Comparison of exercise responses in four ESRD treatments

描述(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，在成功移植后不久显著改善。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(包括每日短期血液透析和夜间缓慢血液透析)的兴趣与日俱增，这可以增加提供的透析量，减少尿毒症症状和体征。我们建议对4种不同方式的终末期肾病患者进行研究：常规血液透析(CHD)(3天/周，3小时/次)、低夜间血液透析(SND)、每日短期血液透析(SDD)和活体供体移植(RTX)，以评估运动的生理反应和决定因素的差异。假设每天接受血液透析治疗的患者对运动的生理反应和运动的决定因素比常规血液透析更正常，与移植接受者的生理反应相似。将进行以下测试：运动能力(VO2max)、心输出量、a-vO2差值、内皮功能(臂动脉反应性)、自主神经功能(24小时心率变异性)、肌肉血流量(多普勒小腿容积图)、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(等速肌肉试验)、氧化能力(磁共振波谱)、总体身体成分(双能X射线吸收法)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，并对不同的ESRD治疗模式进行生理学比较。还将揭示各种生理措施对运动能力的关系和贡献。这项研究的结果将对指导肾病界改进透析治疗具有重要意义，这样患者就可以被指导进行治疗，从而实现更高水平的功能，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.