Hristea Dan, Deschamps Thibault, Paris Anne, Lefrançois Gaëlle, Collet Valérie, Savoiu Corneliu, Ozenne Sophie, Coupel Stéphanie, Testa Angelo, Magnard Justine
Dialysis Unit Laënnec, ECHO Association, Nantes, France.
Laboratory MIP (UPRES-EA4334), University of Nantes, France.
Nephrology (Carlton). 2016 Sep;21(9):785-90. doi: 10.1111/nep.12752.
Protein-energy wasting (PEW), defined as a loss of body protein mass and fuel reserves, is a powerful predictor of adverse outcomes in haemodialysis (HD) patients. Robust arguments suggest that intra-dialytic exercise, combined with oral/parenteral nutrition, enhances the effect of nutritional interventions in HD patients. This pilot randomized controlled trial investigated the feasibility and the effects of a 6 month intra-dialytic cycling program combined to a nutritional support on PEW, physical functioning (gait, balance, muscle strength) and quality of life (QoL) in older HD patients (mean age 69.7 ± 14.2 years).Twenty-one patients fulfilling diagnostic criteria of PEW were randomly assigned to Nutrition-Exercise group (GN-Ex , n = 10) or Nutrition group (GN , n = 11). Both groups received nutritional supplements in order to reach recommended protein and energy intake goals. In addition GN-Ex completed a cycling program. No significant difference between groups was found in the number of patients having reached remission of PEW. Likewise, no change was observed in serum-albumin, -prealbumin, C-reactive protein, body mass index, lean- and fat-tissue index, or quadriceps force. Interestingly, we found positive effects of exercise on physical function and QoL for the GN-Ex , as evidenced by a significant improvement in the 6-min walk test (+22%), the absence of decline in balance (unlike the GN ), and a noteworthy increase in QoL (+53%). Combining intra-dialytic exercise and nutrition in HD patients is feasible, and well accepted, improves physical function and QoL but it appears not to have the potential to reverse PEW.
蛋白质能量消耗（PEW）被定义为身体蛋白质质量和能量储备的损失，是血液透析（HD）患者不良预后的有力预测指标。有力的论据表明，透析期间运动与口服/肠外营养相结合，可增强HD患者营养干预的效果。这项前瞻性随机对照试验研究了一项为期6个月的透析期间骑行计划联合营养支持对老年HD患者（平均年龄69.7±14.2岁）PEW、身体功能（步态、平衡、肌肉力量）和生活质量（QoL）的可行性和影响。21名符合PEW诊断标准的患者被随机分配到营养-运动组（GN-Ex，n = 10）或营养组（GN，n = 11）。两组均接受营养补充剂，以达到推荐的蛋白质和能量摄入目标。此外，GN-Ex组完成了骑行计划。在达到PEW缓解的患者数量上，两组之间未发现显著差异。同样，血清白蛋白、前白蛋白、C反应蛋白、体重指数、瘦组织和脂肪组织指数或股四头肌力量均未观察到变化。有趣的是，我们发现运动对GN-Ex组的身体功能和QoL有积极影响，6分钟步行试验显著改善（+22%）、平衡能力无下降（与GN组不同）以及QoL显著提高（+53%）证明了这一点。在HD患者中联合透析期间运动和营养是可行的，并且易于接受，可改善身体功能和QoL，但似乎没有逆转PEW的潜力。
