Combining intra-dialytic exercise and nutritional supplementation in malnourished older haemodialysis patients: Towards better quality of life and autonomy

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• 作者：Dan Hristea ; Thibault Deschamps ; Anne Paris ; Gaë ; lle Lefranç ; ois ; Valé ; rie Collet ; Corneliu Savoiu ; Sophie Ozenne ; Sté ; phanie Coupel ; Angelo Testa and Justine Magnard
• 刊名：Nephrology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：21
• 期：9
• 页码：785-790
• 全文大小：459K
• ISSN：1440-1797

文摘

Protein-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 (G_N-Ex, n = 10) or Nutrition group (G_N, n = 11). Both groups received nutritional supplements in order to reach recommended protein and energy intake goals. In addition G_N-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 G_N-Ex, as evidenced by a significant improvement in the 6-min walk test (+22%), the absence of decline in balance (unlike the G_N), 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.