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Knobbe TJ, Kremer D, Eisenga MF, van Londen M, Gomes-Neto AW, Douwes RM, Gan CT, Corpeleijn E, Annema C, Navis G, Berger SP, Bakker SJ. Airflow Limitation, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2021; 16:1686-1694. [PMID: 34750161 PMCID: PMC8729428 DOI: 10.2215/cjn.06600521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Many kidney transplant recipients suffer from fatigue and poor health-related quality of life. Airflow limitation may be an underappreciated comorbidity among kidney transplant recipients, which could contribute to fatigue and lower health-related quality of life in this population. In this study, we compared the prevalence of airflow limitation between kidney transplant recipients and healthy controls and investigated associations of airflow limitation with fatigue and health-related quality of life in kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the ongoing TransplantLines Biobank and Cohort study were used. Airflow limitation was defined as forced exhaled volume in 1 second less than the fifth percentile of the general population. Fatigue and health-related quality of life were assessed using checklist individual strength 20 revised (CIS20-R) and Short Form-36 (SF-36) questionnaires. RESULTS A total of 539 kidney transplant recipients (58% men; mean age 56±13 years) and 244 healthy controls (45% men; mean age 57±10 years) were included. Prevalence of airflow limitation was higher in kidney transplant recipients than in healthy controls (133 [25%] versus 25 [10%]). In multinomial regression models, airflow limitation was independently associated with fatigue severity (odds ratio moderate fatigue, 1.68; 95% confidence interval, 0.92 to 3.09 and odds ratio severe fatigue, 2.51; 95% confidence interval, 1.39 to 4.55; P=0.007) and lower physical health-related quality of life (-0.11 SDs; 95% confidence interval, -0.19 to -0.02; P=0.01) in kidney transplant recipients. In exploratory mediation analyses, fatigue accounted for 79% of the association of airflow limitation with physical health-related quality of life. CONCLUSIONS Airflow limitation is common among kidney transplant recipients. Its occurrence is associated with more than two times higher risk of severe fatigue, and it is associated with lower physical health-related quality of life. Mediation analyses suggest that airflow limitation causes fatigue, which in turn, decreases physical health-related quality of life. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER TransplantLines: The Transplantation Biobank, NCT03272841 PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_11_08_CJN06600521.mp3.
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Affiliation(s)
- Tim J. Knobbe
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F. Eisenga
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - António W. Gomes-Neto
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rianne M. Douwes
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C. Tji Gan
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P. Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J.L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Effects of whole-body vibration on muscle strength, quadriceps muscle thickness and functional capacity in kidney transplant recipients: A randomized controlled trial. J Bodyw Mov Ther 2020; 26:101-107. [PMID: 33992228 DOI: 10.1016/j.jbmt.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/31/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Whole-body vibration (WBV) may be an alternative of physical training for kidney transplant recipients. OBJECTIVE To evaluate the effect of a training program on quadriceps muscle strength and thickness, distance walked in the 6-min walking test (6MWT), respiratory muscle strength and quality of life in adult kidney transplant recipients. DESIGN Randomized controlled clinical trial. METHOD Twelve kidney transplant recipients of both genders who underwent WBV training (35 Hz) twice a week for 12 weeks on alternate days (WBVG), and training with a Sham Group (SG) were evaluated before and after intervention. RESULTS No difference was observed in quadriceps muscle strength and thickness between groups, however a large (d = 0.81) and a small (d = 0.44) effect size were observed after the training, respectively. Both groups improved the execution time of Sit-to-Stand Test before and after analysis, but this effect did not show superiority between them, however there was a large effect size provided by training (d = 1.11). No changes were observed between groups in relation to inspiratory muscle strength, but training effects could be observed by the effect size after the study period (d = 0.59). No changes were observed regarding the distance walked in the 6MWT and the effect size was small (d = 0.31). CONCLUSION WBV program would induce physiological responses that must be taken into consideration in adults' kidney transplant recipients. Our results show considerable effect sizes were observed for muscle strength and quadriceps thickness, inspiratory muscle strength, and 6MWT walking distance, although no difference was observed between groups at the end of the study.
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Ulubay G, Uyanik S, Er Dedekarginoglu B, Serifoglu I, Kupeli E, Savas Bozbas S, Sezer S, Haberal M. Peripheral Muscle Strength Indicates Respiratory Function Testing in Renal Recipients. EXP CLIN TRANSPLANT 2017; 15:249-253. [PMID: 28260479 DOI: 10.6002/ect.mesot2016.p120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Muscle wasting occurs in renal recipients due to decreased physical performance, and decreased respiratory muscle strength may occur due to changes in structure and function. Data are scarce regarding the roles of sarcopenia and nutritional status on respiratory muscle function in these patients. Here, we evaluated interactions among peripheral muscle strength, sarcopenia, nutritional parameters, and respiratory muscle function in renal transplant recipients. MATERIALS AND METHODS Ninety-nine patients were prospectively enrolled between September and April 2016 at Baskent University. Forced vital capacity values (via pulmonary function tests), respiratory muscle strength (via maximal static inspiratory and expiratory pressures), and peripheral muscle strength (via hand grip strength test) were recorded. Nutritional parameters, fat weight, arm circumference, waist circumference, and C-reactive protein levels were also recorded. RESULTS Of 99 patients, 68 were renal transplant recipients (43 men, mean age: 39.09 ± 10.70 y) and 31 were healthy participants (14 men, mean age: 34.94 ± 10.95 y). Forced vital capacity (P < .001, r = 0.65), maximal inspiratory (P = .002, r = 0.39) and expiratory (P < .001, r = 0.4) pressure, and hand grip strength showed significant relations in transplant recipients. Positive correlations were found between serum albumin levels and both hand grip strength (P = .16, r = 0.347) and forced vital capacity (P = .03, r = 0.436). Forced vital capacity was statistically different between renal recipients and healthy participants (P = .013), whereas maximal inspiratory and expiratory pressures were not (P > .05). No statistically significant relation was observed between biochemical parameters and maximal inspiratory and expiratory pressures (P ? .05). CONCLUSIONS Respiratory function and peripheral muscle strength were significantly related in renal transplant recipients, with significantly lower peripheral muscle strength suggesting the presence of inadequate respiratory function. Peripheral and respiratory muscle training and nutritional replacement strategies could help to improve postoperative respiratory function.
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Affiliation(s)
- Gaye Ulubay
- Department of Pulmonary Diseases, Baskent University, Ankara, Turkey
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Pomidori L, Lamberti N, Malagoni AM, Manfredini F, Pozzato E, Felisatti M, Catizone L, Barillà A, Zuccalà A, Tripepi G, Mallamaci F, Zoccali C, Cogo A. Respiratory muscle impairment in dialysis patients: can minimal dose of exercise limit the damage? A Preliminary study in a sample of patients enrolled in the EXCITE trial. J Nephrol 2016; 29:863-869. [PMID: 27312989 DOI: 10.1007/s40620-016-0325-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022]
Abstract
AIM Skeletal muscle atrophy and dysfunction with associated weakness may involve the respiratory muscles of dialysis patients. We evaluated the effect of moderate-intensity exercise on lung function and respiratory muscle strength. METHODS Fifty-nine patients (25 F, aged 65 ± 13 years) from two centers participating in the multicenter randomized clinical trial EXerCise Introduction To Enhance Performance in Dialysis (EXCITE) were studied. Subjects were randomized into a prescribed exercise group (E), wherein subjects performed two 10-min walking sessions every second day at an intensity below the self-selected speed, or a control group (C) with usual care. Physical performance was assessed by the 6-min walk test (6MWT). Patient lung function and respiratory muscle strength were evaluated by spirometry and maximal inspiratory pressure (MIP), respectively. RESULTS Forty-two patients (14 F) completed the study. At baseline, the groups did not differ in any parameters. In total, 7 patients (4 in E; 3 in C) showed an obstructive pattern. The pulmonary function parameters were significantly correlated with 6MWT but not with any biochemical measurements. Group E safely performed the exercise program. At follow-up, the spirometry parameters did not change in either group. A deterioration of MIP (-7 %; p = 0.008) was observed in group C, but not in group E (+3.3 %, p = ns). In E, an increase of 6MWT was also found (+12 vs. 0 % in C; p = 0.038). CONCLUSION In dialysis patients, a minimal dose of structured exercise improved physical capacity and maintained a stable respiratory muscle function, in contrast to the control group where it worsened.
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Affiliation(s)
- Luca Pomidori
- Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy. .,Esercizio Vita ONLUS, Via Don Giovanni Calabria 13, 44124, Ferrara, Italy.
| | - Nicola Lamberti
- Department of Biomedical and Surgical Specialties Sciences, Section of Sport Sciences, University of Ferrara, Ferrara, Italy
| | - Anna Maria Malagoni
- Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy.,Unit of Translational Surgery, Hospital University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical and Surgical Specialties Sciences, Section of Sport Sciences, University of Ferrara, Ferrara, Italy
| | - Enrico Pozzato
- Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy.,Esercizio Vita ONLUS, Via Don Giovanni Calabria 13, 44124, Ferrara, Italy
| | - Michele Felisatti
- Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy.,Esercizio Vita ONLUS, Via Don Giovanni Calabria 13, 44124, Ferrara, Italy
| | - Luigi Catizone
- Nephrology Dialysis Unit, Hospital University of Ferrara, Ferrara, Italy
| | - Antonio Barillà
- Nephrology Dialysis Unit, Hospital University of Ferrara, Ferrara, Italy
| | | | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, Reggio Calabria, Italy.,Nephrology and Renal Transplantation Division, Ospedali Riuniti, Reggio Calabria, Italy
| | - Carmine Zoccali
- Nephrology and Renal Transplantation Division, Ospedali Riuniti, Reggio Calabria, Italy
| | - Annalisa Cogo
- Biomedical Sport Studies Centre, University of Ferrara, Ferrara, Italy.,Department of Biomedical and Surgical Specialties Sciences, Section of Sport Sciences, University of Ferrara, Ferrara, Italy
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Cardio-Pulmonary-Renal Interactions: A Multidisciplinary Approach. J Am Coll Cardiol 2015; 65:2433-48. [PMID: 26046738 DOI: 10.1016/j.jacc.2015.04.024] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 12/16/2022]
Abstract
Over the past decade, science has greatly advanced our understanding of interdependent feedback mechanisms involving the heart, lung, and kidney. Organ injury is the consequence of maladaptive neurohormonal activation, oxidative stress, abnormal immune cell signaling, and a host of other mechanisms that precipitate adverse functional and structural changes. The presentation of interorgan crosstalk may include an acute, chronic, or acute on chronic timeframe. We review the current, state-of-the-art understanding of cardio-pulmonary-renal interactions and their related pathophysiology, perpetuating nature, and cycles of increased susceptibility and reciprocal progression. To this end, we present a multidisciplinary approach to frame the diverse spectrum of published observations on the topic. Assessment of organ functional reserve and use of biomarkers are valuable clinical strategies to screen and detect disease, assist in diagnosis, assess prognosis, and predict recovery or progression to chronic disease.
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Otani S, Levvey BJ, Westall GP, Paraskeva M, Whitford H, Williams T, McGiffin DC, Walker R, Menahem S, Snell GI. Long-term successful outcomes from kidney transplantation after lung and heart-lung transplantation. Ann Thorac Surg 2015; 99:1032-8. [PMID: 25624053 DOI: 10.1016/j.athoracsur.2014.11.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/10/2014] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal dysfunction is common after lung and heart-lung transplantation (Tx), and it limits the recipient's survival and quality of life. This study analyzed the outcomes of simultaneous and late kidney Tx following lung and heart-lung Tx. METHODS From a single-center retrospective chart review of 1031 lung and heart-lung Tx recipients, we identified 13 simultaneous or late kidney Tx cases in 12 patients. RESULTS Three patients underwent simultaneous deceased donor lung and kidney Tx. Eight patients underwent lung and heart-lung Tx, followed by nine living donor kidney Tx (including one ABO-incompatible Tx). One additional patient underwent a late deceased donor kidney Tx following heart-lung Tx. The median time from lung and heart-lung Tx to later kidney Tx was 127 (interquartile range [IQR], 23 to 263) months. Three patients died, 1 of sepsis, 1 of multiple organ failure, and 1 of transplant coronary disease. At a median follow-up of 33 (IQR, 10 to 51) months, 9 patients are alive and well. Eight patients required dialysis before kidney Tx for a median time of 14 months (IQR, 5 to 49). Kidney graft loss occurred in 1 patient at 51 months. After kidney Tx, dialysis was necessary in association with acute allograft dysfunction in 2 patients. No acute kidney rejection has been detected in any patient. Treatable acute lung rejection was seen in 1 patient. Well-preserved pulmonary function was noted in recipients of late kidney Tx. CONCLUSIONS Simultaneous kidney Tx and late deceased donor kidney Tx have challenges in the setting of lung Tx. By contrast, late living related kidney Tx after lung Tx is associated with excellent long-term survival and acceptable kidney and lung allograft function.
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Affiliation(s)
- Shinji Otani
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Bronwyn J Levvey
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Glen P Westall
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Miranda Paraskeva
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Helen Whitford
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Trevor Williams
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - David C McGiffin
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Rowan Walker
- Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Solomon Menahem
- Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Gregory I Snell
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
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Alhamad EH, Al-Ghonaim M, Alfaleh HF, Cal JP, Said N. Pulmonary hypertension in end-stage renal disease and post renal transplantation patients. J Thorac Dis 2014; 6:606-16. [PMID: 24976981 DOI: 10.3978/j.issn.2072-1439.2014.04.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/15/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Information regarding lung function parameters and functional capacity in renal failure and post renal transplantation patients with pulmonary hypertension (PH) is limited. The purpose of this study was to examine the clinical characteristics of patients with PH who were receiving hemodialysis (HD) or peritoneal dialysis (PD) or who had undergone renal transplantation. METHODS A prospective study was performed on 116 patients (HD =55, PD =17, and post renal transplantation =44) who underwent Doppler echocardiography. PH was defined as systolic pulmonary artery pressure (SPAP) ≥40 mmHg. Demographic information, clinical characteristics, pulmonary function tests (PFTs) and the six-minute walk test (6MWT) were collected and compared between the patients with and without PH. RESULTS Twelve (21.8%) patients receiving HD, four (23.5%) patients receiving PD, and eight (18.2%) post renal transplantation patients had PH. In the HD group, the physiological indicators (including pulmonary function test parameters, the final Borg score, and walking distance during the 6MWT) were all significantly lower in the patients with PH compared with those without PH (all P<0.0001). However, in the PD and post renal transplantation groups, no significant differences were noted in the demographic characteristics or in the physiological parameters when the PH patients were compared with those without PH (all P>0.05). CONCLUSIONS Among HD patients, marked aberrations in PFT results or walking distance may identify a subset of patients suffering from PH.
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Affiliation(s)
- Esam H Alhamad
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Mohammed Al-Ghonaim
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Hussam F Alfaleh
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Joseph P Cal
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Nazmi Said
- 1 Department of Medicine, College of Medicine, 2 Prince Salman bin Abdulaziz Research Chair for Kidney Disease, 3 Department of Cardiac sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia ; 4 Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
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Abdalla ME, AbdElgawad M, Alnahal A. Evaluation of pulmonary function in renal transplant recipients and chronic renal failure patients undergoing maintenance hemodialysis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Figueiredo RR, Castro AAM, Napoleone FMGG, Faray L, de Paula Júnior AR, Osório RAL. Respiratory biofeedback accuracy in chronic renal failure patients: a method comparison. Clin Rehabil 2012; 26:724-32. [DOI: 10.1177/0269215511431088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To analyse respiratory biofeedback effects on respiratory muscle strengthening in chronic renal failure patients. Design: Randomized controlled study. Setting: Nephrology and dialysis centre. Subjects and intervention: Forty-one end-stage renal patients on haemodialysis treatment were allocated into three groups: control ( n = 10), G-1 (inspiratory muscle training using Threshold IMT device; n = 16) and G-2 (biofeedback; n = 15) and given respiratory muscle training (three sessions/week for six weeks). Main measures: Forced vital capacity (FVC), expiratory volume in the first second (FEV1), FEV1/FVC ratio, maximal voluntary ventilation (MVV) and maximal inspiratory (MIP) and expiratory (MEP) pressures were measured before and after the respiratory muscle training programme. Results: Both training methods were efficient since we found an increase after training in the FVC in the G-1 group (from 2.45 ± 0.17 to 2.85 ± 0.16; P = 0.001) and in the G-2 group (from 2.35 ± 0.19 to 2.55 ± 0.19; P = 0.007), in the FEV1 in G-1 (from 2.18 ± 0.16 to 2.46 ± 0.14; P = 0.01) and in G-2 (from 1.97 ± 0.17 to 2.20 ± 0.15; P < 0.0001), MIP in G-1 (from 70.63 ± 4.03 to 108.75 ± 7.41; P < 0.0001) and in G-2 (from 67.67 ± 5.02 to 96.33 ± 8.30; P < 0.001) and MEP in G-1 (from 73.13 ± 5.10 to 82.50 ± 6.74; P = 0.007) and in G-2 (from 67.67 ± 5.41 to 76.00 ± 4.29; P = 0.002). Conclusions: Respiratory biofeedback is efficient as a respiratory muscle training modality for patients with chronic renal failure.
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