ANABOLIC STEROIDS AND EXERCISE IN HEMODIALYSIS

联邦政府资助的终末期肾病计划于1972年启动，目的是延长肾病患者的生命，并允许他们重返劳动力大军。尽管透析延长了终末期肾病患者的生命，但它并没有产生预期的职业和身体康复程度。最近的一项研究表明，超过三分之一的血液透析患者的卡诺夫斯基评分低于70，这意味着他们无法在没有帮助的情况下进行正常的日常生活活动。对这种惊人虚弱的原因的调查一直有限，但肌肉萎缩和随之而来的虚弱可能是原因之一。在这一人群中，瘦体重(LBM)减少和肌肉无力已被证明。由于肌肉力量与老年受试者的步速等表现指标相关，透析患者LBM的减少可能会影响功能状态，而旨在增加肌肉大小和力量的治疗可能对这些人有利。合成类固醇治疗和抗阻运动训练(RE)都能增加健康受试者的力量和肌肉质量。Re还改善了虚弱老年受试者的功能状态。虽然还没有关于RE对透析患者的影响的报道，但我们最近发现，19-去甲睾酮衍生物--去甲睾酮(ND)可以增加透析患者的LBM，并改善患者的步行和爬楼梯时间。此外，新城疫在这一人群中是安全的，只会导致偶尔的轻微副作用。在目前的应用中，我们建议同时执行两项研究。其中，为了阐明透析患者肌肉缺陷的机制，健康对照组和透析患者将接受体力活动水平、肌肉大小、力量和氧化能力的测量。在第二项研究中，我们将确定RE和/或合成类固醇是否可以增加血液透析患者的肌肉大小，改善肌肉力量和体能。在一项为期12周的研究中，80名血液透析患者将被随机分配到以下4组中的一组：ND组，每周注射ND；EX组，抗阻运动训练+安慰剂注射；ND-EX组，ND注射+RE；PL组，仅注射安慰剂。

The federally-funded End Stage Renal Disease program was initiated in 1972 with the goal of extending the lives of individuals with kidney disease and allowing them to return to the work force. Though dialysis has prolonged the lives of patients with ESRD, it has not produced the expected degree of occupational and physical rehabilitation. A recent study showed that more than one third of hemodialysis patients had a Karnofsky score below 70, meaning that they were unable to perform the normal activities of daily living without assistance. Investigation into the causes of this striking debility has been limited, but muscle atrophy and concomitant weakness probably contribute. Reduced lean body mass (LBM) and muscle weakness have been demonstrated in this population. Since muscle strength correlates with performance measures such as gait speed in elderly subjects, the reduction in LBM in dialysis patients may affect functional status, and treatments designed to increase muscle size and strength could be of benefit to such individuals. Both anabolic steroid treatment and resistance exercise training (RE) increase strength and muscle mass in healthy subjects. RE also resulted in improved functional status in frail elderly subjects. While there have been no reports of the effects of RE in patients on dialysis, we recently showed that nandrolone decanoate (ND), a 19-nortestosterone derivative, increased LBM and improved walking and stair-climbing time in patients on dialysis. Furthermore, ND was safe in this population and resulted in only occasional mild side effects. In the current application, we propose to perform two studies concurrently. In one, to elucidate the mechanisms of the muscle defects of dialysis patients, healthy control subjects and patients on dialysis will undergo measurement of physical activity levels, and of muscle size, strength, and oxidative capacity. In the second, we will determine whether RE and/or anabolic steroids can increase muscle size and improve muscle strength and physical performance in patients on hemodialysis. In a 12-week study, 80 hemodialysis patients will be randomly assigned to one of 4 groups as follows: ND, weekly ND injections; EX, resistance exercise training plus placebo injections; ND-EX, ND injections plus RE; and PL, placebo injections only.