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Cardoso DF, Leal DV, Martins P, Abade EA, Rocha HC, Ferreira M, Baker LA, Smith AC, Viana JL. Novel Approach to Intradialytic Progressive Resistance Exercise Training. Blood Purif 2023; 52:768-774. [PMID: 37742624 DOI: 10.1159/000531973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 07/03/2023] [Indexed: 09/26/2023]
Abstract
Physical activity levels are typically undesirably low in chronic kidney disease patients, especially in those undergoing haemodialysis, and particularly on dialysis days. Intradialytic exercise programmes could be a solution to this issue and have been reported to be safe and relatively easily implemented in dialysis clinics. Nevertheless, such implementation has been failing in part due to barriers such as the lack of funding, qualified personnel, equipment, and patient motivation. Intradialytic aerobic exercise has been the most used type of intervention in dialysis clinics. However, resistance exercise may be superior in eliciting potential benefits on indicators of muscle strength and mass. Yet, few intradialytic exercise programmes have focused on this type of intervention, and the ones which have report inconsistent benefits, diverging on prescribed exercise intensity, absent or subjective load progression, equipment availability, or exercise supervision. Commonly, intradialytic resistance exercise interventions use free weights, ankle cuffs, or elastic bands which hinder load progression and exercise intensity monitoring. Here, we introduce a recently developed intradialytic resistance exercise device and propose an accompanying innovative resistance exercise training protocol which aims to improve the quality of resistance exercise interventions within dialysis treatment sessions.
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Affiliation(s)
- Daniela Filipa Cardoso
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | - Diogo Vaz Leal
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | - Pedro Martins
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
- NephroCare Portugal SA, Lisbon, Portugal
| | - Eduardo Andre Abade
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | | | - Manuel Ferreira
- NephroCare Portugal SA, Lisbon, Portugal
- Nova Medical School, Faculty of Medical Sciences, Lisbon, Portugal
| | - Luke Alexander Baker
- Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - João L Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
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Arazi H, Mohabbat M, Saidie P, Falahati A, Suzuki K. Effects of Different Types of Exercise on Kidney Diseases. Sports (Basel) 2022; 10:sports10030042. [PMID: 35324651 PMCID: PMC8952011 DOI: 10.3390/sports10030042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
The effects of exercise on kidney function have been studied for more than three decades. One of the most common health issues among patients with chronic kidney disease (CKD) is a lack of physical activity, which leads to a low exercise capacity in these patients. The majority of maintenance hemodialysis (MHD) patients do not exercise at all. At each stage of dialysis, patients lose 10–12 g of their amino acids through blood sampling. Dialysis also leads to increased cortisol and circadian rhythm sleep disorders in hemodialysis (HD) patients. Studies have also reported higher C-reactive protein levels in HD patients, which causes arterial stiffness. Exercise has a variety of health benefits in these patients, including improved blood pressure control, better sleep, higher physical function, and reduced anxiety and depression. On the other hand, it should be noted that intense exercise has the potential to progress KD, especially when conducted in hot weather with dehydration. This review aimed to investigate the effects of different types of exercise on kidney disease and provide exercise guidelines. In conclusion, moderate-intensity and long-term exercise (for at least a 6-month period), with consideration of the principles of exercise (individualization, intensity, time, etc.), can be used as an adjunctive treatment strategy in patients undergoing dialysis or kidney transplantation.
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Affiliation(s)
- Hamid Arazi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
- Correspondence: (H.A.); (K.S.); Tel.: +98-911-139-9207 (H.A.)
| | - Majid Mohabbat
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Payam Saidie
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Akram Falahati
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran; (M.M.); (P.S.); (A.F.)
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: (H.A.); (K.S.); Tel.: +98-911-139-9207 (H.A.)
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3
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Parker K, Bennett PN, Tayler C, Lee C, MacRae J. Reasons for Nonparticipation in a Sustained Hemodialysis Intradialytic Exercise Program. J Ren Nutr 2021; 31:421-426. [PMID: 33642193 DOI: 10.1053/j.jrn.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE(S) Patients with end-stage kidney disease requiring hemodialysis suffer frailty and poor physical function. Exercise can improve physical function; however, barriers exist to intradialytic exercise programs. The objective of this study was to explore patients' reasons for not exercising in an extant intradialytic exercise program. DESIGN AND METHODS We conducted a retrospective analysis reporting the reasons for not exercising in an intradialytic exercise program in two hemodialysis centers over a 4-week period. We explored whether patient characteristics and the presence of an exercise professional were associated with missed exercise sessions. RESULTS Seventy-five patients participating in the intradialytic exercise program completed 57% of prescribed intradialytic exercise sessions. The three most frequently reported reasons from patients not exercising were refusal (24%), followed by fatigue (19%) and symptoms (14%). Patients were more than twice as likely to exercise if a kinesiologist was present (odds ratio [OR]: 2.26, confidence interval [CI]: 1.5, 3.4 P = .03). They were less likely to exercise if they were women (OR: 0.66, CI: 0.45, 0.95 P = .002), had been on dialysis greater than 60 months (OR: 0.55, CI: 0.37, 0.80 P < .002), or had more than two comorbid conditions (OR: 0.63, CI: 0.43, 0.90, P = .01). CONCLUSION Patient adherence to intradialytic exercise programs is strongly associated with the presence of exercise professionals.
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Affiliation(s)
| | - Paul N Bennett
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia; Satellite Healthcare, San Jose, California.
| | - Cassandra Tayler
- School of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Chel Lee
- Department of Mathematics, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer MacRae
- Division of Nephrology and Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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4
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Sharma S, Green T, Alexander KE, Bonner A. Educational or behavioural interventions for symptoms and health-related quality of life in adults receiving haemodialysis: A systematic review. J Ren Care 2020; 46:233-249. [PMID: 32319190 DOI: 10.1111/jorc.12329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/13/2020] [Accepted: 03/05/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND People with end-stage kidney disease (ESKD) suffer from multiple symptoms, which have a negative impact on their health-related quality of life (HRQoL). Educational and behavioural interventions are being developed for this population; however, the effect of these interventions is unclear. AIM To evaluate the effectiveness of educational or behavioural interventions compared with standard care or alternative strategies on reducing symptoms and improving HRQoL in adults with ESKD receiving haemodialysis (HD). METHODS An effectiveness systematic review using Joanna Briggs Institute (JBI) procedures was conducted on experimental studies [randomised controlled trials (RCTs), pseudo-RCTs and quasi-experimental designs] published in English between January 2009 and July 2019. Studies were retrieved from CINAHL, PubMed, MEDLINE, Embase, PsycINFO, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial) and JBI databases. Effect size at 95% confidence interval was calculated where possible. RESULTS Eighteen studies involving 791 participants were included in this review. All studies involved behavioural interventions with the majority of studies (n = 11) targeting psychological symptoms. Interventions were categorised as either active or passive. Active interventions seemed to improve some physical symptoms, although there was very little evidence of improvements to HRQoL. Passive interventions tended to have a large effect on psychological symptoms and the mental health components of HRQoL. CONCLUSION Due to great heterogeneity between studies, meta-analyses could not be conducted further limiting the evidence to inform practice. In addition, further research on educational interventions to teach self-management strategies for symptom management and to improve HRQoL in people with ESKD receiving HD are needed.
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Affiliation(s)
- Sita Sharma
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Theresa Green
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.,Surgical Treatment & Rehabilitation Service, Metro North Hospital and Health Service, Brisbane, Australia
| | | | - Ann Bonner
- School of Nursing, Queensland University of Technology, Brisbane, Australia.,Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
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5
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Ren Q, Lian M, Liu Y, Thomas-Hawkins C, Zhu L, Shen Q. Effects of a transtheoretical model-based WeChat health education programme on self-management among haemodialysis patients: A longitudinal experimental intervention study. J Adv Nurs 2019; 75:3554-3565. [PMID: 31441525 DOI: 10.1111/jan.14182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 07/12/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Abstract
AIM To examine the effects of a transtheoretical model-based WeChat health education programme on self-management in haemodialysis patients in China. DESIGN A longitudinal experimental intervention study. METHODS Patients (N = 120) who underwent haemodialysis from December 2015-November 2017 were recruited and randomly allocated to either group 1 (who received a 3-month WeChat health education immediately after randomization) or group 2 (who was combined with group 1 and received the same intervention at the 5th month after enrolment in the study). Self-management, knowledge and self-efficacy were assessed at baseline (T0 ), 3 months after enrolment in the study (T1 ), 21 months after enrolment in the study (T2 ). RESULTS There were significant group effects on self-efficacy; time effects on partnership, self-care, emotion management with total self-management; interaction effects on problem-solving and emotion management within total self-management according to the two-way repeated measures ANCOVA. Further between-group comparisons indicated that patients in group 1 had better self-management than those in group 2 at T1 . Within-group comparisons demonstrated that, compared with the baseline values, group 1 had significantly improved self-management at T1 ; however, group 2 had improved self-management at T2 . CONCLUSION The transtheoretical model-based WeChat health education programme had a potentially positive effect on improving the self-management of haemodialysis patients. IMPACT Self-management is often difficult yet crucial for haemodialysis patients. This study indicated that the transtheoretical model-based WeChat health education resulted in improved self-management in haemodialysis patients and can be implemented in continuing care during the interdialysis period to improve self-management in patients. TRIAL REGISTRATION ChiCTR1800018172.
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Affiliation(s)
- Qingli Ren
- Nursing Department, School of Medicine, Xiamen University, Xiamen, China.,Nursing College, Shanxi Medical University, Taiyuan, China
| | - Minling Lian
- Kidney Medical Ward, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yang Liu
- Nursing Department, School of Medicine, Xiamen University, Xiamen, China
| | | | - Lixia Zhu
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qu Shen
- Nursing Department, School of Medicine, Xiamen University, Xiamen, China
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Regolisti G, Maggiore U, Sabatino A, Gandolfini I, Pioli S, Torino C, Aucella F, Cupisti A, Pistolesi V, Capitanini A, Caloro G, Gregorini M, Battaglia Y, Mandreoli M, Dani L, Mosconi G, Bellizzi V, Di Iorio BR, Conti P, Fiaccadori E. Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment. PLoS One 2018; 13:e0196313. [PMID: 29702702 PMCID: PMC5922547 DOI: 10.1371/journal.pone.0196313] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background and aim of the study In hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff’s attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population. Methods In this prospective, cross-sectional, multicenter study we recruited 608 adult patients and 330 members of the healthcare staff in 16 hemodialysis units in Italy. We assessed patient-perceived barriers to, and healthcare staff’s attitude towards, exercise by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either barriers or staff’s attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile–Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. We also employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers. Results Most barriers were negatively associated with the HAP-AAS (adjusted change attributable to a given barrier ranging between -5.1 [“Feeling too old”, 95% Confidence Interval: -9.4 to -0.8] and -15.6 [“Ulcers on legs and feet”, 95%CI: -24.8 to -6.5]. We found a significant interaction between staff’s attitude and barriers (adjusted P values ranging between 0.03 [“I do not believe that it is physician’s or nurse’s role providing advice on exercise to patients on dialysis”] and 0.001 [“I do not often ask patients about exercise”]). A beneficial effect of a proactive staff’s attitude was evident only in patients not endorsing barriers. Conclusions Barriers and non-proactive staff’s attitude reduce physical activity in hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive staff’s attitude.
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Affiliation(s)
- Giuseppe Regolisti
- Unità di Fisiopatologia dell’Insufficienza Renale, and Scuola di Specializzazione in Nefrologia, Università di Parma, Parma, Italy
- * E-mail:
| | - Umberto Maggiore
- Unità di Fisiopatologia dell’Insufficienza Renale, and Scuola di Specializzazione in Nefrologia, Università di Parma, Parma, Italy
- Centro Trapianti Rene-Pancreas, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Alice Sabatino
- Unità di Fisiopatologia dell’Insufficienza Renale, and Scuola di Specializzazione in Nefrologia, Università di Parma, Parma, Italy
| | - Ilaria Gandolfini
- Unità di Fisiopatologia dell’Insufficienza Renale, and Scuola di Specializzazione in Nefrologia, Università di Parma, Parma, Italy
- Centro Trapianti Rene-Pancreas, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | | | | | - Filippo Aucella
- Nefrologia e Dialisi, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Adamasco Cupisti
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | | | | | | | | | | | - Lucia Dani
- Nefrologia e Dialisi, San Miniato, Empoli, Italy
| | | | | | | | - Paolo Conti
- Azienda USL Toscana Sud Est, Nefrologia e Dialisi, Grosseto, Italy
| | - Enrico Fiaccadori
- Unità di Fisiopatologia dell’Insufficienza Renale, and Scuola di Specializzazione in Nefrologia, Università di Parma, Parma, Italy
- Centro Trapianti Rene-Pancreas, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
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8
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Afsar B, Siriopol D, Aslan G, Eren OC, Dagel T, Kilic U, Kanbay A, Burlacu A, Covic A, Kanbay M. The impact of exercise on physical function, cardiovascular outcomes and quality of life in chronic kidney disease patients: a systematic review. Int Urol Nephrol 2018; 50:885-904. [DOI: 10.1007/s11255-018-1790-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/07/2018] [Indexed: 12/18/2022]
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Chan D, Green S, Fiatarone Singh MA, Barnard R, Bonder CS, Cheema BS. Effect of intradialytic resistance training on pulse wave velocity and associated cardiovascular disease biomarkers in end stage renal disease. Nephrology (Carlton) 2017; 23:1055-1062. [PMID: 29265637 DOI: 10.1111/nep.13212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 11/29/2022]
Abstract
AIMS Cardiovascular disease (CVD) is the leading cause of mortality in patients with end-stage renal disease (ESRD) receiving maintenance haemodialysis treatment. This study investigated the effect of a 12-week intradialytic progressive resistance training (PRT) intervention on pulse wave velocity (PWV) and associated haemodynamic, anthropometric, and hematologic outcomes in patients with ESRD. METHODS Twenty-two patients with ESRD (59% men, 71.3 ± 11.0 years) were recruited. Supervised PRT (three sets of 11 exercises) was prescribed three times per week during routine dialysis. The primary outcome was brachial-ankle PWV via applanation tonometry. Secondary outcomes included augmentation index, brachial and aortic blood pressures, endothelial progenitor cells, C-reactive protein, blood lipids and anthropometrics. RESULTS The intradialytic PRT regimen resulted in no significant change in PWV between control and intervention periods [mean difference = 0 (95% CI = -0.1 to 0.1); P = 0.58]. Similarly, no significant change was noted in any secondary outcome measures between the control and intervention periods. Post-hoc analyses limited to high adherers (≥75% attendance; n = 11) did not differ from the primary analysis, indicating no dose-response effect of our intervention. CONCLUSION Our 12-week PRT intervention did not change PWV or any secondary outcomes. Future studies should determine if higher dosages of intradialytic PRT (i.e. longer duration and/or higher intensity) can be applied as a method to improve arterial stiffness to potentially reduce cardiovascular disease and associated mortality this cohort.
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Affiliation(s)
- Danwin Chan
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Simon Green
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Maria A Fiatarone Singh
- Exercise, Health & Performance Faculty Research Group, Faculty of Health Sciences and Sydney Medical School, University of Sydney, Sydney, Australia.,Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Robert Barnard
- Centre for Physical Activity in Ageing, Central Adelaide Local Health Network, Adelaide, Australia
| | - Claudine S Bonder
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia
| | - Birinder S Cheema
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia.,The National Institute of Complementary Medicine, Sydney, New South Wales, Australia
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Sutcliffe BK, Bennett PN, Fraser SF, Mohebbi M. The deterioration in physical function of hemodialysis patients. Hemodial Int 2017; 22:245-253. [DOI: 10.1111/hdi.12570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brianna K. Sutcliffe
- Institute for Physical Activity and Nutrition; School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University; Geelong Victoria Australia
| | - Paul N. Bennett
- School of Nursing and Midwifery, Faculty of Health; Deakin University; Geelong Victoria Australia
- Satellite Healthcare; San Jose California USA
| | - Steve F. Fraser
- Institute for Physical Activity and Nutrition; School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University; Geelong Victoria Australia
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Piccoli GB, Moio MR, Fois A, Sofronie A, Gendrot L, Cabiddu G, D'Alessandro C, Cupisti A. The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach. Nutrients 2017; 9:E372. [PMID: 28394304 PMCID: PMC5409711 DOI: 10.3390/nu9040372] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 03/17/2017] [Accepted: 03/31/2017] [Indexed: 12/25/2022] Open
Abstract
The history of dialysis and diet can be viewed as a series of battles waged against potential threats to patients' lives. In the early years of dialysis, potassium was identified as "the killer", and the lists patients were given of forbidden foods included most plant-derived nourishment. As soon as dialysis became more efficient and survival increased, hyperphosphatemia, was identified as the enemy, generating an even longer list of banned aliments. Conversely, the "third era" finds us combating protein-energy wasting. This review discusses four questions and four paradoxes, regarding the diet-dialysis dyad: are the "magic numbers" of nutritional requirements (calories: 30-35 kcal/kg; proteins > 1.2 g/kg) still valid? Are the guidelines based on the metabolic needs of patients on "conventional" thrice-weekly bicarbonate dialysis applicable to different dialysis schedules, including daily dialysis or haemodiafiltration? The quantity of phosphate and potassium contained in processed and preserved foods may be significantly different from those in untreated foods: what are we eating? Is malnutrition one condition or a combination of conditions? The paradoxes: obesity is associated with higher survival in dialysis, losing weight is associated with mortality, but high BMI is a contraindication for kidney transplantation; it is difficult to limit phosphate intake when a patient is on a high-protein diet, such as the ones usually prescribed on dialysis; low serum albumin is associated with low dialysis efficiency and reduced survival, but on haemodiafiltration, high efficiency is coupled with albumin losses; banning plant derived food may limit consumption of "vascular healthy" food in a vulnerable population. Tailored approaches and agreed practices are needed so that we can identify attainable goals and pursue them in our fragile haemodialysis populations.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Dipartimento di Scienze Cliniche e Biologiche, University of Torino, 10100 Torino, Italy.
- Nephrologie, Centre Hospitalier le Mans, Avenue Roubillard, 72000 Le Mans, France.
| | - Maria Rita Moio
- Nephrologie, Centre Hospitalier le Mans, Avenue Roubillard, 72000 Le Mans, France.
| | - Antioco Fois
- Nefrologia, Ospedale Brotzu, 09100 Cagliari, Italy.
| | - Andreea Sofronie
- Nephrologie, Centre Hospitalier le Mans, Avenue Roubillard, 72000 Le Mans, France.
| | - Lurlinys Gendrot
- Nephrologie, Centre Hospitalier le Mans, Avenue Roubillard, 72000 Le Mans, France.
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