This article reviews the literature addressing exercise programs for dialysis patients to identify elements necessary for sustaining exercise programs in this population. Literature searches for publications (January 1980-February 2009) in Medline (OVID), PubMed, CINAHL (EBSCO), EBSCOhost EJS, ProQuest Central, Web of Science, Cochrane Library, Google Scholar, ScienceDirect, SpringerLink (Kluwer), and Wiley Interscience (Blackwell) were performed. Reference lists from relevant articles were hand-searched for further publications. Criteria for inclusion included full-text primary research and review articles focused on exercise for adult hemodialysis patients. One hundred and seventy one publications were found with a primary focus on exercise in hemodialysis. Of these, 28 primary research and 14 review articles addressed one or more aspects of sustainability of hemodialysis exercise programs. Factors contributing to sustainable exercise programs included: dedicated exercise professionals; encouragement to exercise intradialytically; dialysis and medical staff commitment; adequate physical requirements of equipment and space; interesting and stimulating; cost implications need to be addressed; exercise is not for everyone; requires individual prescription; and there is no age barrier to exercise on hemodialysis.
The development of a structured exercise programme can improve quality of life, physical functioning, PO4 levels and urea clearances of dialysis patients.
The tool was more sensitive and specific than the NST previously reported by the same investigators. The tool is particularly specific in that it screens those patients not requiring dietitian intervention. The use of this tool may benefit HD units that do not have on-site or regular dietetic support to prioritize patients needing dietitian intervention.
SUMMARY
The purpose of the study was to pilot a nurse‐performed nutritional screening tool (NST) for dialysis patients in order to identify nutritionally at‐risk patients.
Haemodialysis (HD) patients are at risk of nutritional‐related problems. Nutritional screening by nurses may assist in the early recognition of and response to these problems.
An NST was developed using 9 screening parameters. (BMI, weight change, poor appetite, GI symptoms, albumin, pre‐dialysis urea, K+, PO4++, HbA1c). The NST was compared with Standard Dietitian Assessment (SDA).
44 HD patients were screened with the NST and then with SDA.
The tool showed sensitivity of 0.7 (95%Cl+/‐0.21) and a specificity of 0.77 (95%Cl+/‐0.16).
Reliability was low (alpha =.18). Alpha increased to 0.32 if pre‐dialysis urea was removed from the tool and increased to 0.48 if weight loss, appetite, K+ and PO4++ were used alone.
The pilot study showed a low reliability of the NST compared with SDA. With further analysis and modifications, the NST has the potential to assist nutritional screening by nurses in dialysis centres that have limited dietetic access.
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