Aditi Patwardhan

Progressive Exercise for Anabolism in Kidney Disease (PEAK): A Randomized, Controlled Trial of Resistance Training during Hemodialysis

Skeletal muscle wasting is common and insidious in patients who receive maintenance hemodialysis treatment for the management of ESRD. The objective of this study was to determine whether 12 wk of high-intensity, progressive resistance training (PRT) administered during routine hemodialysis treatment could improve skeletal muscle quantity and quality versus usual care. Forty-nine patients (62.6 +/- 14.2 yr; 0.3 to 16.7 yr on dialysis) were recruited from the outpatient hemodialysis unit of the St. George Public Hospital (Sydney, Australia). Patients were randomized to PRT + usual care (n = 24) or usual care control only (n = 25). The PRT group performed two sets of 10 exercises at a high intensity (15 to 17/20 on the Borg Scale) using free weights, three times per week for 12 wk during routine hemodialysis treatment. Primary outcomes included thigh muscle quantity (cross-sectional area [CSA]) and quality (intramuscular lipid content via attenuation) evaluated by computed tomography scan. Secondary outcomes included muscle strength, exercise capacity, body circumference measures, proinflammatory cytokine C-reactive protein, and quality of life. There was no statistically significant difference in muscle CSA change between groups. However, there were statistically significant improvements in muscle attenuation, muscle strength, mid-thigh and mid-arm circumference, body weight, and C-reactive protein in the PRT group relative to the nonexercising control group. These findings suggest that patients with ESRD can improve skeletal muscle quality and derive other health-related adaptations solely by engaging in a 12-wk high-intensity PRT regimen during routine hemodialysis treatment sessions. Longer training durations or more sensitive analysis techniques may be required to document alterations in muscle CSA.

Investigation of skeletal muscle quantity and quality in end-stage renal disease

Aim:  A more precise understanding of the aetiology and sequelae of muscle wasting in end‐stage renal disease (ESRD) is required for the development of effective interventions to target this pathology.

Progressive resistance training during hemodialysis: Rationale and method of a randomized-controlled trial

Skeletal muscle wasting in patients receiving maintenance hemodialysis (HD) has been well documented. The rationale for prescribing progressive resistance training (PRT) in this cohort in an attempt to reverse this catabolism and induce a wide spectrum of physiological, functional, and psychological health‐related adaptations is extremely strong. Unfortunately, the barriers to exercise adoption in this cohort are many, which may explain the persisting sedentariness of this population and the lack of widespread clinical programs such as are now commonplace in cardiac rehabilitation and pulmonary rehabilitation units. Current health care practices for HD patients do not address the negative health issues of inactivity and muscle wasting. Therefore, we conducted the first randomized‐controlled trial to prescribe PRT during maintenance HD treatment. The purpose of this paper is to present the rationale and methodology that we utilized for implementing intradialytic PRT in a conventional outpatient HD clinic. Potential areas for modification of PRT regimens in this setting are also presented.

Evidence-based guidelines for the nutritional management of adult kidney transplant recipients.

OBJECTIVE The present article summarizes the key recommendations of the evidence-based guidelines developed for the nutritional management of adult kidney transplant recipients. BACKGROUND AND METHODS Nutrition interventions play an important role in preventing and managing common health problems associated with renal transplantation such as obesity, hypertension, diabetes, and cardiovascular disease. Two sets of guidelines were developed by a working group of renal dietitians and nephrologists. They were subject to expert panel review, and public consultation by renal clinicians and consumers before final endorsement by 2 authorities in Australia--Caring for Australasians with Renal Impairment (CARI) and Dietitians Association of Australia (DAA). Protocol and rigor of guideline development were previously described and published in the Journal of Renal Nutrition, 2009. RESULTS AND OUTCOMES These guidelines address 13 priority topics identified by the renal community and complement each other with different emphasis, from research translation to day to day clinical practice recommendations. The published guidelines are available to the public through web-access of CARI and DAA, and journal publications. Information includes the guidelines themselves with level of evidence stated, grading of recommendations, suggestions for clinical care, search strategy, background and summary of evidence, recommendations of other guidelines, practice recommendations, appendices of useful tools, and suggestions for audits and future research. CONCLUSIONS Two sets of comprehensive evidence-based nutrition guidelines from CARI and DAA are now available to help improve health outcomes of adult kidney transplant recipients.

Development of Evidence-Based Guidelines for the Nutritional Management of Adult Kidney Transplant Recipients

OBJECTIVE This article documents the development of evidence-based guidelines for the nutritional management of adult kidney transplant recipients. Dietary interventions play an important role in preventing and managing common post-transplant health problems, such as cardiovascular disease and diabetes. However, there are currently no comprehensive, evidence-based guidelines for the nutritional management of kidney transplant recipients. METHODS AND RESULTS Thirteen guideline topics were identified, including obesity, diabetes, dyslipidemia, and bone disease, following broad consultation with clinicians and transplant recipients in Australia and New Zealand. A systematic review of the scientific literature was undertaken, the protocol for which is published in the Cochrane Library. The evidence was graded and synthesized, and evidence-based recommendations formulated consistent with National Health and Medical Research Council of Australia standards. A total of 119 scientific papers were assessed. CONCLUSION There was no level I or II evidence to support any guideline; however, there was sufficient level III and IV evidence to support Grade C and D recommendations for six guideline topics. Experts from 18 transplant units in Australia and New Zealand were consulted to generate consensus-based recommendations for the remaining seven topics, using the Delphi method. Using evidence from a comprehensive literature search and expert opinion, guidelines that represent current best practice have been produced. These guidelines have been evaluated in transplant units throughout Australia and New Zealand and have been submitted to the Dietitians Association of Australia (DAA) and Caring for Australasians with Renal Impairment (CARI) for endorsement.

Nutritional management of overweight and obesity in adult kidney transplant recipients

Date written: June 2008

Nutritional management of diabetes mellitus in adult kidney transplant recipients

Date written: June 2008

Nutritional management of hypertension in adult kidney transplant recipients

Date written: June 2008

Protein requirement in adult kidney transplant recipients

Date draft complete: June 2008

Food safety recommendations for adult kidney transplant recipients

Date written: June 2008