Chan Christopher T, Notarius Catherine F, Merlocco Anthony C, Floras John S
Department of Medicine, University Health Network and Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Nephrol Dial Transplant. 2007 Nov;22(11):3285-91. doi: 10.1093/ndt/gfm368. Epub 2007 Jun 25.
Patients with end-stage renal disease (ESRD) have a reduced exercise capacity as assessed by peak oxygen uptake (VO2peak). Nocturnal haemodialysis (NHD) augments uraemic clearance and vascular responsiveness to nitric oxide and lowers blood pressure (BP) and peripheral resistance.
To assess the impact of NHD on exercise duration and capacity, 13 consecutive ESRD patients [age: 41 +/- 3; (mean +/- SEM)] and healthy normal subjects (n = 14) matched for age and body mass index exercised to peak effort (VO2peak) as determined by open-circuit spirometry during a graded cycle ergometer test with a ramp increase in work rate (by 17 watts/min).
Exercise was performed before, 2 and 3-6 months after conversion from conventional haemodialysis (CHD) (3 sessions per week; 4 h per session) to NHD (5-6 sessions per week; 6-8 h per session). Exercise duration increased progressively [from 617 +/- 50 (CHD) to 634 +/- 47 (NHD 2 months) to 682 +/- 55 [NHD 3-6 months], P = 0.03) as did exercise capacity, expressed as percent of predicted (based on age, sex and body size) VO2peak, [from 66 +/- 8 (CHD) to 72 +/- 6 (NHD 2 months) to 75 +/- 6% (NHD 3-6 months), P < 0.05).
Enhanced uraemia control by NHD improved both exercise duration and capacity. When coupled with augmented uraemia management, an increase in physical activity, perhaps due to more effective oxygen delivery or improved muscle metabolism, has the potential to improve the quality of life of patients with ESRD.
通过峰值摄氧量（VO2peak）评估，终末期肾病（ESRD）患者的运动能力下降。夜间血液透析（NHD）可增强尿毒症清除率以及血管对一氧化氮的反应性，并降低血压（BP）和外周阻力。
为评估NHD对运动持续时间和能力的影响，13例连续的ESRD患者[年龄：41±3；（均值±标准误）]和年龄及体重指数匹配的健康正常受试者（n = 14）在分级自行车测力计测试中，以工作率逐步增加（每分钟增加17瓦），通过开路肺量计确定达到峰值努力（VO2peak）进行运动。
在从常规血液透析（CHD）（每周3次；每次4小时）转换为NHD（每周5 - 6次；每次6 - 8小时）之前、转换后2个月和3 - 6个月进行运动。运动持续时间逐渐增加[从（CHD时）617±50增加到（NHD 2个月时）634±47再到（NHD 3 - 6个月时）682±55，P = 0.03]，运动能力也如此，以预测的（基于年龄、性别和体型）VO2peak的百分比表示[从（CHD时）66±8增加到（NHD 2个月时）72±6再到（NHD 3 - 6个月时）75±6%，P < 0.05]。
NHD增强尿毒症控制可改善运动持续时间和能力。当与强化的尿毒症管理相结合时，身体活动的增加，可能是由于更有效的氧气输送或改善的肌肉代谢，有可能改善ESRD患者的生活质量。
