Effects of Resistance Exercise Training and Nandrolone Decanoate on Body Composition and Muscle Function among Patients Who Receive Hemodialysis

Abstract

Patients who are on hemodialysis commonly experience muscle wasting and weakness, which have a negative effect on physical functioning and quality of life. The objective of this study was to determine whether anabolic steroid administration and resistance exercise training induce anabolic effects among patients who receive maintenance hemodialysis. A randomized 2 ؋ 2 factorial trial of anabolic steroid administration and resistance exercise training was conducted in 79 patients who were receiving maintenance hemodialysis at University of California, San Francisco-affiliated dialysis units. Interventions included double-blinded weekly nandrolone decanoate (100 mg for women; 200 mg for men) or placebo injections and lower extremity resistance exercise training for 12 wk during hemodialysis sessions three times per week using ankle weights. Primary outcomes included change in lean body mass (LBM) measured by dual-energy x-ray absorptiometry, quadriceps muscle cross-sectional area measured by magnetic resonance imaging, and knee extensor muscle strength. Secondary outcomes included changes in physical performance, self-reported physical functioning, and physical activity. Sixty-eight patients completed the study. Patients who received nandrolone decanoate increased their LBM by 3.1 ؎ 2.2 kg (P < 0.0001). Exercise did not result in a significant increase in LBM. Quadriceps muscle cross-sectional area increased in patients who were assigned to exercise (P ‫؍‬ 0.01) and to nandrolone (P < 0.0001) in an additive manner. Patients who exercised increased their strength in a training-specific fashion, and exercise was associated with an improvement in self-reported physical functioning (P ‫؍‬ 0.04 compared with nonexercising groups). Nandrolone decanoate and resistance exercise produced anabolic effects among patients who were on hemodialysis. Further studies are needed to determine whether these interventions improve survival.

Endogenous Testosterone and Mortality in Male Hemodialysis Patients

“…Even if our results indicate that testosterone is not an independent risk factor for mortality, available evidence indicates that increasing testosterone levels may improve other pathophysiologic pathways that are related to the elevated mortality risk of HD patients, such as nutritional status (35,36) and anemia (37), and further insight into the role of this hormone in men who are on HD may increase the interest of therapeutic restoration of testosterone deficiency in these patients.…”

Relationship Between Vitamin D and Muscle Size and Strength in Patients on Hemodialysis

“…Bars represent thigh muscle CSA in cm 2 , measured by magnetic resonance imaging. Subjects were categorized into two groups; those receiving either 1,25 (OH) 2 D (calcitriol), or an analog (paricalcitol) (black bar), and those who were not (light bar) at the time of baseline assessment of the NEXT study [21]. Statistical significance is * P<0.05 by ANCOVA, after adjusting for age and gender.…”

“…Subjects in this cross-sectional study were initially recruited into the NEXT (Nandrolone and Exercise Trial) Study [21]. Briefly, men and women undergoing maintenance hemodialysis three times per week at the outpatient dialysis units at San Francisco General Hospital, the UCSF-Mount Zion Medical Center, and the San Francisco VA Medical Center were eligible to participate in the study.…”

“…Two hundred and seventy-eight hemodialysis patients were screened for the NEXT study, of which one hundred and sixty were found eligible, out of which seventy-nine men and women agreed to participate [21]. Of those, 49 were receiving intravenous doses of 1,25 (OH) 2 vitamin D (calcitriol, n = 26, median dose; 3.0 mcg, min dose; 0.5 mcg -max dose; 9 mcg) or a 1,25 (OH) 2 vitamin D analog (paricalcitol, n = 23, median dose; 9 mcg, min dose; 0.5 mcg -max dose; 42 mcg) one to three times weekly.…”

Benefits of Physical Exercise in Patients with Chronic Kidney Disease and Hemodialysis: A Mini Review

“…In this sense, RE has been reported to increase mitochondrial biogenesis, which is essential for maintaining the functionality and integrity of skeletal muscle [12]. Johansen et al [13] showed how RE has anabolic effects. This study included patients on hemodialysis who received RE for 12 weeks.…”