Barriers to Physical Activity in Chronic Hemodialysis Patients: A Single-Center Pilot Study in an Italian Dialysis Facility

Background/Aims: In patients on chronic dialysis a sedentary lifestyle is a strong, yet potentially modifiable, predictor of mortality. The present single-center pilot study evaluated social, psychological and clinical barriers that may hinder physical activity in this population. Methods: We explored the association between barriers to physical activity and sedentarism in adult patients at a chronic dialysis facility in Parma, Italy. We used different questionnaries exploring participation in physical activity, physical functioning, patient attitudes and preferences, and barriers to physical activity perceived by either patients or dialysis doctors and nurses. Results: We enrolled 104 patients, (67 males, 65%), mean age 69 years (79% of patients older than 60 years); median dialysis vintage 60 months (range 8-440); mean Charlson score 5.55, ADL (Activities of Daily Living) score 5.5. Ninety-two participants (88.5%) reported at least one barrier to physical activity. At multivariable analysis, after adjusting for age and sex, feeling to have too many medical problems (OR 2.99, 95% CI 1.27 to 7.07; P=0.012), chest pain (OR 10.78, 95% CI 1.28 to 90.28; P=0.029) and sadness (OR 2.59, 95% CI 1.10 to 6.09; P=0.030) were independently associated with physical inactivity. Lack of time for exercise counseling and the firm belief about low compliance/interest by the patients toward exercise were the most frequent barriers reported by doctors and nurses. Conclusion: We identified a number of patient-related and health personnel-related barriers to physical activity in patients on chronic dialysis. Solutions for these barriers should be addressed in future studies aimed at increasing the level of physical activity in this population

Definition of Optimal Ventilation Rates for Balancing Comfort and Energy Use in Indoor Spaces Using CO2 Concentration Data

Air ventilation rate plays a relevant role in maintaining adequate indoor air quality (IAQ) conditions in public buildings. In general, high ventilation rates ensure good indoor air quality but entail relevant energy consumption. Considering the necessity of balancing IAQ and energy consumption, a correlation between the number of occupants obtained from analysis of CO2 concentration variation is presented as a general element for controlling the operation of heating ventilation and air cooling (HVAC) systems. The specific CO2 exhalation rate is estimated using experimental data in some real conditions in university classrooms. A method for the definition of optimal values of air exchange rate is defined, highlighting that the obtained values are much lower than those defined in current technical standards with possibilities of relevant reduction of the total energy consumption

Effect of Motivation on Movement Control: Neural Correlates in Dorsal Premotor Cortex

The dorsal premotor cortex (PMd) is a brain area involved in the control of movement. An open question is how the motivation can modulate this function. We trained a macaque monkey to a modified version of the countermanding task, in which Go trials (~65%) require to make a movement after a go signal, while Stop trials (~35%) require to inhibit the reactive movement after a stop signal. In each trial, an initial cue (1000 msec delay) informed about the potential amount of reward that would have been delivered if a correct response would have been produced. The meaning of the cue for correct responses was different. In the Go+Stop- condition the cue indicated more reward for the Go trials and less reward for the Stop trials. The opposite was in the Go-Stop+ condition. The cue was not informative (neutral) for the GoStop condition. We found that the monkey adapted his behavior to the cue value: faster reaction times in Go trials and higher error rate in Stop trials diminished from Go+Stop-, to GoStop and then to Go-Stop+ conditions. In PMd we found that 43/74 neurons recorded distinguished between conditions: some of them started to differentiate between conditions after 500msec from the cue, others close to the go signal. Seventeen/43 neurons were directly involved in movement control and showed different responses to the stop signal presentation depending on the cue presented. These data suggest that in PMd motivational information is integrated into neural mechanism of movement control by a heterogeneous dynamic

[Effects of Dose of Erythropoiesis Stimulating Agents on Cardiovascular Outcomes, Quality of Life and Costs of Haemodialysis. The Clinical Evaluation of the DOSe of Erythropoietins (C.E. DOSE) Trial].

Background: Anaemia is a risk factor for death, adverse cardiovascular outcomes and poor quality of life in patients with chronic kidney disease (CKD). Erythropoietin Stimulating Agents (ESA) are the most used treatment option. In observational studies, higher haemoglobin (Hb) levels (around 11-13 g/dL) are associated with improved survival and quality of life compared to Hb levels around 9-10 g/dL. Randomized studies found that targeting higher Hb levels with ESA causes an increased risk of death, mainly due to adverse cardiovascular outcomes. It is possible that this is mediated by ESA dose rather than haemoglobin concentration, although this hypothesis has never been formally tested. Methods: We present the protocol of the Clinical Evaluation of the Dose of Erythropoietins (C.E. DOSE) trial, which will assess the benefits and harms of a high versus a low ESA dose therapeutic strategy for the management of anaemia of end stage kidney disease (ESKD). This is a randomized, prospective open label blinded end-point (PROBE) design trial due to enroll 900 haemodialysis patients. Patients will be randomized 1:1 to 4000 UI/week i. v. versus 18000 UI/week i. v. of epoetin alfa, beta or any other epoetin in equivalent doses. The primary outcome of the trial is a composite of cardiovascular events. In addition, quality of life and costs of these two strategies will be assessed

Effetti della dose degli agenti stimolanti l'eritropoiesi su esiti cardio-cerebrovascolari, qualita di vita e costi in emodialisi

Introduzione: Nei soggetti con insufficienza renale terminale l\u2019anemia \ue9 un fattore di rischio per morbimortalit\ue0 cardiovascolare e qualit\ue0 di vita (QdV) subottimale. Gli agenti stimolanti l\u2019eritropoiesi sono la principale terapia. Studi osservazionali mostrano che in questa popolazione livelli pi\uf9 alti di Hb (intorno a 11-13 g/dL) si associano a una prolungata sopravvivenza e migliore QdV rispetto a livelli pi\uf9 bassi (9-10 g/dL). Studi randomizzati dimostrano che raggiungere e mantenere un valore target di Hb 6513 g/dL circa causa un significativo incremento del rischio di morte, principalmente per eventi cardiovascolari. \uc8 plausibile, ma non \ue8 mai stato formalmente testato, che questo effetto sia dose-dipendente e correlato alla ESA-resistenza. Metodi: Viene presentato il protocollo dello studio Clinical Evaluation of the DOSe of Erythropoietins (C.E. DOSE), disegnato per valutare l\u2019efficacia comparativa di una strategia terapeutica dell\u2019anemia dell\u2019ESKD basata sul dosaggio massimale di ESA rispetto ad una strategia basata sul dosaggio minimale. Si tratta di uno studio clinico randomizzato, multicentrico, aperto, con valutazione in cieco degli esiti ad opera di una commissione esterna (PROBE-Prospective Randomized Open Blinded End-Point). \uc8 previsto l\u2019arruolamento di 900 soggetti con ESKD in emodialisi, randomizzati a ricevere 4000 UI/settimana ev. vs 18000 UI/settimana ev. di eritropoietina alfa o beta o dosi equivalenti di qualsiasi altra eritropoietina disponibile in commercio. Gli esiti dello studio includono un composito di indici biochimici, eventi cardiovascolari e la valutazione della QdV. Lo studio \ue8 stato approvato e finanziato dall\u2019Agenzia Italiana del Farmaco (AIFA) nell\u2019ambito del programma per la ricerca indipendente (anno 2006) e registrato in www.clinicaltrials.gov (NCT00827021)BACKGROUND: Anaemia is a risk factor for death, adverse cardiovascular outcomes and poor quality of life in patients with chronic kidney disease (CKD). Erythropoietin Stimulating Agents (ESA) are the most used treatment option. In observational studies, higher haemoglobin (Hb) levels (around 11-13 g/dL) are associated with improved survival and quality of life compared to Hb levels around 9-10 g/dL. Randomized studies found that targeting higher Hb levels with ESA causes an increased risk of death, mainly due to adverse cardiovascular outcomes. It is possible that this is mediated by ESA dose rather than haemoglobin concentration, although this hypothesis has never been formally tested. METHODS: We present the protocol of the Clinical Evaluation of the Dose of Erythropoietins (C.E. DOSE) trial, which will assess the benefits and harms of a high versus a low ESA dose therapeutic strategy for the management of anaemia of end stage kidney disease (ESKD). This is a randomized, prospective open label blinded end-point (PROBE) design trial due to enroll 900 haemodialysis patients. Patients will be randomized 1:1 to 4000 UI/week i. v. versus 18000 UI/week i. v. of epoetin alfa, beta or any other epoetin in equivalent doses. The primary outcome of the trial is a composite of cardiovascular events. In addition, quality of life and costs of these two strategies will be assessed. The study has been approved and funded by the Italian Agency of Drugs (Agenzia Italiana del Farmaco (AIFA)) within the 2006 funding plan for independent research on drugs (registered at www.clinicaltrials.gov (NCT00827021))

[Effects of dose of erythropoiesis stimulating agents on cardiovascular outcomes, quality of life and costs of haemodialysis. the clinical evaluation of the DOSe of erythropoietins (C.E. DOSE) Trial]

Background: Anaemia is a risk factor for death, adverse cardiovascular outcomes and poor quality of life in patients with chronic kidney disease (CKD). Erythropoietin Stimulating Agents (ESA) are the most used treatment option. In observational studies, higher haemoglobin (Hb) levels (around 11-13 g/dL) are associated with improved survival and quality of life compared to Hb levels around 9-10 g/dL. Randomized studies found that targeting higher Hb levels with ESA causes an increased risk of death, mainly due to adverse cardiovascular outcomes. It is possible that this is mediated by ESA dose rather than haemoglobin concentration, although this hypothesis has never been formally tested. Methods: We present the protocol of the Clinical Evaluation of the Dose of Erythropoietins (C.E. DOSE) trial, which will assess the benefits and harms of a high versus a low ESA dose therapeutic strategy for the management of anaemia of end stage kidney disease (ESKD). This is a randomized, prospective open label blinded end-point (PROBE) design trial due to enroll 900 haemodialysis patients. Patients will be randomized 1:1 to 4000 UI/week i. v. versus 18000 UI/week i. v. of epoetin alfa, beta or any other epoetin in equivalent doses. The primary outcome of the trial is a composite of cardiovascular events. In addition, quality of life and costs of these two strategies will be assessed. The study has been approved and funded by the Italian Agency of Drugs (Agenzia Italiana del Farmaco (AIFA)) within the 2006 funding plan for independent research on drugs (registered at www.clinicaltrials.gov (NCT00827021))