Effect of Oral Nutritional Supplementation With and Without Exercise on Nutritional Status and Physical Function of Adult Hemodialysis Patients: A Parallel Controlled Clinical Trial (AVANTE-HEMO Study)

Martín-Alemañy, Geovana; Espinosa-Cuevas, Ángeles; Pérez-Navarro, Monserrat; Wilund, Kenneth R.; Miranda-Alatriste, Paola; Cortes-Pérez, Mario; García-Villalobos, Gloria; Gómez-Guerrero, Irma; Cantú-Quintanilla, Guillermo; Ramírez-Mendoza, Marcelo; Valdez-Ortiz, Rafael

doi:10.1053/j.jrn.2019.06.010

Cited by 31 publications

(51 citation statements)

References 41 publications

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“…Combined interventions, such as nutritional supplementation and exercise, offer strategies to improve muscle strength and physical function. Martin-Alemañy et al [ 41 ] showed that the combination of oral nutritional supplementation with aerobic or resistance intradialytic exercise had better effects on physical function than supplementation alone in young HD patients. Due to the association of vitamin D status with muscle health and the high prevalence of vitamin D deficiency in CKD, Olvera-Soto et al [ 42 ] added cholecalciferol supplements to a resistance exercise program intervention in stage 4 CKD patients.…”

Section: Discussionmentioning

confidence: 99%

Age, diabetes mellitus, and dialysis modality are associated with risk of poor muscle strength and physical function in hemodialysis and peritoneal dialysis patients

Silva

Antônio

Reis

et al. 2021

Kidney Res Clin Pract

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Background: Due to the poor outcomes associated with the impairment of physical function and muscle strength in patients on maintenance dialysis, it is important to understand the factors that may influence physical function and muscle strength. The aim of this study was to explore the factors associated with physical function in hemodialysis and peritoneal dialysis patients. Methods: Patients with chronic kidney disease on dialysis for at least 3 months, aged 18 years old or above, were enrolled. Physical function was assessed by handgrip strength, gait and sit-to-stand tests, and the Short Physical Performance Battery (SPPB). Clinical and laboratory data were collected to verify the association with physical function parameters through binary logistic regression. Results: One-hundred ninety patients on maintenance dialysis were included; 140 patients (73.7%) on hemodialysis and 50 (26.3%) on peritoneal dialysis. The mean age was 57.3 ± 14.9 years, 109 (57.4%) were male, and 87 (45.8%) were older than 60 years. The median SPPB was 8.0 points (6.0-10.0 points) and the mean ± standard deviation of handgrip strength was 24.7 ± 12.2 kg. Binary logistic regression showed that age, type of renal replacement therapy, diabetes mellitus, and serum creatinine were significantly associated with both higher 4-meter gait test times and lower SPPB scores. Only age and diabetes mellitus were associated with higher sit-to-stand test times, while age and ferritin were associated with lower handgrip strength. Conclusion: Age, diabetes mellitus, serum creatinine, and hemodialysis modality are factors related to physical function in dialysis patients.

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Section: Discussionmentioning

confidence: 99%

Age, diabetes mellitus, and dialysis modality are associated with risk of poor muscle strength and physical function in hemodialysis and peritoneal dialysis patients

Silva

Antônio

Reis

et al. 2021

Kidney Res Clin Pract

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“…Other promising anti-frailty interventions in CKD include the use of oral nutritional supplements, which were associated with significant improvements in the TUG test, 6MWT, and handgrip strength in patients on dialysis, 148 and better management of anemia. 149 Although metabolic acidosis is a potential contributor to frailty in CKD, in an interventional study, sodium bicarbonate tablets had no impact on Short Physical Performance Battery scores in CKD patients with metabolic acidosis.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Frailty in CKD and Transplantation

Lorenz

Kennedy

Rule

et al. 2021

Kidney International Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…We have identified only one study that prescribed RE intervention with vitamin D (non‐RCT) 68 and four studies prescribing RE with high‐protein ONS; two of which are RCTs 69,70 and two are non‐RCTs 71,72 . RE plus vitamin D examined effects in non‐dialysis CKD Stage 4 patients 68 while RE plus ONS were prescribed in dialysis patients only because high‐protein ONS is contraindicated in non‐dialysis patients 69–72 . Mean sample size of included studies is 32 (±6.7 SD ) while median duration of intervention is 12 weeks (range 12–24).…”

Section: Resistance Exercise Plus Nutritional Interventionsmentioning

confidence: 99%

“…Mean sample size of included studies is 32 (±6.7 SD ) while median duration of intervention is 12 weeks (range 12–24). All five studies investigated outcome in population <65 years of age 68–72 . Heterogeneity is evident in both the type of exercise and the nutrition interventions specifically protein content of prescribed ONS (median 39.2 g/week; range 28.4–199.2) 69–72 .…”

Section: Resistance Exercise Plus Nutritional Interventionsmentioning

confidence: 99%

Resistance exercise and nutritional interventions for augmenting sarcopenia outcomes in chronic kidney disease: a narrative review

Noor

Reid

Slee

2021

J cachexia sarcopenia muscle

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Sarcopenia is an age‐related progressive muscle disease characterized by loss of muscle mass, muscle strength and physical performance with high prevalence in chronic kidney disease (CKD). CKD is associated with decreased muscle protein synthesis and muscle breakdown due to a number of factors including, the uremic inflammatory environment of the disease. CKD patients are highly sedentary and at risk of malnutrition which may exacerbate sarcopenia outcomes even further. Short and long‐term exercise and nutritional interventions have been studied and found to have some positive effects on sarcopenia measures in CKD. This narrative review summarized evidence between 2010 and 2020 of resistance exercise (RE) alone or combined with nutritional interventions for improving sarcopenia outcomes in CKD. Due to lack of CKD‐specific sarcopenia measures, the second European Working Group on Sarcopenia in Older People (EWGSOP2) definition has been used to guide the selection of the studies. The literature search identified 14 resistance exercise‐based studies and 5 nutrition plus RE interventional studies. Muscle strength outcomes were increased with longer intervention duration, intervention supervision, and high participant adherence. Data also suggested that CKD patients may require increased RE intensity and progressive loading to obtain detectable results in muscle mass. Unlike muscle strength and muscle mass, physical performance was readily improved by all types of exercise in long or short‐term interventions. Four studies used RE with high‐protein nutritional supplementation. These showed significant benefits on muscle strength and physical performance in dialysis patients while non‐significant results were found in muscle mass. More research is needed to confirm if a combination of RE and vitamin D supplementation could act synergistically to improve muscle strength in CKD. The current evidence on progressive RE for sarcopenia in CKD is encouraging; however, real‐life applications in clinical settings are still very limited. A multidisciplinary patient‐centred approach with regular follow‐up may be most beneficial due to the complexity of sarcopenia in CKD. Long‐term randomized control trials are needed to verify optimal RE prescription and explore safety and efficacy of other nutritional interventions in CKD.

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Effect of Oral Nutritional Supplementation With and Without Exercise on Nutritional Status and Physical Function of Adult Hemodialysis Patients: A Parallel Controlled Clinical Trial (AVANTE-HEMO Study)

Cited by 31 publications

References 41 publications

Age, diabetes mellitus, and dialysis modality are associated with risk of poor muscle strength and physical function in hemodialysis and peritoneal dialysis patients

Age, diabetes mellitus, and dialysis modality are associated with risk of poor muscle strength and physical function in hemodialysis and peritoneal dialysis patients

Frailty in CKD and Transplantation

Resistance exercise and nutritional interventions for augmenting sarcopenia outcomes in chronic kidney disease: a narrative review

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