Exercise in haemodialysis patients: impact on markers of inflammation

End-stage renal disease patients have a greatly increased risk of cardiovascular disease partly attributed to the elevated levels of systemic inflammation observed in uraemia. One of the key mechanisms underlying inflammation appears to be the immune dysfunction that afflicts almost every aspect of the uraemic immune system. As a consequence patients experience immunosuppression and reduced responsiveness to antigen as well as a simultaneous over-activation leading to a pro-inflammatory environment. In addition, the haemodialysis (HD) treatment itself induces a proinflammatory response but may provide an otherwise opportune time to complete supervised exercise. [Continues.

The Impact of Exercising During Haemodialysis on Blood Pressure, Markers of Cardiac Injury and Systemic Inflammation - Preliminary Results of a Pilot Study

This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.Background/Aims: Patients requiring haemodialysis have cardiovascular and immune dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise has numerous health benefits but in other populations has a profound impact upon blood pressure, inflammation and immune function; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population. Methods: Fifteen patients took part in a randomised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis. We assessed blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation. Results: Exercise increased blood pressure immediately post-exercise; however, 1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm Hg). No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms. Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress neutrophil function. Conclusions: This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise. However, since the fall in blood pressure occurred without evidence of cardiac injury, we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well tolerated

The influence of exercise training status on antigen-stimulated IL-10 production in whole blood culture and numbers of circulating regulatory T cells

Highly trained athletes are associated with high resting antigen-stimulated whole blood culture interleukin (IL)-10 production. The purpose of the present study was to examine the effects of training status on resting circulating T regulatory (T) cell counts and antigen-stimulated IL-10 production and the effect of acute bout of exercise on the T response. Forty participants volunteered to participate and were assigned to one of the four groups: sedentary (SED), recreationally active (REC), sprint-trained athletes and endurance-trained athletes (END). From the resting blood sample, CD4CD25CD127 T cells and in vitro antigen-stimulated IL-10 production were assessed. Ten REC subjects performed 60 min cycling at 70 % of maximal oxygen uptake and blood samples for T analysis were collected post- and 1 h post-exercise. IL-10 production was greater in END compared with the other groups (P  0.05). Our results demonstrate that high training loads in END are associated with greater resting IL-10 production and T cell count and suggest a possible mechanism for depression of immunity commonly reported in athletes engaged in high training loads. © 2013 Springer-Verlag Berlin Heidelberg

The impact of exercising during haemodialysis on blood pressure, markers of cardiac injury and systemic inflammation - preliminary results of a pilot study

Background/Aims: Patients requiring haemodialysis have cardiovascular and immune dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise has numerous health benefits but in other populations has a profound impact upon blood pressure, inflammation and immune function; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population. Methods: Fifteen patients took part in a randomised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis. We assessed blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation. Results: Exercise increased blood pressure immediately post-exercise; however, 1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm Hg). No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms. Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress neutrophil function. Conclusions: This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise. However, since the fall in blood pressure occurred without evidence of cardiac injury, we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well tolerated

An increase in circulating monocyte and platelet derived microparticles during haemodialysis

An increase in circulating monocyte and platelet derived microparticles during haemodialysi

Vladimir Filipović\u27s Attempts at Bringing Philosophy and the natural Sciences closer together

U radu se iznose Filipovićeva gledišta o vezi prirodnih znanosti i filozofije, osobito ona koja su zastupana u njegovom predavanju Prirodne znanosti i filozofija na simpoziju Hrvatskoga prirodoslovnog društva 1975. godine. Ističe se važnost Filipovićeve tvrdnje da je nemoguć izolirani razvitak prirodnih znanosti i filozofije. Prikazuje se i Filipovićevo praktično djelovanje u tom pogledu, pa se opisuju njegova nastojanja na povezivanju i koordinaciji istraživanja povijesti prirodnih znanosti i povijesti filozofije u Hrvatskoj, kao i njegova suradnja na postdiplomskom studiju Filozofija znanosti.The paper .presents Fililpović\u27s views on the bond between the natural sciences and philosophy, especially those presented in his lecture Natural Sciences and Philosophy at a symposium of the Hrvatsko prirodoslovno društvo (Croatian Natural History Society) in 1975. Emphasis is placed on the importance of Filipović\u27s statement that isolated development of the natural sciences and philosophy is impossible. Filipović\u27s practical activity on this topic is presented, and his attempts to interconnect and coordinate research into the history of the natural sciences and the history philosophy in Croatia is described, as well as his cooperation in the graduate studies program of Philosophy of Science

Implementing a theory-based intradialytic exercise programme in practice: a quality improvement project

Background Research evidence outlines the benefits of intradialytic exercise (IDE), yet implementation into practice has been slow, ostensibly due to lack of patient and staff engagement. The aim of this quality improvement project was to improve patient outcomes via the introduction of an IDE programme; evaluate patient uptake, sustainability and enhance the engagement of routine haemodialysis (HD) staff with the delivery of the IDE programme. Methods We developed and refined an IDE programme, including interventions designed to increase patient and staff engagement that were based upon the Theoretical Domains Framework, using a series of ‘Plan, Do, Study, Act’ cycles. The programme was introduced at two UK NHS HD units. Process measures included patient uptake, withdrawals, adherence and HD staff involvement. Outcomes measures were patient-reported functional capacity, anxiety, depression and symptomology. All measures were collected over 12 months. Results 95 patients enrolled in the IDE programme. 64 (75%) were still participating at three months, dropping to 41 (48%) at 12 months. Adherence was high (78%) at three months, dropping to 63% by 12 months. Provision of IDE by HD staff accounted for a mean of 2 (5%) sessions per three-month time point. Patients displayed significant improvements in functional ability (p=0.01), and reduction in depression (p=0.02) over 12 months, but effects seen were limited to those who completed the programme. Conclusions A theory-based IDE programme is feasible and leads to improvement in functional capacity and depression. Sustaining IDE over time is marred by high levels of patient withdrawal from the programme. Significant change at an organisational level is required to enhance sustainability by increasing HD staff engagement or access to exercise professional support

The influence of exercise training status on antigen-stimulated IL-10 production in whole blood culture and numbers of circulating regulatory T cells

The final publication is available at springerlink.com.Highly trained athletes are associated with high resting antigen-stimulated whole blood culture interleukin (IL)-10 production. The purpose of the present study was to examine the effects of training status on resting circulating T regulatory (T) cell counts and antigen-stimulated IL-10 production and the effect of acute bout of exercise on the T response. Forty participants volunteered to participate and were assigned to one of the four groups: sedentary (SED), recreationally active (REC), sprint-trained athletes and endurance-trained athletes (END). From the resting blood sample, CD4CD25CD127 T cells and in vitro antigen-stimulated IL-10 production were assessed. Ten REC subjects performed 60 min cycling at 70 % of maximal oxygen uptake and blood samples for T analysis were collected post- and 1 h post-exercise. IL-10 production was greater in END compared with the other groups (P < 0.05). END had a higher T percentage of total lymphocyte count compared with SED (P < 0.05). A smaller proportion of T CD4 cells were observed in SED compared with all other groups (P < 0.05). IL-10 production significantly correlated with the proportion of T within the total lymphocyte population (r = 0.51, P = 0.001). No effect of acute exercise was evident for T cell counts in the REC subjects (P > 0.05). Our results demonstrate that high training loads in END are associated with greater resting IL-10 production and T cell count and suggest a possible mechanism for depression of immunity commonly reported in athletes engaged in high training loads. © 2013 Springer-Verlag Berlin Heidelberg