Exercise improves albumin fractional synthetic rate in chronic hemodialysis patients

Abstract

Objective: To determine whether exercise augments the improvements in fractional synthetic rate (FSR) of albumin observed with nutrition alone. Design: Randomized crossover study. Each patient randomly participated in two protein metabolism kinetic studies using primed-constant infusion of ( 13 C) leucine 2 h before, during and 2 h after hemodialysis. Plasma enrichments of ( 13 C) leucine and ( 13 C) ketoisocaproate were examined to determine the FSR of albumin. IntroductionChronic hemodialysis (CHD) patients suffer from muscle wasting and decreased visceral protein stores, which significantly impacts their death and hospitalization (USRDS, 1999). We have shown that intra-dialytic parenteral nutrition (IDPN) reverses hemodialysis (HD)-induced catabolism Pupim et al., 2002), including the fractional synthetic rate (FSR) of albumin (Pupim et al., 2004a), a direct estimate of acute changes in hepatic albumin synthesis (De Feo et al., 1991;Barazzoni et al., 1999;Ahlman et al., 2001). As the beneficial effects of IDPN on somatic protein stores are further augmented by the addition of exercise (Pupim et al., 2004b), we hypothesized that exercise performance combined with IDPN during a single HD treatment would lead to a more profound increase in albumin FSR compared to what is observed with IDPN alone. Subjects and methodsAnalyses were conducted as part of a study from which data on whole body and muscle protein homeostasis have already been reported (Pupim et al., 2004b). Out of the six subjects previously recruited (Pupim et al., 2004b), five (46719 years old, four males, four blacks) had information on FSR available for analysis and were included in this study. Inclusion criteria consisted of patients on a thrice-weekly CHD program for more than 6 months, using a biocompatible hemodialysis membrane (Fresenius F80) and an adequate dose of dialysis (single pool Kt/V41.4). Patients with active infectious or inflammatory disease, liver failure of any cause, hospitalized within 3 months before the study, with recirculation in the vascular access and/or vascular access blood flow less than 750 ml/min detected on the arterioveous (AV) shunt, and those receiving steroids and/or immunosuppressive agents were excluded. Detailed design and methods, including IDPN administration and blood sampling can be found elsewhere (Pupim et al., 2004b).Within a week before each study patients were brought to the General Clinical Research Center to estimate the workload required to achieve their maximal heart rate, and to test www.nature.com/ejcn the subject's ability to sustain exercise at 40% of this level for 15 min (Wasserman, 1999). Heart rate and blood pressure were monitored while the patients pedaled on a recumbent stationary cycle (Ergonomics 800, Ergolin, Bandhagen, Sweden) with incremental ( þ 10 W/min) changes in workload until the maximal heart rate was attained. Subsequently, heart rate, blood pressure, oxygen consumption (VO 2 ), carbon dioxide production (VCO 2 ), energy expenditure and respiratory quotient (RQ) were mon...

The Effect of Resistance Exercise to Augment Long-term Benefits of Intradialytic Oral Nutritional Supplementation in Chronic Hemodialysis Patients

“…Multiple studies demonstrated that resistance exercise combined with oral nutritional supplementation facilitates muscle uptake of amino acids and muscle protein accretion in healthy subjects, which is believed to be due to increased blood flow to the muscle as well as enhanced insulin signaling in the cellular level24-27. In accordance with these data, several short-term studies in CHD patients showed that net muscle protein accretion and albumin synthesis are increased with nutritional supplementation combined with exercise when compared to supplementation alone13, 28, 29. Of note, these beneficial effects of combined intervention were above and beyond of what nutritional supplementation provided alone.…”

Investigation of skeletal muscle quantity and quality in end‐stage renal disease

“…Further, Pupim et al. 42 have noted that one 15 min bout of intradialytic cycling in combination with intradialytic parenteral nutrition can increase the fractional synthetic rate of albumin, a direct estimate of hepatic albumin synthesis, versus intradialytic parenteral nutrition alone (26.2 ± 3.1%, 17.7 ± 1.9%; P < 0.05). However, it is not clear at present if the increase in serum albumin observed in these trials would be associated with an improvement in muscle CSA, as it was not measured concomitantly.…”

Review article: Tackling the survival issue in end‐stage renal disease: Time to get physical on haemodialysis

“…Researchers have uniformly called for targeted interventions to ameliorate chronic inflammation in dialysis patients 49,51,67 and recent data suggest that intradialytic exercise may be effective in this capacity 20,68,69 …”

“…Pupim et al. 69 have noted that a single 15 min bout of intradialytic cycling combined with intradialytic parenteral nutrition increased the fractional synthetic rate of albumin, a direct estimate of hepatic albumin synthesis, versus intradialytic parenteral nutrition alone (26.2% ± 3.1%, 17.7% ± 1.9%; P < 0.05).…”