End-Stage Renal Disease (ESRD): Physical Activity and Elucidation of Its Effects on Biochemical and Haematological Parameters in Haemodialysis Patients

Abstract

End-stage renal disease (ESRD) is a progressive disorder for which there is no prospect of recovery, and for which patients receive regular haemodialysis. In ESRD the ability of the kidneys to excrete metabolic waste products and to regulate the composition of extracellular fluid is compromised. Symptoms of ESRD also include cardiovascular dysfunction, anaemia, malnutrition, muscle wasting, muscle weakness, glucose intolerance and reduced bone density. Patients with ESRD are likely to be challenged by participation in exercise whilst undergoing a HD regimen. Nevertheless there is a case for prescribing exercise in patients who struggle to become active. Some benefits of exercise In patients receiving haemodialysis, the benefits of physical exercise, which include: 1) Reduction of toxins and fluid overload in the circulatory system, permitting improved tolerance to the HD regimen and 2) Increased heart rate, which improves cardiovascular performance, 3) a reduction in comorbidities and an increase in well-being, and 4) the facilitation of positive coping strategies. An understanding how exercise can be of clinical advantage in ESRD patients is unique and challenging given the variety of nutritional and clinical conditions with which they present. The haematological and biochemical parameters which should be monitored in these patients (including blood potassium, urea, calcium and hemoglobin levels) need to be prioritized, and this prioritization depends in turn upon general patient well-being. More research is also required in the understanding of physiology and importance of good nutrition in this population. The aim of this work is to provide some background of the key parameters in HD patients and to identify literature on biochemical parameters which are affected during physical activity in HD patients. The results help to emphasize that closer attention should be paid to monitoring HD efficacy and Kt/V, a measure of dialysis adequacy.