Impact of pre-transplant time on dialysis on survival in patients with lupus nephritis

Lupus nephritis (LN) is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) often leading to end-stage renal failure (ESRF) and necessitating renal transplantation (rTp). Optimal timing of rTp in SLE patients with ESRF is uncertain and could potentially affect survival. We investigated the time spent on dialysis before rTp and survival following rTp in a cohort of SLE patients. Retrospective analysis of all adult SLE patients receiving rTp over a 40-year period (1975–2015) in two tertiary UK centres. Cox proportional hazard regression and receiver operator curves (ROC) were used to determine the risk associated with time on dialysis before rTp and other potential predictors. Forty patients (age 35 ± 11 years, 34 female, 15 Caucasian, 15 Afro–Caribbean and 10 South Asian) underwent rTp. During a median follow-up of 104 months (IQR 80,145), eight (20%) patients died and the 5-year survival was 95%. Univariate analysis identified time on dialysis prior to rTp as the only potentially modifiable risk predictor of survival with a hazard ratio of 1.013 for each additional month spent on dialysis (95% CI = 1.001–1.026, p = 0.03). ROC curves demonstrated that > 24 months on dialysis had an adverse effect with sensitivity of 0.875 and specificity 0.500 for death. No other modifiable predictors were significantly associated with mortality, indicating that time on dialysis had an independent effect. Increased time on dialysis pre-transplantation is an independent modifiable risk factor of mortality in this cohort of patients with lupus nephritis

Effects of functional resistance training on muscle strength and musculoskeletal discomfort

Abstract Introduction: Functional resistance training (FRT) is becoming increasingly popular to improve physical fitness of practitioners, however, yet there are gaps in knowledge about effectiveness of FRT in relation conventional resistance training (CRT) in several ambits, as musculoskeletal complaints. Objective: Compare the effect of FRT and CRT in the musculoskeletal discomfort and magnitude of gain in muscle strength in healthy women. Methods: 52 women was divided into three groups, FRT (n = 15; 22 ± 2.35 years): functional resistance training; CRT (n = 14; 22.5 ± 1.78 years): conventional resistance training and CG (n = 13; 20.6 ± 1.10 years): no type of intervention. The training was periodized in 30 sessions over 12 weeks with 3 sessions per week. For the muscle strength variable used the 1RM test and for the musculoskeletal discomfort variable, the Nordic Musculoskeletal Questionnaire (NMQ). Regarding the statistical analysis, all results took into consideration a 5% level of significance. Results: Considerable gain in muscle strength was observed for all exercises in both training groups. In addition, there was a tendency in CRT to relate a more musculoskeletal discomfort; presented 27.3% more complaints compared FRT in the MNQ. Conclusion: The FRT was as effective as the CRT for improving muscle strength, furthermore, there was a tendency for FRT to cause less musculoskeletal discomfort