Kronik böbrek hastalarında solunum kas kuvveti, egzersiz kapasitesi ve fizyolojik harcama indeksinin değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı evre 3 kronik böbrek hastalığı olan bireylerde solunum kas kuvveti, egzersiz kapasitesi ve fizyolojik harcama indeksini değerlendirmek idi. Yöntem: Yirmi dört evre 3 kronik böbrek hastası (46,21±9,48 yıl, 13 kadın (%54,2), 11 erkek (%45,8)) retrospektif olarak incelendi. Solunum kas kuvveti (maksimal inspiratuar basınç ve ekspiratuar basınç) ağız basıncı ölçüm cihazı, egzersiz kapasitesi 6 dakika yürüme testi ve enerji harcaması fizyolojik harcama indeksi ile değerlendirildi. Bulgular: Kronik böbrek hastalarının %62,5’inde inspiratuar kas zayıflığı (81,29±17,74 cmH2O), %79,17’sinde egzersiz kapasitesinde azalma (501,92±58,50 metre) ve %75’inde artmış fizyolojik harcama indeksi (0,47±0,13 atım/metre) vardı. Sonuç: Hastalığın erken evrelerinde olmalarına rağmen evre 3 kronik böbrek hastalarının solunum kas kuvveti ve egzersiz kapasitesinin azaldığı, enerji harcamasının ise arttığı görülmüştür. Bu hastalarda solunum kas ve aerobik egzersiz eğitimi ile solunum kas kuvveti, egzersiz kapasitesi ve enerji harcamasında gelişme sağlanabilir.

Keywords

• Egzersiz kapasitesi
• Kronik böbrek hastalığı
• Solunum kasları

Evaluation of respiratory muscle strength, exercise capacity, and physiological cost index in patients with chronic kidney disease

Abstract

Purpose: The purpose of this study was to evaluate respiratory muscle strength, exercise capacity and physiological cost index in individuals with stage 3 chronic kidney disease. Methods: Twenty-four stage 3 chronic kidney disease patients (46.21±9.48 years, 13 female (54.2 %), 11 male (45.8 %)) were reviewed, retrospectively. Respiratory muscle strength (maximal inspiratory pressure and expiratory pressure) was evaluated by a mouth pressure device, exercise capacity by 6-minute walk test and energy expenditure by physiological cost index. Results: The 62.5 % of chronic kidney disease patients had inspiratory muscle weakness (81.29±17.74 cmH2O), 79.17 % had decreased exercise capacity (501.92±58.50 meters), and 75 % had increased physiological cost index (0.47±0.13 beats/meters). Conclusion: Although they are in the early stages of the disease, patients with stage 3 chronic kidney disease have diminished respiratory muscle strength and exercise capacity, and enlarged energy expenditure. In these patients, respiratory muscle and aerobic exercise training can improve respiratory muscle strength, exercise capacity and energy expenditure.

Keywords

• Exercise capacity
• Chronic kidney disease
• Respiratory muscles

References

1. Qaseem A, Hopkins RH Jr, Sweet DE, et al. Clinical Guidelines Committee of the American College of Physicians. Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159:835-847.
2. Kowal G, Rydzewski A. The effects of respiratory muscle training in chronic kidney disease patients on haemodialysis and peritoneal dialysis: a review. Medical Studies/Studia Medyczne. 2018; 34: 78-85.
3. de Souza Rezende P, Porcher Andrade F, Ferraro Dos Santos Borba C, et al. Pulmonary function, muscle strength, and quality of life have differed between chronic kidney disease patients and healthy individuals. Ther Apher Dial. 2022 ;26:337-344.
4. Faria Rde S, Fernandes N, Lovisi JC, et al. Pulmonary function and exercise tolerance are related to disease severity in pre-dialytic patients with chronic kidney disease: a cross-sectional study. BMC Nephrol. 2013;14:184.
5. Pei G, Tang Y, Tan L, et al. Aerobic exercise in adults with chronic kidney disease (CKD): a meta-analysis. Int Urol Nephrol. 2019 ;51:1787-1795.
6. Wallin H, Asp AM, Wallquist C, et al. Gradual reduction in exercise capacity in chronic kidney disease is associated with systemic oxygen delivery factors. PLoS One. 2018;13:e0209325.
7. Sugiura H, Ohta K, Minatani S, et al. Relationship between respiratory muscle strength and exercise tolerance. J Phys Ther Sci. 2009;21:393-397.
8. MacGregor J. The evaluation of patient performance using long-term ambulatory monitoring technique in the domiciliary environment. Physiotherapy. 1981;67:30-33.

9. Vllasolli TO, Orovcanec N, Zafirova B, et al. Physiological cost index and comfort walking speed in two level lower limb amputees having no vascular disease. Acta Inform Med. 2015;23:12-17.
10. Pella E, Boutou A, Theodorakopoulou MP, et al. Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice. Am J Nephrol. 2021;52:264-278.
11. Kirkman DL, Muth BJ, Stock JM, Townsend RR, et al. Cardiopulmonary exercise testing reveals subclinical abnormalities in chronic kidney disease. Eur J Prev Cardiol. 2018;25:1717-1724.
12. Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158:825-830.
13. Laveneziana P, Albuquerque A, Aliverti A, et al. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J. 2019;53:1801214.
14. Sclauser Pessoa IM, Franco Parreira V, Fregonezi GA, et al. Reference values for maximal inspiratory pressure: a systematic review. Can Respir J. 2014;21:43-50.
15. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-117.
16. Gibbons WJ, Fruchter N, Sloan S, et al. Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil. 2001;21:87-93.
17. Burr JF, Bredin SS, Faktor MD, et al. The 6-minute walk test as a predictor of objectively measured aerobic fitness in healthy working-aged adults. Phys Sportsmed. 2011;39:133-139.
18. Figueiredo PH, Lima MM, Costa HS, et al. The role of the inspiratory muscle weakness in functional capacity in hemodialysis patients. PLoS One. 2017;12:e0173159.
19. Dipp T, Silva AMV, Signori LU, et al. Respiratory muscle strength and functional capacity in end-stage renal disease (ESRD). Rev Bras de Medicina do Esporte. 2010; 16:246-249.
20. de Medeiros AIC, Fuzari HKB, Rattesa C, et al. Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. J Physiother. 2017;63:76-83.
21. Yuenyongchaiwat K, Namdang P, Vasinsarunkul P, et al. Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: A randomized control trial. Physiother Res Int. 2021;26:e1879.
22. Dipp T, Macagnan FE, Schardong J, et al. Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomized controlled trial. Braz J Phys Ther. 2020;24:280-286.
23. Medeiros AIC, Brandão DC, Souza RJP, et al. Effects of daily inspiratory muscle training on respiratory muscle strength and chest wall regional volumes in haemodialysis patients: a randomised clinical trial. Disabil Rehabil. 2019;41:3173-3180.
24. Pellizzaro CO, Thomé FS, Veronese FV. Effect of peripheral and respiratory muscle training on the functional capacity of hemodialysis patients. Ren Fail. 2013;35:189-197.
25. Campos NG, Marizeiro DF, Florêncio ACL, et al. Effects of respiratory muscle training on endothelium and oxidative stress biomarkers in hemodialysis patients: A randomized clinical trial. Respir Med. 2018;134:103-109.
26. Kohl Lde M, Signori LU, Ribeiro RA, et al. Prognostic value of the six-minute walk test in end-stage renal disease life expectancy: a prospective cohort study. Clinics (Sao Paulo). 2012;67:581-586.
27. Bučar Pajek M, Čuk I, Leskošek B, et al. Six-Minute Walk Test in Renal Failure Patients: Representative Results, Performance Analysis and Perceived Dyspnea Predictors. PLoS One. 2016;11:e0150414.
28. Kono K, Nishida Y, Moriyama Y, et al. Investigation of factors affecting the six-minute walk test results in hemodialysis patients. Ther Apher Dial. 2014;18:623-627.
29. Nakamura K, Sasaki T, Yamamoto S, et al. Effects of exercise on kidney and physical function in patients with non-dialysis chronic kidney disease: a systematic review and meta-analysis. Sci Rep. 2020;10:18195.
30. Mehta JN, Gupta AV, Raval NG et al. Physiological cost index of different body mass index and age of an individual. Natl J Physiol Pharm Pharmacol. 2017; 7:1313-1317.
31. Bozdemir Ozel C, Arıkan H, Demirtaş RN, et al. Tip 2 diyabetli bireylerde fizyolojik harcama indeksi, fonksiyonel kapasite ve klinik belirteçler. Osmangazi Tıp Dergisi. 2020;42:652-658.
32. Pawar JS, Shukla S, Jain H, et al. Effect of aerobic exercise training on energy expenditure by physiological cost index in obese individuals. Indian J Physiother Occup Ther. 2020;14:280.