| 1. |
- Borgquist, Ola, et al.
(författare)
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Central venous stenosis after subclavian versus internal jugular dialysis catheter insertion (CITES) in adults in need of a temporary central dialysis catheter : study protocol for a two-arm, parallel-group, non-inferiority randomised controlled trial
- 2023
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Ingår i: Trials. - 1745-6215. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The right internal jugular vein is currently recommended for temporary central dialysis catheters (tCDC) based on results from previous studies showing a lower incidence of central vein stenosis compared to the subclavian vein. Data is however conflicting, and there are several advantages when the subclavian route is used for tCDCs. This prospective, controlled, randomised, non-inferiority study aims to compare the incidence of post-catheterisation central vein stenosis between the right subclavian and the right internal jugular routes. Methods: Adult patients needing a tCDC will be included from several hospitals and randomised to either subclavian or internal jugular vein catheterisation with a silicone tCDC. Inclusion continues until 50 patients in each group have undergone a follow-up CT venography. The primary outcome is the incidence of post-catheterisation central vein stenosis detected by a CT venography performed 1.5 to 3 months after removal of the tCDC. Secondary outcomes include between-group comparisons of (I) the patients’ experience of discomfort and pain, (II) any dysfunction of the tCDC during use, (III) catheterisation success rate and (IV) the number of mechanical complications. Furthermore, the ability to detect central vein stenosis by a focused ultrasound examination will be evaluated using the CT venography as golden standard. Discussion: The use of the subclavian route for tCDC placement has largely been abandoned due to older studies with various methodological issues. However, the subclavian route offers several advantages for the patient. This trial is designed to provide robust data on the incidence of central vein stenosis after silicone tCDC insertion in the era of ultrasound-guided catheterisations. Trial registration: Clinicaltrials.gov; NCT04871568. Prospectively registered on May 4, 2021.
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| 2. |
- Clyne, Naomi, et al.
(författare)
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Relationship between declining GFR and measures of cardiac and vascular autonomic neuropathy.
- 2015
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Ingår i: Nephrology. - : Wiley. - 1320-5358. ; 21:12, s. 1047-1055
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac and vascular autonomic neuropathy contributes to increased morbidity and mortality in patients with chronic kidney disease. The aim of this study was to analyze the effects of a decline in GFR on heart rate variability (HRV) and nocturnal blood pressure dipping.
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| 3. |
- Hellberg, Matthias, et al.
(författare)
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Comparing effects of 4 months of two self-administered exercise training programs on physical performance in patients with chronic kidney disease : RENEXC - A randomized controlled trial
- 2018
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:12
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Tidskriftsartikel (refereegranskat)abstract
- Background Exercise training is recommended to patients with chronic kidney disease (CKD). However, the level of evidence is still low. This randomized controlled trial (RCT) compared two different and self-administered exercise training programs in a representative CKD population. Methods This single centre RCT included 151 non-dialysis dependent CKD patients, irrespective of age and comorbidity. Self-administered exercise training of 150 minutes per week was prescribed for 4 months and consisted of 60 minutes endurance training in combination with 90 minutes of either strength or balance training (strength versus balance group). Overall endurance (6-minute walk-test (6-MWT), stair climbing), muscular endurance (30-seconds sit-to-stand (30-STS), heel rises and toe lifts, handgrip (HGS) and isometric quadriceps (IQS) strength, balance (functional reach (FR) and Berg´s balance scale (BBS)) and fine motor skills (Moberg´s picking up test (MPUT)) were measured at baseline and after 4 months. Intention to treat analyses with mixed models was used. Results 53 women and 98 men, mean age 66 ± 14: range 19 to 87 years, eGFR 20 ± 7: range 8 to 48 ml/min/1.73m2 participated. The strength group (n = 76) improved significantly in 6-MWT, stair climbing, 30-STS, heel rises right and left, toe lifts right, IQS right and left, and MPUT with closed eyes with the right and left hand. The balance group (n = 75) improved significantly in heel rises right and left, IQS left, BBS and left-handed MPUT with open and closed eyes. A significant effect between the groups was found for IQS right.
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| 4. |
- Hellberg, Matthias, et al.
(författare)
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Decline in measured glomerular filtration rate is associated with a decrease in endurance, strength, balance and fine motor skills
- 2017
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Ingår i: Nephrology. - : Wiley. - 1320-5358. ; 22:7, s. 513-519
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Physical performance in chronic kidney disease affects morbidity and mortality. The aim was to find out which measures of physical performance are important in CKD and if there are associations with declining measured GFR.METHODS: Endurance was assessed by 6-minute walk test (6-MWT) and stair climbing, muscular endurance by 30-seconds sit to stand, heel rises and toe lifts, strength by quadriceps- and handgrip strength, balance by functional reach and Berg´s balance scale, and fine motor skills by Moberg´s picking-up test. GFR was measured by Iohexol clearance.RESULTS: The study comprised 101 patients with CKD 3b-5 not started dialysis, 40 women and 61 men, with a mean age of 67 ± 13 (range: 22 - 87) years. All measures of physical performance were impaired. A decrease in GFR of 10 ml/min/1.73 m(2) corresponded to a 35 metre shorter walking distance in the 6-MWT. Multivariable linear regression analysis showed significant relationships between decline in GFR and the 6-MWT (p = 0.04), isometric quadriceps strength left (p = 0.04), balance measured as functional reach (p = 0.02) and fine motor skills in the left hand as measured by Moberg´s picking-up test (p = 0.01), respectively, after sex, age, comorbidity and the interaction between sex and age had been taken into account.CONCLUSION: Endurance, muscular endurance, strength, balance and fine motor skills were impaired in patients with CKD 3b-5. Walking capacity, isometric quadriceps strength, balance, and fine motor skills were associated with declining GFR. The left extremities were more susceptible to GFR, ageing and comorbidities and seem thus to be more sensitive.
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| 7. |
- Hellberg, Matthias, et al.
(författare)
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Randomized Controlled Trial of Exercise in CKD—The RENEXC Study
- 2019
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Ingår i: Kidney International Reports. - : Elsevier BV. - 2468-0249. ; 4:7, s. 963-976
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Home-based, clinically feasible trials in non–dialysis-dependent patients with chronic kidney disease (CKD) are sparse. We compared the effects of 2 different exercise training programs on physical performance, and measured glomerular filtration rate (mGFR) and albuminuria level in patients with CKD stages 3 to 5. Methods: This is a single-center, randomized controlled trial (RCT) comprising 151 patients (mGFR: 22 ± 8 ml/min per 1.73 m 2 ; age 66 ± 14 years) randomized to either balance or strength training. Both groups were prescribed 30 minutes of exercise per day for 5 days per week for 12 months, comprising 60 minutes per week of endurance training and 90 minutes per week of either strength or balance exercises. The exercises were individually prescribed, and the intensity was monitored with Borg's rating of perceived exertion (RPE). Results: There were no treatment differences for any of the primary outcomes measuring physical performance. The strength and balance groups showed significantly increased effect sizes after 12 months for the following: walking (31 m and 24 m, P < 0.001) and the 30-second sit-to-stand test (both: 1 time, P < 0.001); quadriceps strength (right/left: strength 1.2/0.8 kg*m, P < 0.003; balance 0.6/0.9, P < 0.01); functional reach (both: 2 cm, P < 0.01); and fine motor skills (open/closed eyes, right/left, both: between 0.3 and 4 seconds faster, P < 0.05). After 12 months, there was a significant treatment difference for albuminuria (P < 0.02), which decreased by 33% in the strength group. In both groups, mGFR declined by 1.8 ml/min per 1.73 m 2 . Conclusion: Our primary hypothesis that strength training was superior to balance training was not confirmed. Within groups, 12 months of exercise training resulted in significant improvements in most measures of physical performance. Measured GFR declined similarly in the 2 groups. The strength group showed a significant decrease in albuminuria.
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| 8. |
- Hellberg, Matthias, et al.
(författare)
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Small Distal Muscles and Balance Predict Survival in End-Stage Renal Disease.
- 2014
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Ingår i: Nephron Clinical Practice. - : S. Karger AG. - 1660-2110. ; 126:3, s. 116-123
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Survival for patients on renal replacement therapy (RRT) has been shown to correlate to the level of physical activity and exercise capacity. We examined whether composite measures of functional status at the start of RRT predict survival. Methods: In this retrospective study, the same physiotherapist, using a standardized battery of tests for functional status, tested 134 patients at the start of RRT. Results: At the end of the observation period, 112 patients (84%) were still alive. Age (p < 0.0001), co-morbidity (p = 0.028), hand grip strength (right: p = 0.0065; left: p = 0.0039), standing heel rise (right: p = 0.011; left: p = 0.004) and functional reach (p = 0.015) were significant predictors of survival. After adjustment for sex, age and co-morbidity, hand grip strength left (p = 0.023) was a significant predictor of survival. Conclusion: Hand grip strength, standing heel rise and functional reach at the start of RRT seem to affect survival. A 50% reduction in hand grip strength left was associated with an almost 3-fold increase in mortality. Deterioration of function in small distal muscles and balance may be early signs of uraemic myopathy. A relatively simple and clinically feasible battery of tests can help detect patients at risk. © 2014 S. Karger AG, Basel.
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| 9. |
- Petrauskiene, Vaida, et al.
(författare)
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Bone mineral density after exercise training in patients with chronic kidney disease stages 3 to 5 : a sub-study of RENEXC—a randomized controlled trial
- 2024
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Ingår i: Clinical Kidney Journal. - 2048-8505. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background. We evaluated the effects of 12 months of exercise training on bone mineral density (BMD) in patients with chronic kidney disease (CKD) stages 3–5 not on kidney replacement therapy (KRT). Methods. A total of 151 patients were randomized to 12 months of either balance or strength training, both together with endurance training. Some 112 patients completed and 107 (69 men, 38 women) were analysed, with a mean age 66 ± 13.5 years and 31% having diabetes. The exercise training was self-administered, prescribed and monitored by a physiotherapist. Total body, hip and lumbar BMD, T score and Z score were measured at baseline and after 12 months using dual energy X-ray absorptiometry. Results. Both groups showed increased physical performance. The prevalence of osteoporosis and osteopenia was unchanged. The strength group (SG) decreased total body BMD (P < .001), the balance group (BG) increased total body T score (P < .05) and total body Z score (P < .005). Total body ∆T score was negative in the SG and unchanged in the BG (P < .005). Total body ∆Z score was negative in the SG and positive in the BG (P < .001). The proportion of progressors measured by ∆T (P < .05) and ∆Z scores (P < .05) was significantly lower in the BG compared with the SG. In multivariate logistic regression analysis, belonging to the BG was the only factor with a lower risk of deterioration of total body BMD, T and Z scores. Conclusions. Twelve months of balance training together with endurance training seemed to be superior to strength training in maintaining and improving BMD in patients with CKD not on KRT.
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