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Insomnia severity in chronic kidney disease patients with various therapies

100%

Knezevic M. , Djordjevic V. , Bivolarevic I. , Jovic J. , Djordjević V.

Open Medicine

2012

tom 7

nr 1

112-117

The prevalence of insomnia is greater in end-stage renal disease. The aim of our study was to determine the frequency of insomnia and subclinical insomnia in patients with various dialysis therapy and kidney transplant recipients, in order to assess the severity of insomnia and examine whether there is a difference in severity among groups. In cross-sectional study, we evaluated 120 patients with terminal renal failure. Based on therapy, patients were divided into four groups: hemodiafiltration, standard bicarbonate dialysis, peritoneal dialysis and kidney transplant recipients. The severity of insomnia was evaluated through the use of the Insomnia Severity Index (ISI). Most patients who reported any kind of insomnia problems with ISI were on conventional dialysis (80%), followed by hemodiafiltration (76.7%) and peritoneal dialysis (63.3%). Transplant recipients had least difficulties with insomnia (46.7%). Insomnia Severity Index showed that insomnia in end-stage renal patients is not very severe. Most of the patients had “no clinically significant insomnia”. Our findings indicate that patients on hemodiafiltration and transplant recipients have a significantly lower score on Insomnia Severity Index. Patients with end-stage renal disease have high frequency insomnia problems. However, our study shows that insomnia in these patients is not severe. Insomnia is the most frequent and severest in patients on standard bicarbonate dialysis.

Physical training during haemodialysis: a review of subject literature

88%

Chojak-Fijałka K. , Smoleński O.

Medical Rehabilitation

2010

tom 14(3)

25-41

Wstęp: Osoby przewlekle hemodializowane mają obniżoną wydolność fizyczną. Od 30 lat podejmowane są próby rehabilitacji ruchowej tej populacji. Cel: Celem pracy jest analiza przebiegu i efektów programów treningowych prowadzonych podczas hemodializy u osób z przewlekłą chorobą nerek.Metoda: Dokonano przeglądu baz danych – Science Direct, SPORTDiscus, Medline, Academic Search Complete - przy użyciu słów kluczowych związanych z rodzajem treningu fizycznego wykonywanego w czasie hemodializy i jego efektów. Analizie poddano 26 projektów badawczych, które podzielono na 3 grupy: badania niekontrolowane typu przed-po, badania kontrolowane, badania kontrolowane z randomizacją. W dwóch pierwszych grupach zawarto po jednym badaniu z niejednorodną grupą badawczą tj. hemodializowani i dializowani otrzewnowo (HD+CAPD). Wyniki: Pacjentom proponowano różne formy treningu. Najczęściej był to trening wytrzymałościowy ciągły na cykloergometrze, do którego w kilku badaniach dodawano trening oporowy i/lub ćwiczenia koordynacyjne. W sumie we wszystkich badaniach programy treningowe ukończyło 407 pacjentów. Długość programów wahała się od 2 miesięcy do 40 miesięcy. W 16 z 26 programów trening prowadzony był w dwóch pierwszych godzinach zabiegu. W 11 projektach trwał od 30 do 90 min. Intensywność treningu wyrażano w % HRpeak z badania wysiłkowego lub za pomocą skali Borga. W wyniku przeprowadzonych programów uzyskano: poprawę wydolności fizycznej, poprawę w budowie i funkcji mięśni szkieletowych, redukcję czynników ryzyka chorób sercowo-naczyniowych, poprawę jakości życia, zwiększenie efektywności hemodializy. Autorzy nie donoszą o poważnych powikłaniach wynikających z prowadzenia treningu fizycznego w czasie hemodializy.Wnioski: Trening fizyczny podczas hemodializy jest korzystny dla pacjentów z przewlekłą chorobą nerek. Terapia ruchowa efektywnie wspomaga terapię nerkozastępczą.

Background: Individuals chronically haemodialysized have a reduced physical ability. For around 30 years attempts have been undertaken at motor rehabilitation of this population.Aim: The aim of the work is an analysis of the course and effects of training programmes conducted during haemodialysis in individuals with chronic kidney disease.Method: A review of data bases was conducted – Science Direct, SPORTDiscus, Medline, Academic Search Complete – through the application of key words connected with the type of physical training undertaken during haemodialysis and its effects. 26 research projects underwent analysis, these being divided into three groups: non-controlled research work of the ‘before-after’ type, controlled research, and controlled research with randomization. In the two first groups a single research project was included with a heterogeneous research group i.e. those subjected to peritoneal dialysis and haemodialysis (HD+CAPD).Results: Patients were offered various forms of training. The most often was continuous endurance training on a ergometer cycle, to which were added in some pieces of research resistance training and/ or coordination exercises. In total 407 patients completed the training programmes in all the tests. The length of the programmes oscillated from 2 to 40 months. In 16 of the 26 programmes the training was conducted during the first two hours of the haemodialysis treatment. In eleven projects it lasted from 30 to 90 minutes. The intensity of the training sessions was expressed in % HRpeak of the exercise test or by means of the Borg Scale. As a result of the programmes conducted an array of benefits were achieved: improvement in physical fitness, improvement in the composition and function of skeletal muscles, reduction in the factors causing cardiovascular illness risks, improvement in the quality of life, enhanced haemodialysis affectivity.Conclusions: Physical training during haemodialysis is beneficial for patients with chronic kidney disease. Movement therapy effectively helps dialysis therapy.

ADMA and C-reactive protein as mortality predictors in dialysis patients

88%

Ignjatović A. , Cvetković T. , Pavlović R. , Đorđević V. , Milošević Z. , Đorđević V. , Pavlović D. , Stojanović I. , Živanović S.

Open Medicine

2013

tom 8

nr 3

346-353

There is a higher mortality between patients with end-stage renal disease than patients in the general population. These circumstances have led to a search for risk factors as predictors of mortality in dialysis patients. Amongst those, inhibitors of the nitric-oxide (NO) synthesis deserve special attention, since patients with end-stage renal disease are also characterized by accelerated atherosclerosis. Asymmetric-dimethylarginine (ADMA) and symmetric-dimethylarginine (SDMA), as well as C-reactive protein (CRP), have also been recognized as predictors of mortality in patients on dialysis. The aim of our study was to compare the prediction power of ADMA, SDMA and CRP for all-cause mortality in patients with end stage renal disease during the fourteen month follow-up. In total 162 patients on hemodialysis were included. ADMA and SDMA were measured by the high-performance liquid chromatography (HPLC); CRP was measured using immunonephelometric assays. During the 14-month period 28 patients (34.1%) died from all-cause mortality. Using univariate analysis, hazard ratios (HR) of the potential independent predictors of mortality in hemodialysis patients were ADMA (HR 1.39 (1.01–1.91) p=0.043) and CRP (HR 1.024 (1.009–1.1.040) p=0.001). Further, multivariate analysis (MVA), however, showed that ADMA is the only predictor of all-cause mortality (HR 1.76 (1.002–3.11) P=0.049), while SDMA failed to predict death in this population. Therefore, our data shows that ADMA is an independent and better marker of all-cause mortality compared with CRP.