Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized controlled clinical trial

Abstract

BackgroundChronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life.Methods/DesignA prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height2; circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life.DiscussionCKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients.Trial registrationThe protocol for this study is registered with the Brazilian Registry of Clinical Trials (ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN: U1111-1127-9390 [http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/]).

Effects of inspiratory muscle training on pulmonary functions and muscle strength in sedentary hemodialysis patients

“…The current study used pressure vacuum meter to test respiratory muscle strength through measuring both PImax and PEmax that was in accordance with other studies 3 , 22 ) which reported that measuring PImax and PEmax represent the most accurate test for the detection of respiratory muscle strength. Moreover, Moreno et al 23 ) clarified that body position affects the measures of respiratory pressure in both normal and CKD patients.…”

“…Each patient was sitting comfortably in a 90-degrees position. For both measures, three attempts were recorded and the best of them was chosen 3 , 15 , 16 ) . Measuring peripheral oxygen saturation (SpO 2 ) by Finger pulse oximeter (Ana Pulse 100, Ana Wiz Ltd., UK) was positioned on the patient’s forefinger tip to measure SpO 2 .…”

“…Renal replacement therapy represents an essential treatment for about 1 million persons who have end stage renal disease (ESRD) 3 ) . End stage renal failure is rapidly propagating in both developed and developing countries 4 ) .…”

Association and interaction analysis of diabetes mellitus andSCN10Afor cardiovascular autonomic neuropathy in a Chinese population

“…The evidence shows that CAN is common in people with impaired glucose tolerance, which is associated with silent myocardial ischaemia, coronary artery disease, stroke, orthostatic hypotension, perioperative morbidity, and the limitation of exercise capacity 28 29. It seems that diabetes plays an important role in the early pathogenesis of CAN 30. Patients with DM who present with symptoms or signs suggestive of autonomic changes, such as erectile dysfunction, dizziness, resting tachycardia or exercise intolerance (dyspnoea), should be investigated and objective diagnostic tests for CAN should be performed 24 .…”

Analysis of the Synergistic Effects of Fasting Plasma Glucose and Hypertension on Cardiovascular Autonomic Neuropathy

“…Studies have provided evidence that CAN is common in persons with an impaired glucose tolerance. It seems to play an important role in the early pathogenesis of CAN [9,10]. FPG is strongly and independently associated with abnormal heart rate recovery in healthy individuals and diabetic patients [11,12].…”