gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Österreich

Functional evaluation of patients undergoing hemodialysis with chronic kidney disease

Meeting Abstract

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm128

DOI: 10.3205/11esm128, URN: urn:nbn:de:0183-11esm1282

Veröffentlicht: 24. Oktober 2011

© 2011 Novo et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The chronic kidney disease (CKD) is characterized by the loss of the kidney’s ability to eliminate toxic substances, concentrate urine and conserve electrolytes, with subsequent alteration of the remaining kidney function. The severe loss of kidney function is a first-order threat to life and requires the removal of toxic waste that cannot be debugged with sufficient effectiveness for other organ systems, as well as the restoration of an adequate volume and composition of body fluids - dialysis. If the loss of renal function is irreversible patients have two options: kidney transplant or chronic dialysis. Since 1977, with the pioneering study by Jette et al., it is well documented that patients with CKD on hemodialysis are limited in their overall physical capacity between 60 and 70% of that expected for their age, compared with healthy patients [1] and most CKD patients are sedentary [2], [1]. With this study, our main objective is to evaluate the functional status of hemodialysis patients with CKD.

Material/Methods: The study was carried out by the NorDial Clinic (Mirandela city – Portugal) in a total population of 123 patients. We met the exclusion criteria defined by the American College of Sports Medicine. Tests: anthropometric measurements, sit-to-stand, up and go, handgrip strength and blood tests. Material: Tefal scale accurate to ± 100g, metric stadiometer (Detecto D52, USA), chair of 46cm, 8 memory stopwatch with precision 1/100 seconds (Bravo, Spain), cone with 40cm, manual hydraulic dynamometer Jamar®.

Results: 60.5% of the patients of our study were men. This data is extremely variable in publications on hemodialysis. The average age of our participants is 63.46 years (women) and 61.16 years (men). But more important than biological age is the time on hemodialysis, since we know that the mortality of these patients increases in proportion to years of treatment. The men in our sample were on hemodialysis for 4.42 years and women for 6.17. In the sit-to stand 60s test both men and women were able to reach an average of more than 30 repetitions (35.76±9.66 and 32.26±8.46 respectively). These values are higher when compared with other studies [3]. It is widely reported that patients undergoing hemodialysis have marked skeletal muscle dysfunction and that this dysfunction is also observed in handgrip strength. The values found in this study (175.91±51.35N for women and 321.1±84.1 for men, both for right hand) agree with the findings in the scientific literature. Comparing men and women, we observe lower values of strength in women as showed in other studies, which is perfectly described by the metabolic and structural differences. This is an important result due to the relationship between handgrip strength and quality of life [4]. The up-and-go test is a classic test to assess the mobility and walking capacity and is strongly related to lower limb strength and balance. In our study the results of this test were 7.6±3.05s and 9.37±3.78, for men and women respectively – results slightly higher than others published in other investigations like in [5]. As it is well known, the internal milieu of hemodialysis patients suffer numerous homeostatic changes derived from many factors, making it difficult to interpret analytical results, comparing men and women. Anyway, we found no baseline differences in the data published by other researchers relating to hemoglobin and hematocrit, since there is a consensus on the minimum tolerable to keep these patients through the dosage of erythropoietin.

Conclusion: a) The anthropometrics results of our patients are similar to other publications.

b) The overall functional capacity of our patients is lower than healthy population.

c) The overall functional capacity of our patients is higher than shown by other studies.


References

1.
Johansen KL, Chertow GM, Ng AV, Mulligan K, Carey S, Schoenfeld PY, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int. 2000;57(6):2564-70.
2.
Painter P, Carlson L, Carey S, Paul SM, Myll J. Low-functioning hemodialysis patients improve with exercise training. Am J Kidney Dis. 2000;36(3):600-8.
3.
McIntyre CW, Selby NM, Sigrist M, Pearce LE, Mercer TH, Naish PF. Patients receiving maintenance dialysis have more severe functionally significant skeletal muscle wasting than patients with dialysis-independent chronic kidney disease. Nephrol Dial Transplant. 2006;21(8):2210-6.
4.
Hsieh RL, Lee WC, Chang CH. Maximal cardiovascular fitness and its correlates in ambulatory hemodialysis patients. Am J Kidney Dis. 2006;48(1):21-7.
5.
Jamal SA, Leiter RE, Jassal V, Hamilton CJ, Bauer DC. Impaired muscle strength is associated with fractures in hemodialysis patients. Osteoporos Int. 2006;17(9):1390-7.