Resistance exercise: an effective strategy to reverse muscle wasting in hemodialysis patients?

Connie M Rhee, Kamyar Kalantar-Zadeh, Connie M Rhee, Kamyar Kalantar-Zadeh

Abstract

Muscle wasting is a common complication afflicting maintenance hemodialysis (HD) patients, and it is associated with decreased muscle function, exercise performance, physical function, and quality of life. Meanwhile, numerous epidemiologic studies have consistently shown that greater muscle mass (ascertained by body anthropometry surrogates, body composition tests such as dual x-ray absorptiometry, and/or serum creatinine in patients with little to no residual kidney function) is associated with increased survival in this population. The pathophysiology of muscle wasting in HD patients is complex and may be caused by poor dietary intake, catabolic effects of dialysis therapy, hormonal alterations (e.g., decreased levels or resistance to anabolic hormones, increased levels of catabolic hormones), inflammation, metabolic acidosis, and concurrent comorbidities. Muscle disuse resulting from low physical activity is an important yet under-appreciated risk factor for muscle wasting. Intra-dialytic resistance exercise training has been suggested as a potential strategy to correct and/or prevent this complication in HD patients, but prior studies examining this exercise modality as an anabolic intervention have shown mixed results. In a recently published 12-week randomized controlled trial of a novel intra-dialytic progressive resistance exercise training (PRET) program vs. control therapy conducted in HD and non-HD patients, PRET resulted in increased muscle volume and strength in both groups. At this time, further study is needed to determine if anabolic improvements imparted by resistance exercise translates into improved physical function and quality of life, decreased hospitalization and mortality risk, and greater cost-effectiveness in HD patients.

Figures

Fig. 1
Fig. 1
Risk factors and sequelae of muscle wasting in hemodialysis patients

References

    1. Dong J, Ikizler TA. New insights into the role of anabolic interventions in dialysis patients with protein energy wasting. Curr Opin Nephrol Hypertens. 2009;18:469–75. doi: 10.1097/MNH.0b013e328331489d.
    1. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73:391–8. doi: 10.1038/sj.ki.5002585.
    1. Kalantar-Zadeh K, Rhee C, Sim JJ, Stenvinkel P, Anker SD, Kovesdy CP. Why cachexia kills: examining the causality of poor outcomes in wasting conditions. J Cachexia Sarcopenia Muscle. 2013;4:89–94. doi: 10.1007/s13539-013-0111-0.
    1. Ikizler TA. Exercise as an anabolic intervention in patients with end-stage renal disease. J Ren Nutr Off J Counc Ren Nutr Natl Kidney Found. 2011;21:52–6. doi: 10.1053/j.jrn.2010.10.012.
    1. Johansen KL, Shubert T, Doyle J, Soher B, Sakkas GK, Kent-Braun JA. Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function. Kidney Int. 2003;63:291–7. doi: 10.1046/j.1523-1755.2003.00704.x.
    1. Kalantar-Zadeh K, Streja E, Kovesdy CP, Oreopoulos A, Noori N, Jing J, et al. The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving hemodialysis. Mayo Clin Proc. 2010;85:991–1001. doi: 10.4065/mcp.2010.0336.
    1. Kalantar-Zadeh K, Streja E, Molnar MZ, Lukowsky LR, Krishnan M, Kovesdy CP, et al. Mortality prediction by surrogates of body composition: an examination of the obesity paradox in hemodialysis patients using composite ranking score analysis. Am J Epidemiol. 2012;175:793–803. doi: 10.1093/aje/kwr384.
    1. Molnar MZ, Streja E, Kovesdy CP, Bunnapradist S, Sampaio MS, Jing J, et al. Associations of body mass index and weight loss with mortality in transplant-waitlisted maintenance hemodialysis patients. Am J Transplant Off J AmSoc Transplant Ame SocTransplant Surg. 2011;11:725–36. doi: 10.1111/j.1600-6143.2011.03468.x.
    1. Noori N, Kopple JD, Kovesdy CP, Feroze U, Sim JJ, Murali SB, et al. Mid-arm muscle circumference and quality of life and survival in maintenance hemodialysis patients. Clin J Am Soc Nephrol. 2010;5:2258–68. doi: 10.2215/CJN.02080310.
    1. Noori N, Kovesdy CP, Bross R, Lee M, Oreopoulos A, Benner D, et al. Novel equations to estimate lean body mass in maintenance hemodialysis patients. Am J Kidney Dis Off J Natl Kidney Found. 2011;57:130–9. doi: 10.1053/j.ajkd.2010.10.003.
    1. Park J, Jin DC, Molnar MZ, Dukkipati R, Kim YL, Jing J, et al. Mortality predictability of body size and muscle mass surrogates in Asian vs white and African American hemodialysis patients. Mayo Clin Proc. 2013;88:479–86. doi: 10.1016/j.mayocp.2013.01.025.
    1. Park J, Mehrotra R, Rhee CM, Molnar MZ, Lukowsky LR, Patel SS, et al. Serum creatinine level, a surrogate of muscle mass, predicts mortality in peritoneal dialysis patients. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc. 2013;28:2146–55.
    1. Patel SS, Molnar MZ, Tayek JA, Ix JH, Noori N, Benner D, et al. Serum creatinine as a marker of muscle mass in chronic kidney disease: results of a cross-sectional study and review of literature. J Cachexia Sarcopenia Muscle. 2013;4:19–29. doi: 10.1007/s13539-012-0079-1.
    1. Streja E, Molnar MZ, Kovesdy CP, Bunnapradist S, Jing J, Nissenson AR, et al. Associations of pretransplant weight and muscle mass with mortality in renal transplant recipients. Clin J Am Soc Nephrol. 2011;6:1463–73. doi: 10.2215/CJN.09131010.
    1. Isoyama N, Qureshi AR, Avesani CM, Lindholm B, Barany P, Heimburger O, et al. Comparative associations of muscle mass and muscle strength with mortality in dialysis patients. Clinical Journal of the American Society of Nephrology: CJASN. 2014. Epub 2014/07/31.
    1. Rhee CM, Alexander EK, Bhan I, Brunelli SM. Hypothyroidism and mortality among dialysis patients. Clin J Am Soc Nephrol. 2013;8:593–601. doi: 10.2215/CJN.06920712.
    1. Rhee CM, Brent GA, Kovesdy CP, Soldin OP, Nguyen D, Budoff MJ, et al. Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association—European Renal Association. 2014. Epub 2014/02/28.
    1. Painter P, Marcus RL. Assessing physical function and physical activity in patients with CKD. Clin J Am Soc Nephrol. 2013;8:861–72. doi: 10.2215/CJN.06590712.
    1. Kirkman DL, Mullins P, Junglee NA, Kumwenda M, Jibani MM, Macdonald JH. Anabolic exercise in haemodialysis patients: a randomised controlled pilot study. J Cachexia Sarcopenia Muscle. 2014. Epub 2014/04/09.
    1. Johansen KL, Chertow GM, Kutner NG, Dalrymple LS, Grimes BA, Kaysen GA. Low level of self-reported physical activity in ambulatory patients new to dialysis. Kidney Int. 2010;78:1164–70. doi: 10.1038/ki.2010.312.
    1. Avesani CM, Trolonge S, Deleaval P, Baria F, Mafra D, Faxen-Irving G, et al. Physical activity and energy expenditure in haemodialysis patients: an international survey. Nephrol Dial Transplant Off Publ Eur Dial Transplant Assoc Eur Ren Assoc. 2012;27:2430–4.
    1. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. American journal of kidney diseases: the official journal of the National Kidney Foundation. 2005; 45(4 Suppl 3):S1–153.
    1. Physical Activity Guidelines Advisory Committee: Physical Activity Guidelines Advisory Committee Report, 2008, Washington, DC, U.S. Department of Health and Human Services, 2008.
    1. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–31.
    1. Johansen KL, Sakkas GK, Doyle J, Shubert T, Dudley RA. Exercise counseling practices among nephrologists caring for patients on dialysis. Am J Kidney Dis Off J Natl Kidney Found. 2003;41:171–8. doi: 10.1053/ajkd.2003.50001.
    1. Johansen KL. Exercise in the end-stage renal disease population. J Am Soc Nephrol. 2007;18:1845–54. doi: 10.1681/ASN.2007010009.
    1. Lemmey AB, Marcora SM, Chester K, Wilson S, Casanova F, Maddison PJ. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum. 2009;61:1726–34. doi: 10.1002/art.24891.
    1. Johansen KL, Painter P. Exercise in individuals with CKD. Am J Kidney Dis Off J Natl Kidney Found. 2012;59:126–34. doi: 10.1053/j.ajkd.2011.10.008.
    1. Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: a randomized, controlled trial. J Am Soc Nephrol. 2006;17:2307–14. doi: 10.1681/ASN.2006010034.
    1. Kopple JD, Wang H, Casaburi R, Fournier M, Lewis MI, Taylor W, et al. Exercise in maintenance hemodialysis patients induces transcriptional changes in genes favoring anabolic muscle. J Am Soc Nephrol. 2007;18:2975–86. doi: 10.1681/ASN.2006070794.
    1. Cheema B, Abas H, Smith B, O’Sullivan A, Chan M, Patwardhan A, et al. Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study. Am J Kidney Dis Off J Natl Kidney Found. 2007;50:574–84. doi: 10.1053/j.ajkd.2007.07.005.
    1. Cheema B, Abas H, Smith B, O’Sullivan A, Chan M, Patwardhan A, et al. Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. J Am Soc Nephrol. 2007;18:1594–601. doi: 10.1681/ASN.2006121329.
    1. Dong J, Sundell MB, Pupim LB, Wu P, Shintani A, Ikizler TA. The effect of resistance exercise to augment long-term benefits of intradialytic oral nutritional supplementation in chronic hemodialysis patients. J Ren Nutr Off J Counc Ren Nutr Natl Kidney Found. 2011;21:149–59. doi: 10.1053/j.jrn.2010.03.004.
    1. Headley S, Germain M, Mailloux P, Mulhern J, Ashworth B, Burris J, et al. Resistance training improves strength and functional measures in patients with end-stage renal disease. Am J Kidney Dis Off J Natl Kidney Found. 2002;40:355–64. doi: 10.1053/ajkd.2002.34520.

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