Resistance Training during Maintenance Dialysis

描述（由申请人提供）： 在美国，肾衰竭的发病率不断上升，结果不佳，费用高昂。终末期肾病（ESRD）影响美国近375，000人，每年的费用超过140亿美元。尽管透析和移植治疗取得了进展，但肾衰竭导致不良结局、不良预后和高医疗保健成本。营养不良和潜在的全身性炎症反应在慢性肾脏疾病过程中发展，在ESRD期间恶化，并导致不良结局、发病率和死亡率增加。肌肉萎缩、功能能力受损和生活质量差是与肾衰竭中营养不良和炎症相关的最重要因素。我们已经在中度慢性肾功能不全的透析前患者中证明，抗阻运动训练的合成代谢作用导致蛋白质利用率、营养状况和功能能力的显著改善，即使在厌食和规定的低蛋白饮食的情况下也是如此。因此，我们建议在血液透析期间为ESRD患者开发、测试和实施渐进式抗阻运动常规。我们的假设是，在透析期间增加30-45分钟的抗阻运动训练将抵消肾脏疾病的负担，并将导致：1）ESRD患者可行且安全的运动方式（在10名患者中测试了6周可行性阶段）; 2）净抑制率，如以下所示：改善营养状况（即蛋白质分解率、肌肉质量和肌肉力量增加）;减少全身炎症反应（即降低的C-反应蛋白和白细胞介素-6，并增加血清白蛋白水平）与随机分配的对照组进行血液透析，但不进行运动训练（在20例患者/组中测试的6个月疗效阶段）; 3）通过阻力训练观察到的自我报告的身体功能改善（即SF-36身体成分量表增加）将与营养状态和炎症反应的改善相关。长期目标是在血液透析期间实施抗阻运动训练程序，以克服ESRD的潜在营养不良和炎症，并改善疾病结局和预后。通过实施这种干预，我们希望通过与透析单位工作人员合作，提供一种可以纳入终末期肾病患者护理标准的治疗策略。

DESCRIPTION (provided by applicant): There is a rising incidence of kidney failure in the US, with poor outcomes and high cost. End-stage renal disease (ESRD) affects almost 375,000 individuals in the US at a cost of more than $14 billion per year. Despite advances in dialysis and transplantation therapies, kidney failure leads to poor outcomes, poor prognosis and high health care costs. Malnutrition and the underlying systemic inflammatory response developed during the course of chronic kidney disease, worsen during ESRD, and leads to adverse outcomes, increased morbidity and mortality. Muscle wasting, impaired functional capacity and poor quality of life are the most important factors associated with malnutrition and inflammation in renal failure. We have shown in pre-dialysis patients with moderate chronic renal insufficiency that the anabolic effects of resistance exercise training result in significant improvements in protein utilization, nutritional status and functional capacity even in the context of anorexia and prescribed low protein diets. Thus, we propose to develop, test and implement a progressive resistance exercise routine for ESRD patients during the hemodialysis session. Our hypotheses are that the addition of 30-45 min of resistance exercise training during the dialysis session will counteract the burden of renal disease and will result in: 1) A feasible and safe exercise modality for ESRD patients (6-wk feasibility phase tested in 10 patients); 2) Net anabolism as evidenced by: improved nutritional status (i.e. increased protein catabolic rate, muscle mass and muscle strength); and reduced systemic inflammatory response (i.e. reduced C-reactive protein and interleukin-6, and increased serum albumin levels) compared to a randomly assigned control group on hemodilaysis but not exercise training (6-mo efficacy phase tested in 20 patients/group); and that 3) Improved self-reported physical function (i.e. increased SF-36 physical component scale) observed with resistance training will be associated with the improvements in nutritional status and inflammatory response. The long-term goal is to implement resistance exercise training routines during hemodialysis to overcome the underlying malnutrition and inflammation of ESRD and to improve disease outcome and prognosis. By implementing such intervention, we hope to offer a therapeutic strategy that can be incorporated to the standard of care of ESRD patients by working in conjunction with the dialysis unit staff.