Comparison of exercise responses in four ESRD treatments

描述（由申请人提供）：接受常规血液透析治疗的终末期肾病（ESRD）患者的运动能力极低，在移植成功后不久显著改善。人们怀疑与尿毒症相关的因素损害了运动中增加氧气运输和利用所需的生理系统的正常整合。人们对每日缓慢血液透析（包括每日短时间血液透析和夜间缓慢血液透析）的兴趣越来越大，这增加了透析提供并减少了尿毒症体征和症状。我们建议研究接受4种不同方式治疗的ESRD患者：常规血液透析（CHD）（3天/周，3小时/次）、低夜间血液透析（SND）、短每日血液透析（SDD）和活体供体移植（RTX），以评估运动对生理反应的差异和决定因素。假设是，与传统血液透析相比，接受每日血液透析治疗的患者对运动的生理反应和运动决定因素更正常，与移植受体相似。将进行测试以测量以下内容：运动能力（VO2max）、心输出量、a- vo2差、内皮功能（肱动脉反应性）、自主功能（24小时心率变率）、肌肉血流（多普勒小腿体积脉搏图）、腿部肌肉质量（磁共振成像）、肌肉超微结构（肌肉活检分析）、肌肉功能（等速肌肉测试）、氧化能力（磁共振光谱）、全身成分（双能x线吸收仪）、和生活质量（KDQOL）。这项研究将为尿毒症患者的功能限制提供新的信息，并提供各种ESRD治疗模式的生理学比较。本文还将揭示各种生理指标对运动能力的影响及其相互关系。这项研究的结果对于指导肾脏病界改善透析治疗非常重要，这样患者就可以直接接受能够达到更高水平功能的治疗，从而可能改善康复和生活质量。

DESCRIPTION (provided by applicant): Exercise capacity is extremely low in patients with end stage renal disease (ESRD) treated with conventional hemodialysis, and improves significantly shortly after successful transplantation. It is suspected that factors associated with uremia impair the normal integration of physiological systems required for increased oxygen transport and utilization during exercise. There is growing interest in slow daily hemodialysis(both short daily hemodialysis and slow nocturnal hemodialysis), which increases the dialysis provided and reduces uremic signs and symptoms. We propose to study patients with ESRD treated with 4 different modalities: conventional hemodialysis (CHD) (3days/week, 3 hours/treatment), low nocturnal hemodialysis (SND), short daily hemodialysis (SDD) and living donor transplantation (RTX) to assess differences in physiological responses to and determinants of exercise. The hypothesis is that physiological responses to exercise and the determinants of exercise in patients treated with daily hemodialysis are more normal compared to conventional hemodialysis and similar to those of transplant recipients. Testing will be performed to measure the following: exercise capacity (VO2max), cardiac output, a-vO2difference, endothelial function (brachial artery reactivity), autonomic function (24 hour heart rate variability), muscle blood flow (calf plethysmography with doppler), leg muscle mass (magnetic resonance imaging), muscle ultrastructure (muscle biopsy analysis), muscle function (isokinetic muscle testing), and oxidative capacity (magnetic resonance spectroscopy), total body composition (dual energy x-ray absorptiomtetry), and quality of life (KDQOL). This study will provide new information on the limitations to functioning in uremic patients and provide physiological comparisons of the various ESRD treatment modes. The relationship between and contributions of the various physiological measures to exercise capacity will also be revealed. The results of this study will be important in guiding the nephrology community in improving dialysis treatments so patients can be directed into therapies that are found to achieve higher levels of functioning and thus possibly improve rehabilitation and quality of life.