P1575STUDY ON THE CLINICAL CHARACTERISTICS OF PROTEIN-ENERGY WASTING AND PERSISTENCY RATE OF EXERCISE TRAINING IN PATIENTS ON HEMODIALYSIS
Authors: Taira Takayasu 
Published: June 2020

Abstract

Background and Aims
Frailty is common among elderly patients on hemodialysis (HD), and is associated with protein-energy wasting (PEW), sarcopenia and dynapenia. Frailty and PEW are associated with impaired physical performance, poor quality of life (QOL), disability and reduced survival. Prevention and treatment of these conditions often requires a multifaceted approach. In this study, we examine the effect of PEW and the persistency rate of exercise training among elderly patients on HD.

Method
Study (1): The HD program included 722 patients (515 males, 207 females), who underwent 4-h HD sessions, were assigned to 2 groups (PEW group and non-PEW group). We collected the biochemical data and investigated dry weight (DW: kg), duration of HD (months), body mass index (BMI), % creatinine generation rate (%CGR), and normalized protein catabolic rate (nPCR). Study (2): This was retrospective, multi-center study and included 53 patients on HD (25 males, 28 females; mean age: 72.5±9.1 years, BMI; 22.5±3.5 kg/m2). The HD patients were non-randomly assigned to an exercise training group during HD (E group) or to an exercise training group at home (H group). The E group used medicine balls during the first 2 h of the HD sessions. The H group strengthened the quadriceps and the gastrocnemius muscles by half-squatting by raising the heel or single-leg standing, respectively. We collected the main biochemical data after 6 months of exercise training and measured the left and right knee extension strength using a hand-held dynamometer. We investigated the persistency rate of exercise training and its factors.

Results
Study (1): The mean age of the patients was 67.0±13.1 years; the mean HD duration was 83.2±83.6 months. PEW and non-PEW groups consisted of 162 HD patients (22.4%; 112 males, 50 females, HD duration 76.5±91.5 months) and 560 HD patients (77.6%; 403 males, 157 females, HD duration 85.1±78.4 months), respectively. The mean age of the PEW group was significantly higher than that of the non-PEW group (71.0±12.5 vs 66.0±13.1 years; P&lt;0.01). The mean DW (54.6±13.8 vs 60.4±13.4 kg, P&lt;0.01), mean serum albumin (3.3±0.3 vs 3.5±0.4 g/dL, P&lt;0.01), mean BMI (20.4±4.3 vs 22.5±3.9 kg/m2, P&lt;0.01), mean %CGR (72.0±24.0 vs 96.7±22.5 %, P&lt;0.01), and mean nPCR (0.75±0.16 vs 0.91±0.14 g/kg/day, P&lt;0.01) of the PEW group were significantly lower than those of the non-PEW group. By multiple logistic regression analysis, the partial regression coefficient of age was 0.28, and the odds ratio was 1.029. Study (2): After 3 months, the persistency rate of exercise training was 77.4% (41 HD patients). After 6 months, the persistency rate of exercise training was 50.3% (27 HD patients). The factors of dropout of exercise training were loss of motivation (42.9%), leg pain (21.4%), physical deconditioning (14.3%), change in blood pressure (7.1%), hospitalization (7.1%), and admission to a nursing facility (7.1%). In the H group, the muscle strength of the knee extensors significantly increased from 25.7±7.1 kgf (baseline) to 28.6±7.7 kgf (after 3 months of exercise training; p=0.023).

Conclusion
(1) The PEW group showed significantly lower %CGR than the non-PEW group. (2) An adapted low-intensity exercise program improved the muscle strength of patients with HD patients. The persistency rate of exercise training after 6 months was 50.3%, and the main reasons for dropout of exercise training were loss of motivation and leg pain.