Resistance Training during Maintenance Dialysis

描述(由申请人提供)： 在美国，肾衰竭的发病率正在上升，结果很差，成本也很高。终末期肾病(ESRD)在美国影响着近375,000人，每年造成超过140亿美元的损失。尽管透析和移植疗法取得了进展，但肾衰竭导致了不良的结局、不良的预后和高昂的医疗费用。营养不良和潜在的全身炎症反应在慢性肾脏疾病的过程中发展，在终末期肾病期间恶化，并导致不良后果，增加发病率和死亡率。肌肉萎缩、功能受损和生活质量差是导致肾功能衰竭患者营养不良和炎症的最重要因素。我们已经在中度慢性肾功能不全的透析前患者中表明，抗阻运动训练的合成代谢效应导致蛋白质利用率、营养状况和功能能力的显著改善，即使在厌食症和处方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终末期肾病患者开发、测试和实施渐进式阻力训练程序。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)对于终末期肾病患者来说，一种可行而安全的运动方式(在10名患者中进行了6周的可行性测试)，2)净合成代谢，其证据是：营养状况改善(即蛋白质分解代谢率、肌肉质量和肌肉力量增加)；与随机分配的对照组相比，运动训练(在20名患者/组中测试6个月的有效性期)可以降低全身炎症反应(即降低C-反应蛋白和白细胞介素6，升高血清白蛋白水平)；3)阻力训练观察到的自我报告的身体功能(即增加的SF-36身体成分评分)将与营养状况和炎症反应的改善有关。长期目标是在血液透析期间实施阻力运动训练，以克服ESRD潜在的营养不良和炎症，并改善疾病结局和预后。通过实施这种干预措施，我们希望通过与透析室工作人员的合作，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.