An International Survey of Peritoneal Dialysis Exercise Practices and Perceptions

Exercise training and chronic kidney disease: characterization and bibliometrics of citation classics of clinical intervention trials

BACKGROUND

Exercise research targeting chronic kidney disease (CKD) has been conducted for more than 30 years, and the benefits of exercise for CKD patients have been progressively demonstrated. This study analyzes citation classics on clinical intervention trials on exercise training and CKD to describe the research landscape and hotspots through bibliometric analysis.

METHODS

To identify clinical trials of exercise training interventions for CKD with more than 100 citations from the Web of Science Core Collection database. Extracted bibliometric information, participant information, and study characteristics of the included articles. The total citations, annual average citations, publication of year, author keywords, and study-related data were bibliometric analyzed and described using Excel 2019 and VOSviewer software.

RESULTS

A total of 30 citation classics were included, with a total citation frequency of 102 to 279 (mean ± standard deviation: 148.4 ± 49.4). The American Journal of Kidney Diseases (n = 7) published the most (n = 7) classic citations in the field of CKD exercise research, and the Journal of the American Society of Nephrology was the most cited. The hotspot of research around CKD and exercise training interventions focused on population (hemodialysis and end-stage renal disease), exercise type (resistance training, yoga, and leg-cycling), and outcomes (cardiovascular indices, physical performance, psychological status, kidney function, physical activity). Reported dropout rates ranged from 0.0% to 47.4%.

CONCLUSION

A bibliometric analysis of citation classics on exercise training and CKD highlights the potential benefits of exercise as a non-pharmacological therapy for patients with CKD, as well as developments and hotspots in the field.

A Current State of the Art and Science of Exercise in Dialysis: A Narrative Review

Purpose of the review

The purpose of the review is to discuss current proven benefits and problems of integrating exercise in the care of people receiving dialysis by reviewing literature from the last few years and identifying important questions that still need to be asked and answered.

Methods

A focused review and appraisal of the literature were done. Original peer-reviewed articles, review articles, opinion pieces and guidelines were identified from PubMed and Google Scholar databases. Only sources in English were accessed. Search terms "exercise" and "dialysis" were used to find active recruiting randomized trials in various clinical trial registry platforms.

Key findings

Numerous studies have demonstrated the benefits of exercise training in individuals receiving dialysis, limited by factors such as short duration of follow-up and inconsistent adverse event reporting and outcomes selected. Notable gaps in exercise research in dialysis include ways to maintain programs and patient motivation, studies in peritoneal dialysis and home hemodialysis patients, and how best to define and measure outcomes of interest.

Implications

This review summarizes the current state of exercise in people receiving dialysis and serves as a call to action to conduct large, randomized controlled trials to improve the quality of evidence needed to implement and sustain innovative, exercise interventions, and programs for this population.

Objectively measured daily steps as an outcome in a clinical trial of chronic kidney disease: a systematic review

BACKGROUND

Physical inactivity is prevalent among individuals with chronic kidney disease (CKD) and is linked to unfavorable outcomes. In recent years, daily steps have emerged as a prominent target for interventions in clinical trials. The present study endeavors to scrutinize the effectiveness and/or efficacy of various interventions on daily steps in patients with full-spectrum CKD.

METHODS

In December 2022, a systematic search was conducted across three databases, namely PubMed, Embase, and Web of Science, and subsequently updated in June 2023. The inclusion criteria included randomized controlled studies, quasi-experimental studies, and single-arm trials that assessed an intervention's impact on objectively measured daily steps in patients with chronic kidney disease. The Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool was used to assess the risk of bias in non-randomized controlled trials (RCT), while the Cochrane revised tool (ROB-2) was utilized for RCTs.

RESULTS

Seventeen studies were deemed eligible for inclusion in this review, with a focus on examining the efficacy and/or effectiveness of exercise training-based interventions (n = 10), daily step goal-oriented interventions (n = 4), mobile health (mHealth) interventions (n = 1), different dialysis modalities (n = 1), and a "Sit Less, Interact, Move More" intervention (n = 1). The studies exhibit variability in their characteristics and assessment tools, reflecting the findings' heterogeneity. The results indicate that increasing physical activity levels remain challenging, as only a limited number of studies demonstrated significant improvements in participants' daily step counts from baseline to endpoint.

CONCLUSION

Clinical trials with daily steps as an outcome are still lacking in the CKD population. Well-designed clinical trials that objectively assess the physical activity of CKD patients are needed.

Influencing factors for residual kidney function in incident peritoneal dialysis patients: a systematic review and meta-analysis

BACKGROUND

Residual kidney function (RKF) impacts patients' survival rate and quality of life when undergoing peritoneal dialysis (PD). This meta-analysis was conducted to systematically identify risk and protective factors associated with RKF decline and loss.

METHODS

We searched three English and one Chinese databases from inception to January 31, 2023, for cohort and cross-sectional studies exploring factors associated with RKF decline or loss. The random effects model was employed to aggregate risk estimates and 95% confidence intervals (CIs) from multivariate analysis. Sensitivity and subgroup analyses were performed to explore the heterogeneity among the studies.

RESULTS

Twenty-seven studies comprising 13549 individuals and 14 factors were included in the meta-analysis. Based on the meta-analysis results, risk factors involving male gender (hazard ratio (HR) 1.689, 95%CI 1.385-2.061), greater body mass index (BMI) (odds ratio (OR) 1.081, 95% confidence interval (CI) 1.029-1.135), higher systolic blood pressure (SBP) (HR 1.014, 95%CI 1.005-1.024), diabetes mellitus (DM) (HRRKF loss 1.873, 95%CI 1.475-2.378), DM (ORRKF decline 1.906, 95%CI 1.262-2.879), peritonitis (relative ratio (RR) 2.291, 95%CI 1.633-3.213), proteinuria (OR 1.223, 95%CI 1.117-1.338), and elevated serum phosphorus (RR 2.655, 95%CI 1.679-4.201) significantly contributed to the risk of RKF decline and loss in PD patients. Conversely, older age (HR 0.968, 95%CI 0.956-0.981), higher serum albumin (OR 0.834, 95%CI 0.720-0.966), weekly Kt/V urea (HR 0.414, 95%CI 0.248-0.690), baseline urine volume (UV) (HR 0.791, 95%CI 0.639-0.979), baseline RKF (HR 0.795, 95%CI 0.739-0.857) exhibited protective effects. However, diuretics use, automatic peritoneal dialysis (APD) modality and baseline RKF did not significantly impact RKF decline.

CONCLUSIONS

Patients with male gender, greater BMI, higher SBP, DM, peritonitis, proteinuria, and elevated serum phosphorus might have a higher risk of RKF decline and loss. In contrast, older age, higher serum albumin, weekly Kt/V urea, baseline UV, and baseline RKF might protect against RKF deterioration.

Increased extracellular water/body mass is associated with functional impairment in hemodialysis patients

BACKGROUND

Functional impairment, malnutrition and fluid overload are prevalent in patients undergoing maintenance hemodialysis (MHD). The extracellular water/body cell mass ratio (ECW/BCM) is a new indicator reflecting fluid overload and malnutrition. A previous study has suggested that it performs better than other indices in assessing fluid status. This study investigates the relationship between pre-dialysis whole-body ECW/BCM and physical function in MHD patients.

METHODS

We conducted a multicenter, cross-sectional study in Guizhou Province in Southwest China. The Karnofsky Performance Status (KPS) was used to evaluate patients' functional status. Patients with KPS scores of ≤ 80 were considered to have a functional impairment. The body composition was measured using the body composition monitor (BCM), and the value of the ECW/BCM ratio was calculated. The subjects were classified into three groups according to ECW/BCM tertiles. Multiple logistic regression models and interactive analyses were conducted.

RESULTS

The final analysis included 2818 subjects. Multivariate logistic regression analyses showed that compared with the lowest tertile (tertile 1), the adjusted odds ratio of functional impairment were 1.95 (95% CI: 1.21-3.13, p < 0.001) and 2.10 (95% CI: 1.31-3.37, p < 0.001) in the second and the third tertiles of ECW/BCM, respectively after adjusting for age, sex, current smoking status, history of stroke, heart failure, diabetes, and myocardial infarction. Subgroup analysis showed that the association existed stably across all subgroups stratified by age, gender, cognitive impairment (CI), history of stroke, heart failure, and diabetes (all p values for interaction >0.05).

CONCLUSIONS

Elevated ECW/BCM is independently linked to an increased risk of functional impairment in patients with MHD.