Effects of a six-month intradialytic physical ACTIvity program and adequate NUTritional support on protein-energy wasting, physical functioning and quality of life in chronic hemodialysis patients: ACTINUT study protocol for a randomised controlled trial

Abstract

BackgroundProtein-energy wasting (PEW) is common in hemodialysis patients and is a powerful predictor of morbidity and mortality. Although much progress has been made in recent years in identifying the causes and pathogenesis of PEW in hemodialysis patients, actual management by nutritional interventions is not always able to correct PEW. Some investigators suggest that physical exercise may increase the anabolic effects of nutritional interventions, and therefore may have a potential to reverse PEW. The aim of this study is to investigate the effect of intra-dialytic progressive exercise training and adequate nutritional supplementation on markers of PEW, functional capacities and quality of life of adult hemodialysis patients.Methods and designFifty end-stage renal disease patients undergoing hemodialysis, who meet the diagnostic criteria for PEW, will be randomly allocated into an exercise or control group for 6 months. The exercise consists of a progressive submaximal individualized cycling exertion using an adapted cycle ergometer, during the three weekly dialysis sessions. Biological markers of nutrition (albumin, prealbumin) will be followed monthly and all patients will be assessed for body composition, walk function, muscle strength, postural stability and quality of life at baseline and during the eighth week (t+2), the sixteenth week (t+4) and the twenty-fourth week (t+6) of the 6-month adapted rehabilitation program.DiscussionThe successful completion of this current trial may give precious clues in understanding PEW and encourage nephrologists to extend prescription of exercise programs as well as therapeutic and as preventive interventions in this high-risk population.Trial registrationThe protocol for this study was registered with the France Clinical Trials Registry NCT01813851.

Body composition in chronic kidney disease

“…Thus, aerobic exercise may be a promising strategy to decrease visceral fat as well as to build muscle and improve physical functioning. In addition, an RCT of intradialytic cycling is currently underway to evaluate its effects on PEW [55]. …”

The Level of Anxiety and Depression in Dialysis Patients Undertaking Regular Physical Exercise Training - a Preliminary Study

“…The time was steadily increased while maintaining a moderate level of intensity for a minimum of 2 to 3 weeks. The final stage of rehabilitation was the accomplishment of a 35-50-minute ride on the cycle ergometer at a moderate level of intensity [30]. The exercise was carried out until reaching subjective feeling of fatigue (5-6 on the 10 -point Borg scale)…”

Rehabilitation nutrition support for a hemodialysis patient with protein-energy wasting and sarcopenic dysphagia: a case report

“…Nutritional therapies such as enteral nutrition, parenteral nutrition, and oral nutritional supplementation can be used to treat PEW [1]. A list of these studies, along with their reported nutritional outcomes, is provided in Table 1 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The studies designed to establish the benefits of nutritional supplementation on the long-term improvements in overall nutritional status in hemodialysis patients with PEW have yielded encouraging results.…”