Physical activity and energy expenditure in haemodialysis patients: an international survey

Background. The assessment of physical activity and energy expenditure is relevant to the care of maintenance haemodialysis (MHD) patients. In the current study, we aimed to evaluate measurements of physical activity and energy expenditure in MHD patients from different centres and countries and explored the predictors of physical activity in these patients. Methods. In this cross-sectional multicentre study, 134 MHD patients from four countries (France, Switzerland, Sweden and Brazil) were included. The physical activity was evaluated for 5.0 ± 1.4 days (mean ± SD) by a multisensory device (SenseWear Armband) and comprised the assessment of number of steps per day, activity-related energy expenditure (activity-related EE) and physical activity level (PAL). Results. The number of steps per day, activity-related EE and PAL from the MHD patients were compatible with a sedentary lifestyle. In addition, all parameters were significantly lower in dialysis days when compared to non-dialysis days (P < 0.001). The multivariate regression analysis revealed that diabetes and higher body mass index (BMI) predicted a lower PAL and older age and diabetes predicted a reduced number of steps. Conclusions. The physical activity parameters of MHD patients were compatible with a sedentary lifestyle. This inactivity was worsened by aging, diabetes and higher BMI. Our results indicate that MHD patients should be encouraged by the health care team to increase their physical activit

Annonce de la création de l’Association francophone de diététique et nutrition dans les maladies rénales

International audienc

Long term survey of body composition in hemodialysis patients using the Body Composition Monitor® (BCM)

Since 2 years all 265 incident patients in self-dialysis units were included in a prospective study. Every 6-months, clinical and biological nutritional evaluation was associated to a BCM measure. 205 pts have a complete set of data at start (age 60±16 years, BMI 25±5 kg/m2, albumin 37±4 g/L, prealbumin 0.32±0.1 g/L, CRP median 5 mg/L), 135 pts at 6 mo and 56 pts at 2 years. Measures were performed before HD session to ensure stability and reproducibility of body fluid compartments by the same examiner. Lean and fat masses (lean tissue index: LTI, fat tissue index: FTI) were normalized by square body height and compared with a reference range derived from 2000 healthy controls, according to gender and age. 28% of pts had values of LTI below the 10th percentile. A linear correlation exists (p<0.001) between pre-dialysis creatinine level and LTI. Albumin or prealbumin were not predictive of sarcopenia. Prescribed post dialysis BW was underestimated in 25% of pts and 16% remain overhydrated. In stable patients repeated measures analysis reveal no significant variation of LTI even in case of reevaluation of BW and gain of BW is associated with fat mass increase. BCM is a simple tool in clinical practice to evaluate body composition and hydratation status and help to guide nutritional support

Integration of a specific nutrition program into a comprehensive program of therapeutic education

Nutritional education strategies should be included in a multidisciplinary team for therapeutic education (TPE). We conduct a comprehensive program of therapeutic education for out-center hemodialysis patients. 5 education workshops were performed during dialysis sessions, every 15 days: Illness experience (psychologist), vascular access (nurses), medication management (pharmacist), nutrition management (dietitian) and final evaluation. A specific program of nutrition (EDAM project: Education of the dialysis patient for better food ) was added using 3 specific tools: a companion guide for patients, a game of questions-answers about nutrition(Dialygame) and a guide for the health team to use the tools and conduct nutrition workshops. 64 pts agree to join the program and were compared with a control group of 61 pts who received standard information. Specific questionnaires were created associated with quality of life evaluation (KDQOL) and usual clinical and biological data were noted before and after the 5 sessions as a short-term evaluation. Final results were under evaluation. We present a multidisciplinary TPE program which integrate a specific nutrition TPE and innovative nutrition tools will be shown