@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2016;22(1):35-41

Background
… [1-23] Through liquid transfer, isotonic and isometric movements can control blood pressure and prevent hypotension and cramp [24].
Previous Studies
There are few studies about the effects of simple movements and isotonic movements with isometrics on the criterion of dialysis adequacy.
Aim(s)
The aim of this study was to determine the effects of simultaneous isotonic and isometric movements during hemodialysis on dialysis adequacy of hemodialysis patients.
Research type
This is a clinical trial study.
Research society, place and time
Hemodialysis patients were studied in two hemodialysis centers of Gonabad and Ghayen Townships (Iran) in 2014.
Sampling method and number
50 patients were selected through simple random sampling method. Based on a pilot study, sample size of each group was estimated 22 persons.
Used devices&materials
Data was collected, using a demographic questionnaire assessing age, gender, job, education level, marriage status, and smoking history, and the register form of measuring dialysis adequacy containing the patient’s weight before dialysis, the patient’s weight after dialysis, hemodialysis length, the device ultrafiltration level, filter clearance rate, hemodialysis solvent speed, urea before hemodialysis, and urea after hemodialysis. In experiment group, simultaneous isotonic and isometric activities were done and the intensity of the activities was being adapted according to the patient’s ability. The activities were successively done from up to down parts of the body structure as semi-sitting and supine positions on the bed by the patient. The activities included flexion and extension of the non-dominant hand and knee, adduction and abduction in the neck, hand, and legs, and internal rotation- external rotation in wrist and ankle. Every sport activity was repeated 5-10 times. The program was conducted during hemodialysis for 6 weeks and 3 sessions a week. Dialysis adequacy was measured at the end of the 6th week in both groups. There was no sport activity for control group in the interval (6 weeks). To determine dialysis adequacy, a form was completed by the researcher before intervention and at the end of the 6th week in both groups. Urea level was measured before hemodialysis via sampling from artery. After hemodialysis and before separating the patient from the device, blood sampling was done through artery set before the dialyzer. Dialysis adequacy was computed before and after the intervention, using kt/v software. Kt/v equal to 1.2 or more was assessed as dialysis adequacy criterion. Data was analyzed, using SPSS 14.5 software. To investigate the correlation between dialysis adequacy and personal characteristics (gender, marital status, resident place, and smoking history) Independent T test was used. Chi-square test was used to compare gender, education level, marital status, resident place, age, and dialysis adequacy in both groups. Pearson Correlation Coefficient was used to determine the correlation between age and the mean score of dialysis adequacy. Spearman test was used to investigate the correlation between dialysis adequacy and education level.
Findings by Text
30 persons (60.0%) and 20 persons (40.0%) were male and female, respectively. 36 persons (72.0%) were married. 30 persons (60.0%) were self-employed. 8 persons (16.0%) were smoking. The mean age was 49.94±16.37years. The mean length of treatment with hemodialysis was 3.78±2.05years. There were no significant differences between the groups in gender, education level, marital status, resident place, and age (Table 1). There was no significant difference between the groups in dialysis adequacy before the intervention, and the groups were homogeneous. Nevertheless, there was a significant difference between the groups. In experimental group and before the intervention, the dialysis adequacy score was less than 1.2, while the percentage reached 40% after the intervention. However, in control group, the number of the patients with dialysis adequacy less than 1.2 varied from 72% to 76% (Table 2). There was a significant correlation between dialysis adequacy and gender and marital status, showing a significant higher mean score of dialysis adequacy in females and single persons than males and married persons. However, there was no significant correlation between dialysis adequacy and resident place and smoking history. Nevertheless, dialysis adequacy in smoking persons and city resident persons was as 0.1 less than non-smoking persons and those who live in the countries. There were no significant correlations between dialysis adequacy and age and between dialysis adequacy and education level.
Main comparison to the similar studies
In the present study, mean kt/v value reached 1.30 from 1.09, which was acceptable [25]. There has been a significant increase in the dialysis adequacy level (20.0%) after sport activities using stationary bikes or ergometers during hemodialysis [15]. There has been an increase (20%) in the dialysis adequacy level after a 2-month sport course using stationary bikes, which is not significant. However, the increase in kt/v from 1.03 to 1.25 is clinically important [20]. Regular sport exercises during hemodialysis lead to higher bodily activities and a reduction in muscular atrophy. Nevertheless, they have no significant effects on the quality of dialysis [7]. … [26] Dialysis adequacy in females was significantly higher than males. There has been a higher dialysis adequacy in females than the male patients, and there is a significant difference between dialysis adequacy and gender [11, 12, 27]. There is no significant correlation between gender and dialysis adequacy [28]. Dialysis adequacy in single persons was significantly higher than married persons. The result has not been reported by other studies. … [29]
Suggestions
More and two-blended studies should be done to investigate the general effects of sport activities.
Limitations
Lack of enough samples, weak control on intervening parameters, and not enough facilities to monitor the patients during sport were of the limitations for the present study.
Conclusions
Simultaneous isotonic and isometric activities during hemodialysis can improve dialysis adequacy in patients with chronic renal failure.
Acknowledgments
The staffs of Gonabad 22 Bahman and Shohada-ye Ghayen Hospitals are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
The study was confirmed by Regional Research Ethics Committee of Gonabad University of Medical Sciences.
Funding Sources
The study was funded by Research Deputy of Gonabad University of Medical Sciences.

TABLES and CHARTS

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