Domenico Giannese

Dialysis Exercise Team: The Way to Sustain Exercise Programs in Hemodialysis Patients

Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involvement of exercise professionals, b) real commitment of nephrologists and dialysis professionals, c) individual patient adaptation of the exercise program. Dialysis staff have a crucial role to encourage and assist patients during intra-dialysis exercise, but other professionals should be included in the ideal “exercise team” for dialysis patients. Evaluation of general condition, comorbidities (especially cardiovascular), nutritional status and physical exercise capacity are mandatory to propose an exercise program, in either extra-dialysis or intra-dialysis setting. To this aim, nephrologist should lead a team of specialists and professionals including cardiologist, physiotherapist, exercise physiologist, renal dietician and nurse. In this scenario, dialysis nurses play a pivotal role since they guarantee a constant and direct approach. Unfortunately dialysis staff may often lack of information and formation about exercise management while they take care patients during the dialysis session. Building an effective exercise team, promoting the culture of exercise and increasing physical activity levels lead to a more complete and modern clinical care management of ESRD patients.

Long-term Functional Outcomes in Patients With a W-shaped Ileal Orthotopic Neobladder With No Antireflux Mechanism

OBJECTIVE To evaluate the long-term renal function, continence, and voiding function in 64 patients, surviving for 5 or more years after W-shaped ileal neobladder with a short afferent limb and refluxing ureterointestinal anastomoses. MATERIALS AND METHODS Kidney morphology and function were evaluated using nuclear renography, creatinine, and glomerular filtration rate. Continence and voiding function were evaluated with a diary on frequency, voided volumes, number of pads, and with the incontinence severity index (ISI) questionnaire, the American Urological Association-Symptom Index (AUA-SI), and the American Urological Association-Symptom Problem Index. RESULTS The renal scan showed a dilatation of the upper urinary tract in 4.8% of renoureteral units. Of the patients, 12.5% voided with intermittent or permanent catheterization. The remaining 87.5% voided spontaneously; 75% did not use pads, 12.5% used protection for safety, 7.1% 1 pad, and 5.4% more than 1 pad, during the day; during night, 55.3% did not use pads, 23.2% used protection for safety, and 12.6% and 8.9% 1 or more than 1 pad. The ISI questionnaire showed that 35.7% were fully continent, whereas 41%, 12.5%, and 10.8% had slight, moderate, and severe incontinence. The AUA-SI showed that 50% had mild, 39.3% moderate, and 10.7% severe lower urinary tract symptoms. Urinary incontinence, daytime frequency, and nocturia correlated positively with the age of patients at follow-up and negatively with voided volume. CONCLUSION Long-term detrimental effect on renal function of orthotopic neobladder with no antireflux anastomoses is limited. Long-term continence and voiding function results are satisfactory. The ISI questionnaire might be useful to evaluate and grade incontinence in patients with orthotopic neobladder, whereas the AUA-SI has many limitations.

Approaches to Minimize Delayed Graft Function in Renal Transplantation

Delayed graft function is a complication in the early posttransplant period that impacts the short and long-term graft outcome. It may be related to different factors that include center, recipient, or donor features. The etiology is still controversial, although different pathophysiologic mechanisms have been implicated. There is no effective treatment; however, early diagnosis and therapeutic interventions may reduce the consequence of this complication.

Physical activity in peritoneal dialysis: the opinion of the Nephrologists

At the 17th national meeting of the “Peritoneal dialysis” Study Group (Italian Society of Nephrology), held in Montecatini Terme (20–22 March, 2014), 141 physicians received a questionnaire to survey the opinion of the Italian Nephrologists on the issue of physical activity in peritoneal dialysis patients. All participants agreed on the benefits of physical activity and on the need for its implementation in dialysis patients. Overall, 90% of the participants considered physical activity as an important aspect of the clinical care management. Most of the Nephrologists (61%) believed that patients are interested in exercising and that they can improve their physical activity if motivated or stimulated by the dialysis staff. However, some warnings (by 85% of the physicians) emerged about the safety of physical activity in dialysis patients. Despite this, many Nephrologists believed they could be able to prescribe exercises to their patients. About 86% of the participants declared to give advices about physical activity, but only few of them (7%) provided written informative material or worked together with professionals in the field of physical activity care. In conclusion, the survey revealed that participants strongly believe that a sedentary lifestyle is deleterious and that physical activity should be implemented in peritoneal dialysis patients. However, this implementation seems to be rather difficult in real life. Therefore, it is highly desirable to create a scientific cooperation among specialists and health professionals of different fields to improve the physical activity and exercise programs of peritoneal dialysis patients.