End Stage Renal Failure on Dialysis
Conditions
Keywords
hemodialysis, dialysis efficacy, cardiorespiratory capacity, exercise capacity, children and adolescents
Brief summary
Physical activity is considered essential for optimal health, development, socialization and well-being of children. However patients with end-stage renal disease (ESRD) are often restricted from participation in exercise activities. This is especially true for children on hemodialysis (HD). As a consequence their exercise capacity is reduced, both before, but most impressively after HD. In a nationwide randomized, multi-center design this study aims to proof the influence of an individualised endurance training program by bicycle ergometer performed during dialysis on the efficacy of HD, measured as single pool Kt/V. Secondary goals are to enhance physical performance, physical and mental well-being, and to improve measurable blood and treatment parameters (e.g. haemoglobin level, amount of medication). A positive impact of physical activity was observed in adults on HD, although most studies did not address this issue in a randomised protocol. Despite this beneficial evidence in adults, sport is still not integrated as part of standard care in patients on maintenance HD. The study protocol, developed in close collaboration with the German Sport University Cologne, differs substantially from previously published reports as it uses bicycle ergometer training in an upright position outside the dialysis couch and adapts the intensity of intervention to the patient's capabilities. Based on the expected results the investigators will develop an individualised training program to be integrated in the standard care of (pediatric) patients on maintenance HD.
Interventions
OTHERBicycle-Ergometer Training
Performance adapted, hence individualised three times weekly bicycle-ergometer training during hemodialysis. Each training will last 30 to 50 minutes with 70-80% of the patient specific maximum workload over 12 weeks (36 training sessions - first part of the study compared to no intervention). In the second part of the study both groups get the opportunity for another 12 weeks of individualised three times weekly bicycle-ergometer training during hemodialysis.
Sponsors
German Sport University, Cologne
University Hospital, Bonn
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
6 Years to 19 Years
Healthy volunteers
No
Inclusion criteria
* End stage renal disease with need of renal replacement therapy * children and adolescents aged ≥6 to ≤19 years * maintenance hemodialysis for at least 3 months * Stable and appropriate dialysis condition in the last 4 weeks before inclusion to the study (basically stable blood and dialysate flow rate and same dialyser) * single pool Kt/V according to Dialysestandard 2006 \> 1.2 * Informed consent
Exclusion criteria
* Participation in another interventional clinical trial * severe primary neurologic, orthopaedic or cardiac disease, or secondary disease known as a contraindication for endurance training * uncontrolled hyper- or hypotension, or cardiac disease * Recurrent uncontrolled epileptic seizures * dialysis shunt at the lower limbs * pregnancy * already planned medical intervention, for example living donor kidney transplantation or any other surgery, within the first period of the trial which will cause cancelation of more then 3 training units in a row * Subjects who are in dependency to the sponsor or the PI of the trial, or confined to an institution on judicial or official behalf
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change of single pool Kt/V (KDOQI Guidelines) - expressed as the change of single pool Kt/V from week 0 to 12 of intervention (period 1) | 12 weeks | Change of single pool Kt/V (spKt/V) measured at week 12 (V1) compared to baseline (V0). Single pool Kt/V is the standard measure to assess dialysis efficacy. As dialysis efficacy is the primary aim of dialysis treatment and the spKt/V is the best way to measure efficacy this figure has an important clinical relevance for the patient. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of Life | 12 and 24 weeks | For quality of life assessment the validated and standardized PedsQL® questionnaires will be filled in by patients and parents. |
| Change of solute removal during hemodialysis | 12 and 24 weeks | Solute removal during hemodialysis has a clear impact on the patient's health and well-being, as it reduces sequelae and offers the patient less restrictions on their diet, which would lead to a better compliance. |
| Change of solute removal in the two compartment model (assessed in a subgroup of patients) | 12 and 24 weeks | Solute removal in the two compartment model will only be analyzed in patients 12 years of age or older with explicit consent to a second blood drawing 30 minutes after end of hemodialysis session. It was previously used showing a significant enhancement during exercise, explained by an increase of skeletal muscles perfusion during exercise. |
| Change of the possible workload (maximum physical performance) achieved | 12 and 24 weeks | The maximal possible workload will be determined by an exercise evaluation program with increasing power on a leg bicycle ergometer before a hemodialysis session, measuring the peak oxygen uptake (VO2-peak), heart rate, blood pressure and lactate levels during exercise. |
| Body Composition Monitoring (BCM) | 12 and 24 weeks | Body Cpomposition Monitoring (BCM) will be performed to exermine further information on nutrional status, overhydration and muscle growth. |
| Change of number and dose of medication needed | 12 and 24 weeks | Number and dose of medication will be recorded, changes will be evaluated, and data will be correlated to e.g. the measured blood pressure (antihypertensive drugs) or haemoglobin levels (EPO or EPO stimulating agents). |
| Telomere length and Telomerase activity | 12 and 24 weeks | Telomere length and telomerase activity \[units\] will be used as markers for cell survival, which may be influenced by endurance training. |
| Inflammation, nutritional status and bone metabolism | 12 and 24 weeks | The nutritional status and bone metabolism will be determined as they are important for optimal health and growth of paediatric hemodialysis patients. Evidence is based on studies that showed trends towards a better nutritional status and less chronic inflammation. |
Countries
Germany
Outcome results
None listed