Rehabilitation in chronic kidney disease patients on hemodialysis: A systematic literature review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i3.26181

Keywords:

Rehabilitation; Chronic Kidney Disease; Renal dialysis; Physiotherapy.

Abstract

Introduction: Chronic Kidney Disease (CKD) represents a slow, progressive and irreversible loss of kidney function. Treatment may range from conservative to substitutive therapies such as hemodialysis. As a result, patients undergoing treatment may present secondary changes to hemodialysis that could be treated and prevented by physical therapy interventions through physical exercises applied in the intradialytic period. Objective: To analyze the effects of physiotherapeutic rehabilitation when applied in patients with CKD during hemodialysis sessions. Methods: This is a systematic literature review, which concentrated clinical trials found in the databases: LILACS, PEDro and PubMed, published in Portuguese and English languages, between 2016 and 2021, which were subsequently standardized according to the PEDro Scale. Results: Of the 229 articles found, 21 clinical trials were analyzed. In general, interventions such as aerobic exercise, resistance exercise, combined exercise, thermotherapy and respiratory muscle training were presented. Furthermore, it was possible to observe improvement in muscle strength, functional capacity, exercise capacity, physical inactivity, cardiovascular risk factors, and improvement in sleep quality, besides providing improvement in aspects related to inflammatory biomarkers and quality of dialysis. These exercises were performed with an average of 30 to 40 minutes, three times a week, for an average of 12 weeks. Conclusion: It can be concluded that an intradialytic rehabilitation program can offer positive effects to the patient on hemodialysis. However it is suggested that the quality of life of these patients should be treated as a primary outcome, getting this way a complete and wide rehabilitation of patients with CKD.

References

Álvares, V. R. C., Ramos, C. D., Pereira, B. J., Pinto, A. L., Moysés, R. M. A., Gualano, B., & Elias, R. M. (2017). Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial. American Journal of Nephrology, 45(5), 409–416. https://doi.org/10.1159/000471513

Bacelete, V. S. B., & Gama, A. C. C. (2021). Therapeutic effects of photobiomodulation in the speech-language-hearing clinic: An integrative literature review. Revista CEFAC, 23(1). https://doi.org/10.1590/1982-0216/20212319120

Bastos, M. G., Bregman, R., & Kirsztajn, G. M. (2010). Doença renal crônica: Frequente e grave, mas também prevenível e tratável. Revista da Associação Médica Brasileira, 56(2), 248–253. https://doi.org/10.1590/s0104-42302010000200028

Brasil. Ministério da Saúde. (2014). Diretrizes clínicas para o cuidado ao paciente com doença renal crônica–DRC no Sistema Único de Saúde. https://portalarquivos2.saude.gov.br/images/pdf/2014/marco/24/diretriz-cl--nica-drc-versao-final.pdf.

Breitsameter, G., Figueiredo, A. E., & Kochhann, D. S. (2012). Cálculo de Kt/V em hemodiálise: Comparação entre fórmulas. Jornal Brasileiro de Nefrologia, 34(1), 22–26. https://doi.org/10.1590/s0101-28002012000100004

Brüggemann, A. K., Mello, C. L., Dal Pont, T., Hizume Kunzler, D., Martins, D. F., Bobinski, F., Pereira Yamaguti, W., & Paulin, E. (2017). Effects of Neuromuscular Electrical Stimulation During Hemodialysis on Peripheral Muscle Strength and Exercise Capacity. Archives of Physical Medicine and Rehabilitation, 98(5), 822–831.e1. https://doi.org/10.1016/j.apmr.2016.12.009

Carvalho, A. R., Sousa, I. M. d., Silva, D. H. d., Silva, A. R. d., Adad, R. B. S. d. F., & Silva, V. O. d. (2020). Os efeitos do exercício físico em pacientes submetidos à hemodiálise: uma revisão sistemática. Revista Pesquisa em Fisioterapia, 10(2), 309. https://doi.org/10.17267/2238-2704rpf.v10i2.2638

Cho, J.-H., Lee, J.-Y., Lee, S., Park, H., Choi, S.-W., & Kim, J. C. (2018). Effect of intradialytic exercise on daily physical activity and sleep quality in maintenance hemodialysis patients. International Urology and Nephrology, 50(4), 745–754. https://doi.org/10.1007/s11255-018-1796-y

Costa, J. A., & Damasceno, M. J. F. (2018). Benefícios do treinamento resistido em pacientes com doença renal crônica em tratamento de hemodiálise. Health Research Journal, 1(3), 18-32.

Dias, H. S. (2019). O efeito do exercício físico em pacientes submetidos ao tratamento de hemodiálise. Revista Brasileira de Fisiologia do Exercício, 18(1), 58. https://doi.org/10.33233/rbfe.v18i1.2880

Doenças renais: Causas, sintomas, diagnóstico, tratamento e prevenção. (2019, 14 de março). Ministério da Saúde. https://antigo.saude.gov.br/saude-de-a-z/doencas-renais.

Dong, Z.-J., Zhang, H.-L., & Yin, L.-X. (2019). Effects of intradialytic resistance exercise on systemic inflammation in maintenance hemodialysis patients with sarcopenia: a randomized controlled trial. International Urology and Nephrology, 51(8), 1415–1424. https://doi.org/10.1007/s11255-019-02200-7

Escala PEDro - PEDro. (1999). PEDro. https://pedro.org.au/portuguese/resources/pedro-scale/.

Fernandes, P. N. R., & Gardenghi, G. (2019). Fisioterapia intradialítica nas unidades de terapia intensiva, uma revisão sobre as barreiras, segurança e viabilidade. 9(1), 44–54. https://rescceafi.com.br/vol9/n1/artigo5_pags_44a54.pdf

Figueiredo, P. H. S., Lima, M. M. O., Costa, H. S., Martins, J. B., Flecha, O. D., Gonçalves, P. F., Alves, F. L., Rodrigues, V. G. B., Maciel, E. H. B., Mendonça, V. A., Lacerda, A. C. R., Vieira, É. L. M., Teixeira, A. L., de Paula, F., & Balthazar, C. H. (2018). Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: A randomized clinical trial. Plos One, 13(7), Artigo e0200727. https://doi.org/10.1371/journal.pone.0200727

Freitas, T. P. (2016). Efeitos da eletroestimulação neuromuscular e exercício resistido sobre a atividade elétrica e força do bíceps braquial. Fisioterapia Brasil, 13(3). https://doi.org/10.33233/fb.v13i3.539

Guimarães, C. K. D., Alves, D. A. G., & Guimarães, L. H. d. C. T. (2011). Avaliação da qualidade e quantidade do sono em pacientes renais crônicos submetidos à hemodiálise. Revista Neurociências, 19(4), 609–613. https://doi.org/10.34024/rnc.2011.v19.8322

Huang, M., Lv, A., Wang, J., Zhang, B., Xu, N., Zhai, Z., Gao, J., Wang, Y., Li, T., & Ni, C. (2020). The effect of intradialytic combined exercise on hemodialysis efficiency in end-stage renal disease patients: A randomized-controlled trial. International Urology and Nephrology, 52(5), 969–976. https://doi.org/10.1007/s11255-020-02459-1

Jesus, N. M., Souza, G. F. D., Mendes-Rodrigues, C., Almeida, O. P. D., Rodrigues, D. D. M., & Cunha, C. M. (2019). Qualidade de vida de indivíduos com doença renal crônica em tratamento dialítico. Brazilian Journal of Nephrology, 41, 364-374.

Júnior, C. M. A. L., Lima, W. P., Souza, L. M. V., Souza, C. M. S., Dos Santos, J. R., Costa, F. B., Silva, A. L. d. S., De Jesus, E. V., Carvalho, P. E., & Dantas, E. H. M. (2021). O treinamento físico como estratégia de intervenção em pessoas com Insuficiência Renal Crônica. Revista Eletrônica Acervo Saúde, 13(2), Artigo e6140. https://doi.org/10.25248/reas.e6140.2021

Junior, J. E. R. (2004). Doença renal crônica: definição, epidemiologia e classificação. J. Bras. Nefrol., 26 (3 suppl. 1), 1-3.

Lima, A. P. F., Rocha, B. S., Menezes, I. H. C. F., & Pereira, E. R. S. (2021). Refletindo sobre a Educação Permanente em Saúde: potencialidades e limitações na terapia renal substitutiva. Interface-Comunicação, Saúde, Educação, 25. https://doi.org/10.1590/interface.200494

Macagnan, F. E., Baroni, B. M., Cristofoli, É. Z., Godoy, M., Schardong, J., & Plentz, R. D. M. (2018). Acute effect of photobiomodulation therapy on handgrip strength of chronic kidney disease patients during hemodialysis. Lasers in Medical Science, 34(4), 835–840. https://doi.org/10.1007/s10103-018-2593-7

Neves, P. D. M. D. M., Sesso, R. D. C. C., Thomé, F. S., Lugon, J. R., & Nasicmento, M. M. (2020). Censo Brasileiro de Diálise: análise de dados da década 2009-2018. Brazilian Journal of Nephrology, 42, 191-200.

Orcy, R. B., Dias, P. S., Seus, T. L., Barcellos, F. C., & Bohlke, M. (2012). Combined Resistance and Aerobic Exercise is Better than Resistance Training Alone to Improve Functional Performance of Haemodialysis Patients - Results of a Randomized Controlled Trial. Physiotherapy Research International, 17(4), 235–243. https://doi.org/10.1002/pri.1526

Ortí, E. S., Domínguez, B. P., Villar, L. O. d., Oliva, E. M., Gramage, J. M., Maset, R. G., & Gómez, J. A. G. (2018). Virtual reality exercise intradialysis to improve physical function: A feasibility randomized trial. Scandinavian Journal of Medicine & Science in Sports, 29(1), 89–94. https://doi.org/10.1111/sms.13304

Paim, F., Somavilla, A. B., Mayer, F. D. A., Kupske, J. W., Moreira, P. R., & Krug, R. D. R. (2021, July). MAPEAMENTO DOS PROGRAMAS DE EXERCÍCIOS FÍSICOS INTRADIALÍTICOS NO BRASIL. In Congresso Internacional em Saúde (No. 8).

Powers, S. K., & Howley, E. T. (2014). Fisiologia do Exercício: Teoria e Aplicação ao Condicionamento e ao Desempenho (8a ed.). Manole.

PRISMA. (2020). PRISMA. http://www.prisma-statement.org/

Pu, J., Jiang, Z., Wu, W., Li, L., Zhang, L., Li, Y., Liu, Q., & Ou, S. (2019). Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis. BMJ Open, 9(1), Artigo e020633. https://doi.org/10.1136/bmjopen-2017-020633

Ramos, E. C. C., Santos, I. D. S. D., Zanini, R. D. V., & Ramos, J. M. G. (2015). Qualidade de vida de pacientes renais crônicos em diálise peritoneal e hemodiálise. Brazilian Journal of Nephrology, 37, 297-305.

Rosa, C. S. d. C., Nishimoto, D. Y., Souza, G. D. e., Ramirez, A. P., Carletti, C. O., Daibem, C. G. L., Sakkas, G. K., & Monteiro, H. L. (2018). Effect of continuous progressive resistance training during hemodialysis on body composition, physical function and quality of life in end-stage renal disease patients: A randomized controlled trial. Clinical Rehabilitation, 32(7), 899–908. https://doi.org/10.1177/0269215518760696

Roxo, R. S., Xavier, V. B., Miorin, L. A., Magalhães, A. O., Sens, Y. A. d. S., & Alves, V. L. d. S. (2016). Impact of neuromuscular electrical stimulation on functional capacity of patients with chronic kidney disease on hemodialysis. Jornal Brasileiro de Nefrologia, 38(3). https://doi.org/10.5935/0101-2800.20160052

Santos, B. P., Oliveira, V. A., Soares, M. C., & Schwartz, E. (2017). Doença renal crônica: relação dos pacientes com a hemodiálise. ABCS Health Sciences, 42(1).

Schardong, J., Dipp, T., Bozzeto, C. B., da Silva, M. G., Baldissera, G. L., Ribeiro, R. d. C., Valdemarca, B. P., do Pinho, A. S., Sbruzzi, G., & Plentz, R. D. M. (2017). Effects of intradialytic neuromuscular electrical stimulation on strength and muscle architecture in patients with chronic kidney failure: Randomized clinical trial. Artificial Organs, 41(11), 1049–1058. https://doi.org/10.1111/aor.12886

Schardong, J., Falster, M., Sisto, I. R., Barbosa, A. P. O., Normann, T. C., de Souza, K. S., Jaroceski, G., Bozzetto, C. B., Baroni, B. M., & Plentz, R. D. M. (2020). Photobiomodulation therapy increases functional capacity of patients with chronic kidney failure: Randomized controlled trial. Lasers in Medical Science, 36(1), 119–129. https://doi.org/10.1007/s10103-020-03020-3

Shiwa, S. R., Costa, L. O. P., Moser, A. D. D. L., Aguiar, I. D. C., & Oliveira, L. V. F. D. (2011). PEDro: a base de dados de evidências em fisioterapia. Fisioterapia em Movimento, 24, 523-533.

Silva, V. R. O. e., Belik, F. S., Hueb, J. C., Gonçalves, R. d. S., Caramori, J. C. T., Vogt, B. P., Barretti, P., Bazan, S. G. Z., Stefano, G. M. M. F., Martin, L. C., & Franco, R. J. d. S. (2019). Aerobic Exercise Training and Nontraditional Cardiovascular Risk Factors in Hemodialysis Patients: Results from a Prospective Randomized Trial. Cardiorenal Medicine, 9(6), 391–399. https://doi.org/10.1159/000501589

Sociedade Brasileira de Nefrologia (SBN). Diálise peritoneal (2021, 3 de março). https://www.sbn.org.br/orientacoes-e-tratamentos/tratamentos/dialise-peritoneal/.

Sociedade Brasileira de Nefrologia (SBN). Doença renal crônica: Diagnóstico e prevenção. (2021, 3 de março). https://www.sbn.org.br/noticias/single/news/doenca-renal-cronica-diagnostico-e-prevencao/

Sociedade Brasileira de Nefrologia (SBN). Hemodiálise - SBN. (2021, 3 de março). https://www.sbn.org.br/orientacoes-e-tratamentos/tratamentos/hemodialise/

Soto, M. G. O., Ortiz, R. V., Alvarenga, J. C. L., & Cuevas, M. d. l. Á. E. (2016). Effect of Resistance Exercises on the Indicators of Muscle Reserves and Handgrip Strength in Adult Patients on Hemodialysis. Journal of Renal Nutrition, 26(1), 53–60. https://doi.org/10.1053/j.jrn.2015.06.006

Souza, R. L. (2018). Aplicação de um programa de fisioterapia em pacientes com insuficiência renal crônica. Revista Experiências e Evidências em Fisioterapia e Saúde-ISSN 2595-7872, 1(1). http://www.cescage.com.br/revistas/index.php/Exper_Evid_Fisioterapia/article/view/165.

Suhardjono, V. U., Tedjasukmana, D., & Setiati, S. (2019). The effect of intradialytic exercise twice a week on the physical capacity, inflammation, and nutritional status of dialysis patients: A randomized controlled trial. Hemodialysis International, 23(4), 486–493. https://doi.org/10.1111/hdi.12764

Suzuki, T., Ikeda, M., Minami, M., Matayoshi, Y., Nakao, M., Nakamura, T., & Abo, M. (2018). Beneficial effect of intradialytic electrical muscle stimulation in hemodialysis patients: A randomized controlled trial. Artificial Organs, 42(9), 899–910. https://doi.org/10.1111/aor.13161

Testal, A. G., Maset, R. G., Marín, D. H., Domínguez, B. P., Maicas, P. R., Salvador, I. S. R., Oliva, E. M., Aracil, J. M., Chiva, M. M., Blanco, O. D. P., Díaz, P. O., Najera, J. E. F., Juan, E. T. D., Carrera, C. B., & Ortí, E. S. (2018). Influence of physical exercise on the dialytic adequacy parameters of patients on hemodialysis. Therapeutic Apheresis and Dialysis, 23(2), 160–166. https://doi.org/10.1111/1744-9987.12762

Vanin, A. A., Marchi, T. D., Tomazoni, S. S., Tairova, O., Casalechi, H. L., Carvalho, P. d. T. C. d., Bjordal, J. M., & Junior, E. C. L. (2016). Pre-Exercise Infrared Low-Level Laser Therapy (810 nm) in Skeletal Muscle Performance and Postexercise Recovery in Humans, What Is the Optimal Dose? A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Photomedicine and Laser Surgery, 34(10), 473-482. https://doi.org/10.1089/pho.2015.3992

Yang, L., Chen, H., Su, Y., & Chin, C. (2018). The effect of transcutaneous electrical nerve stimulation on increasing salivary flow rate in hemodialysis patients. Oral Diseases, 25(1), 133–141. https://doi.org/10.1111/odi.12948

Yeh, M.-L., Wang, M.-H., Hsu, C.-C., & Liu, Y.-M. (2020). Twelve-week intradialytic cycling exercise improves physical functional performance with gain in muscle strength and endurance: A randomized controlled trial. Clinical Rehabilitation, 34(7), 916–926. https://doi.org/10.1177/0269215520921923

Young, H. M. L., March, D. S., Highton, P. J., Graham-Brown, M. P. M., Churchward, D. C., Grantham, C., Goodliffe, S., Jones, W., Cheung, M.-M., Greenwood, S. A., Eborall, H. C., Conroy, S., Singh, S. J., Smith, A. C., & Burton, J. O. (2020). Exercise for people living with frailty and receiving haemodialysis: A mixed-methods randomised controlled feasibility study. BMJ Open, 10(11), Artigo e041227. https://doi.org/10.1136/bmjopen-2020-041227

Yuenyongchaiwat, K., Namdang, P., Vasinsarunkul, P., Phongsukree, P., Chaturattanachaiyaporn, K., Pairojkittrakul, S., & Traitanon, O. (2020). Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: A randomized control trial. Physiotherapy Research International. https://doi.org/10.1002/pri.1879.

Waclawovsky, G., Pedralli, M. L., Eibel, B., Schaun, M. I., & Lehnen, A. M. (2021). Efeitos de Diferentes Tipos de Treinamento Físico na Função Endotelial em Pré-Hipertensos e Hipertensos: Uma Revisão Sistemática. Arquivos Brasileiros de Cardiologia, 116(5), 938–947.

Published

09/02/2022

How to Cite

CARDOSO, H. de C.; RIBEIRO, H. G. G. Rehabilitation in chronic kidney disease patients on hemodialysis: A systematic literature review. Research, Society and Development, [S. l.], v. 11, n. 3, p. e2411326181, 2022. DOI: 10.33448/rsd-v11i3.26181. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/26181. Acesso em: 24 apr. 2024.

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Section

Health Sciences