Repercussões da insuficiência renal crônica na capacidade de exercício, estado nutricional, função pulmonar e musculatura respiratória de crianças e adolescentes

Abstract

Objective: To evaluate functional capacity, pulmonary function, respiratory musculature and nutritional status among children and adolescents with chronic renal insufficiency (CRI) undergoing conservative treatment. Methods: This study was conducted with 30 volunteers, divided into two groups: a group of children and adolescents with CRI undergoing conservative therapy (CRI Group) and a group without renal disease (Control Group). The volunteers underwent physical therapy evaluation, spirometry, strength and resistance tests on their respiratory musculature, nutritional status evaluation and functional capacity assessment. The data were analyzed using the Mann-Whitney test with a significance level of 5%. Results: The Tiffeneau index was significantly lower in the CRI Group (p= 0.003). In relation to respiratory muscle function, the maximum expiratory pressure values were lower (p= 0.010) and the time values of the resistance test were greater (p= 0.003). In the functional assessment, the variables that differed statistically were: lower distance walked (p< 0.001), greater mean arterial pressure (p< 0.001), final respiratory rate (p< 0.001) and Borg scale (p= 0.048). Regarding nutritional status, all the statistically significant variables were lower. Conclusions: Children and adolescents with CRI undergoing conservative treatment may present significantly impaired functional capacity, respiratory musculature and nutritional status.

Effect of Exercise Performed during Hemodialysis: Strength versus Aerobic

“…9 In this study, we observed that 81.2% of the 32 patients presented arterial hypertension, this result being similar to comorbidities reported by other investigators. 29,30 The cardiovascular dysfunctions of patients under HD could decrease the tolerance to exercises in 50% of the anticipated value, supposedly due to musculoskeletal catabolism and intramuscular fat accumulation; these events interfere with both types of stimulation: the sympathetic one, thus inhibiting the chronotropic effect, and the respiratory one, thus decreasing the respiratory muscular strength and the "pulmonary function."…”

“…33 However, the cause of this weakness and the grade of functional jeopardy are not clear in the literature, 34 but a relationship with uremic myopathy, carnitine deficiency, vitamin D, and excess of parathormone is suggested. 9,16,35,36 The hypotrophy of type II fibers, myofibrillar ATPase, jeopardy of energetic metabolism due to lower capacity to stimulate the pyruvate dehydrogenase activity, decrease in the utilization of fat as metabolic source, chronic inflammation with cytokine alterations, and intramuscular fat produced by dialysis are also mentioned as factors initiating muscular weakness. 7,16,29,36,37 A study emphasizes that children and teenagers with CRF already present respiratory muscular weakness with conservative treatment only, based on the hypothesis that air flow limitation results from muscular strength decrease, which could retard the contractile function of muscular fibers.…”

“…[48][49][50] Supposedly, such metabolic alterations influence the adenosine triphosphate (ATP), phosphocreatine (PCr), and glycogen concentrations, being the substrate generators of energy for muscular contraction, and able to affect the oxidative capacity. 17,29 All of these alterations affect the HD patients' perception with respect to their quality of life (QoL), which could also improve with the practice of physical exercises, 9 decreasing the tiredness and fatigue signals and symptoms, and the cramps manifested by dialysis.…”

“…5 The circulating toxins, excess of body liquid, electrolytic disturbances, nutritional alterations, as well as the inactiveness itself and the presence of inflammatory processes all contribute together, in direct or indirect manner, for the appearance of these situations, thus decreasing the patients' survival. 9,10 Studies demonstrate that exercises developed with patients subjected to hemodialysis (HD), in the first 2 h of this procedure, can present a gain in "aerobic capacity," "muscular strength," an "increase in dialysis efficiency," as well as an improvement in their "toxin clearance" and "quality of life." However, there is no consensus in the literature about which exercise program would be more indicated to be developed during HD.…”

Reference values for respiratory muscle strength in brazilian children: a review

“…Nevertheless, some authors 21,22 used predicted equations for adults, such as those proposed by Black and Hyatt 23 and Neder et al 12 , in the discussion of their studies involving pediatric patients. The clinical applicability of the equations for MRP assessment in children can be mainly observed by monitoring chronic diseases, such as neuromuscular diseases, asthma and cystic fi brosis.…”