extremity tests with worse composite lower extremity score when compared to other categories of body composition. Conclusions Patients with hemodialysis treated kidney failure have largest functional deficits in balance, flexibility and lower extremity functions. Lean and fat mass associate oppositely with physical performance measures and individuals at unfavorable extremes of these indices express significantly impaired lower extremity functions.
Objective. To document the effect of a diet free from animal-sourced nutrients on body composition indices. Methods. This was a nonrandomized interventional (n=241)-control (n=84) trial with a ...10-week, low-fat, plant-based diet supplemented with two daily meal replacements. The meals were allowed to be eaten to full satiety without prespecified calorie restrictions. Control subjects received weekly lectures on the rationale and expected benefits of plant-based nutrition. Body composition indices were measured with bioimpedance analysis. Results. Relative to controls, in cases, postintervention body fat percentage was reduced by 4.3 (95% CI 4.1–4.6)% points (a relative decrement of −13.4%), visceral fat by 1.6 (95% CI 1.5–1.7) fat cross-sectional surface units, and weight by 5.6 kg (95% CI 5.2–6), while muscle mass was reduced by 0.3 kg (95% CI 0.06–0.5) with a relative increase of muscle mass percentage of 4.2 (3.9–4.4)% points. Analysis of covariance showed significantly larger adjusted fat reductions in cases compared to controls. Late follow-up revealed further weight loss in 60% of cases and no significant change in controls. Conclusions. Low-fat, plant-based diet in free-living nonresidential conditions eaten ad libitum enables significant and meaningful body fat reductions with relative preservation of muscle mass. This trial is registered with NCT02906072, ClinicalTrials.gov.
The prevalence of cognitive impairment in hemodialysis (HD) patients is extremely high. Despite the well-documented benefits of interventions on cognitive function, there is a widespread call for ...effective strategies that will show the long-term consequences in patients undergoing dialysis. The aim of this research protocol was to investigate the effect of cognitive training combined with physical exercise on cognitive function, physical performance, and frailty indicators in the HD population. We will conduct a randomized controlled intervention trial to examine the effects of a combined non-pharmacological intervention in the form of intradialytic physical exercise and intradialytic cognitive training on cognitive function, indicators of frailty, and physical performance measures in HD patients. The group of patients receiving the study intervention will be compared to the control group receiving standard HD care. The duration of the intervention will be 12 weeks. We will use sensitive instruments (cognitive domain tests) to assess cognitive functions. The primary outcome of the study at 12 weeks will be performance on the Alertness subtest of the computerized Test of Attentional Performance. Secondary study outcomes are: Performance in other domains of cognitive function (executive function, psychomotor speed, information processing efficiency, working memory, and attention), physical fitness (10 repetition sit-to-stand test, timed up and go test, handgrip strength test, spontaneous gait speed, and stork balance test), and assessment of frailty (Edmonton Frail Scale). Study outcomes will be assessed at baseline, immediately after the 12-week intervention, and 6 months after the end of the study without specific further intervention (retention effect assessment). This study will be among the first to test the synergistic effects of a uniquely designed physical exercise and cognitive training intervention on functional status in HD patients. We believe our results will contribute to dementia prevention research by demonstrating the long-term efficacy of our combined intervention.
ClinicalTrials.Gov, NCT05150444.
Introduction. Serum creatinine concentration is an important uremic marker and predictor of survival in dialysis patients. This cross-sectional case-control study was made to quantitatively describe ...the relation between lean body mass (LBM), physical performance measures, and serum creatinine values. Methods. Ninety hemodialysis patients and 106 controls were measured by bioimpedance spectroscopy, handgrip strength, sit-to-stand test, and biochemical serum tests. Univariate and multivariate general linear models were used to analyze quantitative relations. Results. At univariate regression LBM accounted for 13.6% variability of serum creatinine concentration. In adjusted analyses with age, height, and body mass, LBM persisted as the only significant predictor of midweek predialysis serum creatinine concentration. Physical performance measures handgrip strength and sit-to-stand performance did not improve prediction of serum creatinine. With addition of serum urea concentration and residual diuresis the predictive value of the regression model improved to account for 45% of serum creatinine variability. Each kg of LBM was associated with 7.7 μmol/l increase in creatinine concentration (95% CI 3.4-12.1, p=0.001). Conclusion. Bioimpedance derived LBM has a significant linear relation with predialysis serum creatinine concentrations. Hereby described quantitative relation should help clinicians to better evaluate observed creatinine concentrations of hemodialysis patients when bioimpedance derived LBM is available.
Intradialytic cycling is a widely used workout mode, whereas added benefit of other exercise modalities remains unknown. This is the first randomised controlled trial on the effects and ...sustainability of functional training and counselling in addition to intradialytic cycling. Patients were randomly assigned to a kinesiologist-guided functional training in addition to intradialytic cycling (n = 20, experimental group) or intradialytic cycling only (n = 20, control group) over 16 weeks. The experimental group attended predialysis functional exercise in the first eight weeks and afterward performed functional training at home for the next eight weeks. The primary study endpoint was 10-repetition-sit-to-stand test time at eight weeks: at this test, the experimental group improved significantly better than controls (-4.5 ± 1.9 s, 95%CI -8.4 to -0.7; P = 0.021), which was maintained at week 16 (-4.7 ± 2.1 s, 95%CI -9.0 to -0.3; P = 0.037). At week 8, the experimental group significantly outperformed controls also at handgrip strength (P = 0.004), lower body flexibility test (P < 0.001), balance test (P < 0.001), and upper body flexibility test (P = 0.003). At week 16, superior results of the experimental group in secondary end-points remained preserved for handgrip strength, balance, and upper body flexibility tests. Functional training with exercise counselling meaningfully improves physical performance and successfully prepares patients for sustainable home exercise.
Thermal imaging is used in various fields of industry and research to measure temperature and its possible differences. Since there is a lack of research and literature on palm temperatures and ...prevention of blisters on hands, our question was how palm temperature differs in human hands after different loads (Hang and Swing in Hang) for 30 s on a high bar. Thirty-eight students from the Faculty of Sport at the University of Ljubljana were measured with a high-quality thermal imaging camera. Palm temperatures were measured before the load was applied, immediately after and every 30 s for a period of 5 min after the load. Each hand was divided into nine different regions of interest (ROIs). Mean (XA), standard deviation (SD), maximum and minimum, and number of pixels were calculated. We found that there was no difference between the left and right hand. The temperature right after the load was applied decreased significantly for both loads and then increased above the level before the load was applied. After the static load, the temperature reached a constant higher level after 3 min. After the dynamic load, the temperatures continued to increase throughout the measurement period. Further investigation is needed to determine the time period in which the hand temperature reaches the temperature before the load is applied.
Vitamin D stores in dialysis patients may be associated with their muscle function and physical performance. We analyzed associations of 25-hydroxyvitamin D levels with functional test results in ...prevalent hemodialysis patients and healthy controls.
Study sample included 54 dialysis patients and 81 healthy controls who performed a 6-minute walk test, sit-to-stand test, handgrip strength measurement, and self-rated habitual adjusted activity score with Human Activity Profile questionnaire. Adjusted general linear models were used to analyze association of 25-hydroxyvitamin D levels with test results.
Serum 25-hydroxyvitamin D concentration was 73.1 ± 35.4 nmol/L in dialysis patients and 64.6 ± 22 nmol/L in controls (p = 0.12). When adjusted for age, sex, body height, spontaneous gait speed, and dialysis dependence, 25-hydroxyitamin D was significantly positively associated with 6-minute walk test result, explaining 5% of variability in walked distance (B = 0.6 m/nmol/L, p = 0.008) and 12% of variability in adjusted activity score (B = 0.1 point/nmol/L, p < 0.001). There was no significant association with handgrip strength or sit-to-stand performance in adjusted models.
Serum 25-hydroxyvitamin D levels are significantly positively associated with submaximal aerobic physical performance and habitual activity level in dialysis patients. .
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