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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2019  |  Volume : 30  |  Issue : 1  |  Page : 265-267
Physical activity in patients undergoing automated and continuous ambulatory peritoneal dialysis: A cross-sectional study


1 Division of Nephrology and Hypertension, Yokohama city Seibu Hospital, Yokohama, Japan
2 Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
3 Japan Community Health Care Organization Tokyo Takanawa Hospital, Tokyo, Japan

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Date of Submission11-May-2018
Date of Acceptance04-Jul-2018
Date of Web Publication26-Feb-2019
 

How to cite this article:
Oishi D, Sakurada T, Shibagaki Y, Kimura K. Physical activity in patients undergoing automated and continuous ambulatory peritoneal dialysis: A cross-sectional study. Saudi J Kidney Dis Transpl 2019;30:265-7

How to cite this URL:
Oishi D, Sakurada T, Shibagaki Y, Kimura K. Physical activity in patients undergoing automated and continuous ambulatory peritoneal dialysis: A cross-sectional study. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 May 19];30:265-7. Available from: http://www.sjkdt.org/text.asp?2019/30/1/265/252925


To the Editor,

There are only a few reports evaluating physical activity (PA) in patients undergoing peritoneal dialysis (PD); PA of PD patients has been reported to be as low as that of hemodialysis (HD) patients.[1],[2] In terms of therapeutic modality, PD can be divided into automated PD (APD) and continuous APD (CAPD). In APD, daytime bag replacement is unnecessary, or is less frequent, because PD solution is automatically replaced. Hence, the most important advantage of APD as compared to CAPD is likely the less physical restriction during daytime. This study aimed to compare PA between patients undergoing APD and those undergoing CAPD using a pedometer.

We conducted a retrospective cross-sectional study in the University Hospital of St. Marianna School of Medicine, Kawasaki Municipal Tama Hospital, and Yokohama Seibu Hospital between March 2011 and February 2016. Exclusion criteria included severe infection, neurologic or orthopedic diseases, cardio-pulmonary failure, diabetic patients with poor blood sugar control, patients who needed a wheelchair and a walking stick, and patients undergoing HD.

The study participants were supplied with a pedometer (Lifecoder EX®, Suzuken Co., Nagoya, Japan).

Eighty-six patients were initially screened, of whom 25 were excluded, leaving 61 patients eligible for enrollment in the study (APD, n = 29; CAPD, n = 32).

The baseline characteristics of patients undergoing APD and those undergoing CAPD are shown in [Table 1]. The number of steps/day was 4568 ± 3878 (mean ± standard deviation) in patients undergoing APD and 4976 ± 2909 in those undergoing CAPD. PA was not statistically significantly different between the two groups (P = 0.28).
Table 1: Baseline characteristics of the patients undergoing automated peritoneal dialysis and those undergoing continuous ambulatory peritoneal dialysis.

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In patients undergoing APD, PA was comparable between those who used icodextrin (n = 13) and those who did not (n = 16). No statistically significant difference in the number of steps/day was found between both groups (P = 0.81).

This finding might be explained by the following: first, the nutritional status. In our study, normalized protein equivalent of nitrogen appearance was higher in patients undergoing CAPD than in those undergoing APD. It has been previously reported that serum albumin, which is an indicator of the nutritional status, and PA were positively correlated in HD patients.[3] Second, we assumed that the lower PA in patients undergoing PD may be related to dialysate bag exchange rate, dialysate dwell time, or dialysate fill volume. Patients undergoing CAPD need to frequently change the dialysate bag and to retain the dialysate in the peritoneal cavity for long periods during daytime. Therefore, PA was expected to be less due to the time consumed during changing the dialysate and its retention in the peritoneal cavity. It has been reported that the presence of 2 L of dialysate in the peritoneal cavity does not affect the exercise capacity, as measured by parameters including maximal oxygen consumption, exercise time, and anaerobic threshold.[4] In our study, none of these factors showed any correlation with the number of steps/day in patients undergoing APD, those undergoing CAPD, or all PD patients. Furthermore, the use of icodextrin in patients undergoing APD who dwell dialysate while sleeping did not affect PA. Therefore, dialysate bag exchange rate, dialysate dwell time, and dialysate fill volume were not expected to affect PA. This study demonstrated that there is no significant difference in PA between APD and CAPD patients. The APD patients tended to have lower PA than CAPD patients.

Conflict of interest:

None declared.



 
   References Top

1.
Zamojska S, Szklarek M, Niewodniczy M, Nowicki M. Correlates of habitual physical activity in chronic haemodialysis patients. Nephrol Dial Transplant 2006;21:1323-7.  Back to cited text no. 1
    
2.
Painter PL, Agarwal A, Drummond M. Physical function and physical activity in peritoneal dialysis patients. Perit Dial Int 2017;37:598-604.  Back to cited text no. 2
    
3.
Cobo G, Gallar P, Gama-Axelsson T, et al. Clinical determinants of reduced physical activity in hemodialysis and peritoneal dialysis patients. J Nephrol 2015;28:503-10.  Back to cited text no. 3
    
4.
Ohmura N, Tamura H, Kawaguchi Y, Ohta M, Miyahara T. The influence of dialysis solution on the exercise capacity in patients on CAPD. Adv Perit Dial 1989;5:46-8.  Back to cited text no. 4
    

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Correspondence Address:
Tsutomu Sakurada
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki
Japan
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DOI: 10.4103/1319-2442.252925

PMID: 30804295

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