scholarly journals Participant acceptability of exercise in kidney disease (PACE-KD): a feasibility study protocol in renal transplant recipients

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017494
Author(s):  
Nicolette C Bishop ◽  
Roseanne Billany ◽  
Alice C Smith
Keyword(s):  
Renal Transplant ◽  
Kidney Disease ◽  
Large Scale ◽  
Positive Impact ◽  
Interval Training ◽  
Risk Scores ◽  
Moderate Intensity ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Continuous Training

IntroductionCardiovascular disease (CVD) is a major cause of mortality in renal transplant recipients (RTRs). General population risk scores for CVD underestimate the risk in patients with chronic kidney disease (CKD) suggesting additional non-traditional factors. Renal transplant recipients also exhibit elevated inflammation and impaired immune function. Exercise has a positive impact on these factors in patients with CKD but there is a lack of rigorous research in RTRs, particularly surrounding the feasibility and acceptability of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) in this population. This study aims to explore the feasibility of three different supervised aerobic exercise programmes in RTRs to guide the design of future large-scale efficacy studies.Methods and analysisRenal transplant recipients will be randomised to HIIT A (16 min interval training with 4, 2 and 1 min intervals at 80%–90% of peak oxygen uptake (VO2 peak)), HIIT B (4×4 min interval training at 80%–90% VO2peak) or MICT (~40 min cycling at 50%–60% VO2peak) where they will undertake 24 supervised sessions (approximately thrice weekly over 8 weeks). Assessment visits will be at baseline, midtraining, immediate post-training and 3 months post-training. The study will evaluate the feasibility of recruitment, randomisation, retention, assessment procedures and the implementation of the interventions. A further qualitative sub-study QPACE-KD (Qualitative Participant Acceptability of Exercise in Kidney Disease) will explore patient experiences and perspectives through semistructured interviews and focus groups.Ethics and disseminationAll required ethical and regulatory approvals have been obtained. Findings will be disseminated through conference presentations, public platforms and academic publications.Trial registration numberProspectively registered;ISRCTN17122775.

P1722HIGH INTENSITY INTERVAL TRAINING AND MODERATE INTENSITY CONTINUOUS TRAINING IN RENAL TRANSPLANT RECIPIENTS: THE PACE-KD STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Roseanne E Billany ◽  
Alice Smith ◽  
Ganisha Hutchinson ◽  
Daniel Nixon ◽  
Nicolette Bishop
Keyword(s):  
Blood Pressure ◽  
Body Composition ◽  
Renal Transplant ◽  
Cardiorespiratory Fitness ◽  
Interval Training ◽  
Moderate Intensity ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Specific Exercise ◽  
Continuous Training

Abstract Background and Aims Cardiovascular disease (CVD) is a major cause of morbidity and mortality in renal transplant recipients (RTRs). General CVD risk scores underestimate the risk in RTRs who also exhibit elevated inflammation and impaired immune function. Exercise has a positive impact on these unique factors and there is growing consensus on the need for formal and specific exercise guidelines in RTRs. Despite this, there is limited rigorous research in this population, particularly surrounding novel high intensity interval training (HIIT) versus moderate intensity continuous training (MICT). Method 24 RTRs (male 17; eGFR 55 ml/min/1.73 m2 [26-90]; age 48 years [27-76]) were randomised to: HIITA (n=8; 4, 2 and 1 min intervals; 80-90% of watts at peak oxygen uptake (V̇O2 peak)), HIITB (n=8, 4 × 4 min intervals; 80-90% V̇O2 peak) or MICT (n=8, ∼35.5 min; 50-60% V̇O2 peak) for 24 supervised sessions on a stationary bike (approx. 3x/week over 8 weeks). Assessments of cardiorespiratory fitness, body composition (weight and body fat %), and physical function (sit-to-stand 60 (STS60), gait speed, and calf strength) were conducted pre and post-intervention. Data were analysed using ANCOVA and paired samples t-tests. Results Twenty participants completed the intervention, 8 of whom reached the required intensity (HIITA 0/6 [0%], HIITB 3/8 [38%], MICT 5/6 [83%]). Although participants completed 92% (average) of the 24 sessions, there were 105 cancelled/rearranged sessions (illness 68, other commitments 33, investigator illness 4) and an average duration of 10 weeks to complete the intervention. There were significant post-training improvements in V̇O2 peak (ml/kg/min)(See Table 1: HIITA, p=0.007; HIITB, p=0.025; MICT, p=0.012) and in peak power output (wattpeak)(HIITA, p=0.001; HIITB, p=0.005; MICT, p=0.002) for all groups. There was a significant post-training reduction in systolic and diastolic blood pressure (SBP and DBP, respectively) in MICT (p<0.001) and a significant reduction in DBP in HIITB (p<0.001). There were no significant changes in body composition. Gait speed improved in MICT (p=0043) and STS60 performance improved in HIITA (p=0.012). After controlling for baseline values, there were no significant between group differences for any post-training variables. Conclusion Enhanced cardiorespiratory fitness has been widely reported to correlate with a reduced risk of CVD and mortality. These early feasibility results, whilst acknowledging some baseline variations, show promising effects of both HIIT and MICT on the cardiorespiratory fitness of RTRs. Results also show promising reductions in blood pressure, a leading risk factor for CVD. Although fewer RTRs met the required intensity for the HIIT protocols than MICT, there were no serious adverse events or detrimental results reported. There were a large number of sessions cancelled due to illness; potentially attributable to immunosuppressive agents. We would recommend further large-scale trials of different HIIT protocols potentially with shorter intervals and less intense recovery periods in order to facilitate the achievement of the required intensity. Overall, these results further support the call for specific exercise guidance in this population in order to supplement current post-transplantation clinical advice.

Quality of Life and Health Status among those receiving Renal Replacement Therapy in Trinidad and Tobago. West Indies.

2020 ◽  
Author(s):  
Sharlene Maria Sanchez ◽  
Surujpal Teelucksingh ◽  
Ronan Ali ◽  
Henry Bailey ◽  
George Legall
Keyword(s):  
Quality Of Life ◽  
Renal Replacement Therapy ◽  
Renal Transplant ◽  
Kidney Disease ◽  
Trinidad And Tobago ◽  
Replacement Therapy ◽  
Health State ◽  
Renal Transplant Recipients ◽  
Transplant Recipients

Abstract Background A cross sectional study was conducted over a 1-year period in order to evaluate quality of life and health state for patients receiving renal replacement therapy in a resource constrained Caribbean island of Trinidad and Tobago. Methods Five hundred and thirty patients were enlisted in the study. For those who had received renal transplants (n=100) and for those on peritoneal dialysis (n=80), all were included. Among the 1000-odd patients who were receiving haemodialysis 350 were studied using convenience sampling. To be included, one had to be on renal replacement therapy for 3 months or more and at least 18 years of age. The Kidney Disease Quality of Life (KDQOL-36) and the EuroQol (EQ-5D-3L) instruments were administered after demographic data were collected. Transplant recipients were further evaluated with the Kidney Transplant Questionnaire (KTQ). Inferential analysis of data included 95% confidence intervals, hypothesis testing, multiple regression and analysis of variance. SPSS24, STATA14 and MINITAB18 were used. Results Of the 530 patients, 52.5% were male and 37.5% were in the 56-65 years age group. Hypertension (68.9%) and type 2 diabetes mellitus (50.5%) were reported as the main causes of kidney disease. The KDQOL-36 domain scores and significantly associated variables included modality of renal replacement (p=0.000), age (p=0.001), Charlson’s Comorbidity Index (p=0.001), income (p=0.000) and employment status (p=0.000). Transplant patients performed the best in the KDQOL-36. The mean visual analogue scale and index scores from the EQ-5D-3L were highest among renal transplant recipients (p=0.000). Conclusion Renal transplant recipients enjoy the best quality of life and health state among patients on renal replacement therapy in Trinidad and Tobago.

scholarly journals Acute kidney injury in renal transplant recipients undergoing cardiac surgery

2020 ◽  
Vol 36 (1) ◽  
pp. 185-196
Author(s):  
Gregory L Hundemer ◽  
Anand Srivastava ◽  
Kirolos A Jacob ◽  
Neeraja Krishnasamudram ◽  
Salman Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Risk Factor ◽  
Renal Transplant ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Trough Levels

Abstract Background Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. Methods We conducted a retrospective cohort study of RTRs (n = 83) and non-RTRs (n = 83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. Results RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36–5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DD-RTRs versus LD-RTRs; P = 0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P = 0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P = 0.004). Conclusions RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.

scholarly journals Optimization of osteoporosis and osteopenia management among renal transplant recipients

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohammed K. Afifi ◽  
Ahmed S. Kenawy ◽  
Heba H. El Demellawy ◽  
Amany A. Azouz ◽  
Torki Al-Otaibi ◽  
...  
Keyword(s):  
Side Effects ◽  
Renal Transplant ◽  
Positive Impact ◽  
Renal Transplant Recipients ◽  
Close Monitoring ◽  
Transplant Recipients ◽  
Mineral Density ◽  
T Score ◽  
Spinal Osteoporosis ◽  
One Year

Abstract Background Osteoporosis and osteopenia occur frequently in renal transplant recipients due to long-term use of immune-suppressants including corticosteroids. Previous treatment options like bisphosphonates had acceptable but rather unsatisfactory results after transplant. The aim of the current study is to directly compare the efficacy of denosumab and oral ibandronate in late RTR with low bone mineral density. Results The study was conducted Iin Hamed Al-Essa Kidney transplant center, Kuwait, in 2020. The data of 52 denosumab and 48 ibandronate patients were collected at the baseline and after one year of treatment. Spine and hip T-score readings, side effects, and other laboratory results were analyzed to evaluate the use of both medications. The mean number of months after transplant was 25 (± 13.9) months. After one year of treatment, denosumab alleviated both spinal osteoporosis and osteopenia T-score values from −3.13 to −2.4 (p = 0.008) and from −1.9 to −1.5 (p = 0.015), respectively. Besides, it reduced hip osteoporosis and osteopenia insignificantly from −3.45 to −3.1 and from −1.5 to −1.3, respectively (p > 0.05). Ibandronate improved spinal osteopenia from −1.6 to −1.55 (p = 0.97) and failed to show any positive impact on other sites; the spinal osteoporosis changed from −2.8 to −3 and hip osteoporosis and osteopenia changed from −3.1 to −3.12 and from −1.4 to −1.45, respectively (p > 0.05). The use of ibandronate was more associated with gastrointestinal tract (GIT) side effects, while hypocalcemia episodes were significantly higher in the denosumab group. Conclusion Denosumab improved both spinal and hip T-score values in comparison with ibandronate in RTR. Close monitoring is required for denosumab patients to prevent the associated hypocalcemia. Graphical Abstract

scholarly journals Influence of acute moderate- to high-intensity aerobic exercise on markers of immune function and microparticles in renal transplant recipients

2020 ◽  
Vol 318 (1) ◽  
pp. F76-F85
Author(s):  
Patrick J. Highton ◽  
Alice E. M. White ◽  
Daniel G. D. Nixon ◽  
Thomas J. Wilkinson ◽  
Jill Neale ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Transplant ◽  
Kidney Disease ◽  
Aerobic Exercise ◽  
Tissue Factor ◽  
Control Group ◽  
Monocyte Subset ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
The Impact

Renal transplant recipients (RTRs) and patients with nondialysis chronic kidney disease display elevated circulating microparticle (MP) counts, while RTRs display immunosuppression-induced infection susceptibility. The impact of aerobic exercise on circulating immune cells and MPs is unknown in RTRs. Fifteen RTRs [age: 52.8 ± 14.5 yr, estimated glomerular filtration rate (eGFR): 51.7 ± 19.8 mL·min−1·1.73 m−2 (mean ± SD)] and 16 patients with nondialysis chronic kidney disease (age: 54.8 ± 16.3 yr, eGFR: 61.9 ± 21.0 mL·min−1·1.73 m−2, acting as a uremic control group), and 16 healthy control participants (age: 52.2 ± 16.2 yr, eGFR: 85.6 ± 6.1 mL·min−1·1.73 m−2) completed 20 min of walking at 60–70% peak O2 consumption. Venous blood samples were taken preexercise, postexercise, and 1 h postexercise. Leukocytes and MPs were assessed using flow cytometry. Exercise increased classical ( P = 0.001) and nonclassical ( P = 0.002) monocyte subset proportions but decreased the intermediate subset ( P < 0.001) in all groups. Exercise also decreased the percentage of platelet-derived MPs that expressed tissue factor in all groups ( P = 0.01), although no other exercise-dependent effects were observed. The exercise-induced reduction in intermediate monocyte percentage suggests an anti-inflammatory effect, although this requires further investigation. The reduction in the percentage of tissue factor-positive platelet-derived MPs suggests reduced prothrombotic potential, although further functional assays are required. Exercise did not cause aberrant immune cell activation, suggesting its safety from an immunological standpoint (ISRCTN38935454).

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