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，在成功移植后不久显著改善。 据推测，尿毒症相关因素损害了运动过程中增加氧运输和利用所需的生理系统的正常整合。 人们越来越关注缓慢的每日血液透析（包括每日短时间血液透析和缓慢的夜间血液透析），这增加了所提供的透析并减少了尿毒症体征和症状。 我们建议研究接受4种不同方式治疗的终末期肾病患者：常规血液透析（CHD）（每周3天，每次治疗3小时），低夜间血液透析（SND），每日短时间血液透析（SDD）和活体移植（RTX），以评估对运动的生理反应和决定因素的差异。 该假设是，与常规血液透析相比，接受每日血液透析治疗的患者对运动的生理反应和运动的决定因素更正常，与移植受者相似。 将进行测试以测量以下内容：最大摄氧量（VO 2 max），心输出量，a-VO 2差值，内皮功能（肱动脉反应性），自主神经功能（24小时心率变异性），肌肉血流量（小腿体积描记术与多普勒），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）和氧化能力（磁共振光谱）、全身组成（双能X线吸收测定）和生活质量（KDQOL）。 本研究将提供尿毒症患者功能限制的新信息，并提供各种ESRD治疗模式的生理学比较。 还将揭示各种生理测量对运动能力的关系和贡献。 本研究的结果对于指导肾脏病学界改善透析治疗非常重要，因此患者可以直接接受可实现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.