Effects of daily inspiratory muscle training on respiratory muscle strength and chest wall regional volumes in haemodialysis patients: a randomised clinical trial

Abstract

www.ClinicalTrials.gov ; study number: NCT02599987; name of trial registry: IMT in Patients with End-stage Renal Disease. Implications for rehabilitation Muscular impairment in chronic kidney disease patients results from a series of common alterations, affecting respiratory muscles. Patients with chronic kidney disease have low values of diaphragmatic thickness. The daily inspiratory muscle training (IMT) or breathing exercise over a period of 8 weeks provided increased respiratory muscle strength. The daily inspiratory muscle training presented a change in tri-compartment distribution of lung volume compared to the sham group, with increased inspiratory capacity of the pulmonary rib cage.

Exercise interventions for improving objective physical function in patients with end-stage kidney disease on dialysis: a systematic review and meta-analysis

“…Selection bias. Because it was a requirement of the review that included studies be RCTs, most studies had adequate randomization or participant allocation (12,14,16,18,23,41,45,50,55,60,62,74,76,77,81,84,90,92). Concealment of the randomization method was described in only 18 of the included studies (12,14,16,18,23,41,45,50,53,55,60,62,74,76,77,81,84,92).…”

“…Because it was a requirement of the review that included studies be RCTs, most studies had adequate randomization or participant allocation (12,14,16,18,23,41,45,50,55,60,62,74,76,77,81,84,90,92). Concealment of the randomization method was described in only 18 of the included studies (12,14,16,18,23,41,45,50,53,55,60,62,74,76,77,81,84,92). One study allocated participants to intervention or control group by dialysis shift, which appeared to provide a random representation of the whole sample, as there was no significant difference in baseline characteristics between groups (22).…”

Effect of a Home-Based Exercise Program on Indices of Physical Function and Quality of Life in Elderly Maintenance Hemodialysis Patients

“…Potential mechanisms that may explain impaired respiratory function in patients undergoing MHD include not only reduced respiratory muscle strength but also volume overload causing lung congestion and chronic inflammation underlying telomere shortening, which has been shown to lead to senescence of lung alveolar and endothelial cells [60,61]. Regular exercise has been shown to reduce the decline in pulmonary function in CKD [21,59]; in particular, studies designed specifically to strengthen the respiratory muscles have reported improved respiratory muscle strength and pulmonary function [59,[62][63][64]. Pomidori et al [65] reported improvements in respiratory muscle strength after a 6-month home walking program in MHD subjects, but no changes in FVC or FEV 1 .…”

Análise da capacidade funcional pelo Six Minute Walk Test (6MWT) em doentes renais crônicos

“…De acordo com a National Kidney Fundation, a doença renal crônica (DRC) é caracterizada por alterações na função ou estrutura renal durante 3 meses ou mais, de caráter assintomático e progressivo, levando a perda funcional dos rins, sendo necessário realizar terapia substitutiva, por meio de diálise peritoneal ou hemodiálise, estabelecendo um equilíbrio metabólico e nutricional 1,2 .…”

“…A doença renal apresenta elevadas taxas de sobrevida, entretanto, é considerada uma doença altamente intrusiva devido às complicações e restrições que podem proporcionar, juntamente com a incerteza do seu prognóstico, esses fatores são somados e potencializados devido a instabilidade familiar, pessoal e laboral no qual o doente se encontra 3,6 . A DRC apresenta 5 estágios os quais são classificados de acordo com a fase da doença e sua causa, além das anormalidades no sedimento urinário, alteração em exame de imagem renal e determinação da taxa filtração glomerular (TFG) 1,7 . A última fase, conhecida como crônica é representada com a incompatibilidade dos rins com a vida, perdendo totalmente a sua função e o controle com o meio interno, sendo necessário realizar terapia de substituição renal ou transplante, compreendendo a uma TFG inferior à 15 ml/min/1.73 m2 7 .…”