Dan Hristea1, Thibault Deschamps2, Anne Paris1, Gaëlle Lefrançois3, V. Collet4, C Savoiu1, S. Ozenne1, Stéphanie Coupel3, Angelo Testa3, Justine Magnard2
1Dialysis Unit Laënnec, ECHO Association Nantes France
2Laboratory MIP (UPRES-EA4334), University of Nantes, France
3Dialysis Unit Confluent, ECHO Association, Nantes, France
4Biometrics, CHU Nantes, Nantes, France
Tóm tắt
AbstractProtein‐energy wasting (PEW), defined as a loss of body protein mass and fuel reserves, is a powerful predictor of adverse outcomes in haemodialysis (HD) patients. Robust arguments suggest that intra‐dialytic exercise, combined with oral/parenteral nutrition, enhances the effect of nutritional interventions in HD patients. This pilot randomized controlled trial investigated the feasibility and the effects of a 6 month intra‐dialytic cycling program combined to a nutritional support on PEW, physical functioning (gait, balance, muscle strength) and quality of life (QoL) in older HD patients (mean age 69.7 ± 14.2 years).Twenty‐one patients fulfilling diagnostic criteria of PEW were randomly assigned to Nutrition‐Exercise group (GN‐Ex, n = 10) or Nutrition group (GN, n = 11). Both groups received nutritional supplements in order to reach recommended protein and energy intake goals. In addition GN‐Ex completed a cycling program. No significant difference between groups was found in the number of patients having reached remission of PEW. Likewise, no change was observed in serum‐albumin, ‐prealbumin, C‐reactive protein, body mass index, lean‐ and fat‐tissue index, or quadriceps force. Interestingly, we found positive effects of exercise on physical function and QoL for the GN‐Ex, as evidenced by a significant improvement in the 6‐min walk test (+22%), the absence of decline in balance (unlike the GN), and a noteworthy increase in QoL (+53%). Combining intra‐dialytic exercise and nutrition in HD patients is feasible, and well accepted, improves physical function and QoL but it appears not to have the potential to reverse PEW.
