ORIGINAL PAPER
Effects of respiratory muscle training in chronic kidney disease patients on peritoneal dialysis: a pilot study
1
Physical Rehabilitation Clinic, Kielce, Poland
2
Lower Silesian Center of Oncology, Pulmonology and Hematology, Wroclaw, Poland
3
Department of Data Science and Engineering, Silesian University of Technology, Gliwice, Poland
4
Department of Internal Medicine, Nephrology and Transplantation, The National Institute ofMedicine of the Ministry of Interior and Administration, Warsaw, Poland
Submission date: 2024-03-05
Final revision date: 2024-05-22
Acceptance date: 2024-06-24
Publication date: 2024-09-19
Medical Studies 2025;41(1):15-27
KEYWORDS
physical therapychronic kidney diseasebreathing exercisesrespiratory muscle trainingperitoneal dialyses
TOPICS
ABSTRACT
Introduction::
The strength of inspiratory and expiratory muscles in patients treated with peritoneal dialysis is lower than in haemodialysis patients and in those after kidney transplantation. The dialysate in the abdominal cavity increases intraabdominal pressure and disturbs diaphragm contraction.
Aim of the research::
To compare the effects of inspiratory muscle training (IMT) on respiratory and functional parameters in patients undergoing peritoneal dialysis.
Material and methods::
A randomised, unblinded trial was conducted. Subjects were randomly assigned to perform 6 weeks of IMT at 40% of maximal inspiratory pressure. Measurements were taken at baseline and 6 weeks after the intervention. Primary outcomes included functional capacity (assessed by 6-minute walk test), maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), and spirometry parameters.
Results::
Initially, a cohort of 37 peritoneal dialysis patients, with an average age of 51.3 years (95% CI: 47.1–55.5), underwent randomisation. The control group consisted of 18 participants, whereas the study group comprised 19 subjects. Owing to attrition prior to the conclusion of the 6-week duration, the control group was subsequently reduced to 11, and the study group to 18. Patients who underwent IMT showed significant improvement in PImax (p < 0.0001), PEmax (p = 0.048), and 6MWT distance (p = 0.01). Increases in systolic blood pressure (SBP, p = 0.036) and heart rate (HR, p = 0.045) induced by the 6MWT were less marked in the respiratory training group.
Conclusions::
Respiratory muscle training appears to enhance respiratory muscle strength, potentially improving exercise tolerance. Despite the attrition, our study provides valuable insights into the effects of IMT on respiratory and functional parameters in peritoneal dialysis patients.
The strength of inspiratory and expiratory muscles in patients treated with peritoneal dialysis is lower than in haemodialysis patients and in those after kidney transplantation. The dialysate in the abdominal cavity increases intraabdominal pressure and disturbs diaphragm contraction.
Aim of the research::
To compare the effects of inspiratory muscle training (IMT) on respiratory and functional parameters in patients undergoing peritoneal dialysis.
Material and methods::
A randomised, unblinded trial was conducted. Subjects were randomly assigned to perform 6 weeks of IMT at 40% of maximal inspiratory pressure. Measurements were taken at baseline and 6 weeks after the intervention. Primary outcomes included functional capacity (assessed by 6-minute walk test), maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), and spirometry parameters.
Results::
Initially, a cohort of 37 peritoneal dialysis patients, with an average age of 51.3 years (95% CI: 47.1–55.5), underwent randomisation. The control group consisted of 18 participants, whereas the study group comprised 19 subjects. Owing to attrition prior to the conclusion of the 6-week duration, the control group was subsequently reduced to 11, and the study group to 18. Patients who underwent IMT showed significant improvement in PImax (p < 0.0001), PEmax (p = 0.048), and 6MWT distance (p = 0.01). Increases in systolic blood pressure (SBP, p = 0.036) and heart rate (HR, p = 0.045) induced by the 6MWT were less marked in the respiratory training group.
Conclusions::
Respiratory muscle training appears to enhance respiratory muscle strength, potentially improving exercise tolerance. Despite the attrition, our study provides valuable insights into the effects of IMT on respiratory and functional parameters in peritoneal dialysis patients.
REFERENCES (42)
1.
GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020 Feb; 395(10225): 709-733.
2.
Dejardin A, Robert A, Goffin E. Intraperitoneal pressure in PD patients: relationship to intraperitoneal volume, body size and PD-related complications. Nephrol Dial Transplant. 2007 May; 22(5): 1437-1444.
3.
Gómez-Fernández P, Sánchez Agudo L, Calatrava JM, Escuin F, Selgas R, Martínez ME, Montero A, Sánchez-Sicilia L. Respiratory muscle weakness in uremic patients under continuous ambulatory peritoneal dialysis. Nephron. 1984; 36(4): 219-223.
4.
Nascimento MM, Qureshi AR, Stenvinkel P, Pecoits- Filho R, Heimbürger O, Cederholm T, Lindholm B, Bárá- ny P. Malnutrition and inflammation are associated with impaired pulmonary function in patients with chronic kidney disease. Nephrol Dial Transplant. 2004 Jul; 19(7): 1823-1828.
5.
Pellizzaro CO, Thomé FS, Veronese FV. Effect of peripheral and respiratory muscle training on the functional capacity of hemodialysis patients. Ren Fail. 2013; 35(2): 189-197.
6.
Silva VG, Amaral C, Monteiro MB, Nascimento DM, Boschetti JR. Effects of inspiratory muscle training in hemodialysis patients. J Bras Nefrol. 2011 Mar; 33(1): 62-68.
7.
Simões M, Gregório ML, Godoy MFD, Accioly MF. Respiratory and muscular effects of a physiotherapy protocol carried out during hemodialysis in individuals with chronic renal failure: preliminary results. Motriz: Revista de Educação Física. 2020; 26(03): e10200001.
8.
Figueiredo PHS, Lima MMO, Costa HS, Martins JB, Dumont Flecha O, Gonçalves PF, Alves FL, Rodrigues VGB, Maciel EHB, Mendonça VA, Lacerda ACR, Vieira ÉLM, Teixeira AL, de Paula F, Balthazar CH. 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. 2018; 13(7): e0200727.
9.
Kowal G, Rydzewski A. The effects of respiratory muscle training in chronic kidney disease patients on haemodialysis and peritoneal dialysis: a review. Medical Studies. 2018; 34(1): 78-85.
10.
Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, McCormack MC, Carlin BW, Sciurba FC, Pitta F, Wanger J, MacIntyre N, Kaminsky DA, Culver BH, Re- vill SM, Hernandes NA, Andrianopoulos V, Camillo CA, Mitchell KE, Lee AL, Hill CJ, Singh SJ. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014 Dec; 44(6): 1428-1446.
11.
Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982; 14(5): 377-381.
12.
Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005 Aug; 26 (2): 319-338.
13.
Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969 May; 99(5): 696-702.
14.
Yuenyongchaiwat K, Namdang P, Vasinsarunkul P, Phongsukree P, Chaturattanachaiyaporn K, Pairojkittrakul S, Traitanon O. Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: a randomized control trial. Physiother Res Int. 2021 Jan; 26(1): e1879.
15.
Dornelas BR, Lima FA. Effects of daily inspiratory muscle training on respiratory muscle strength and chest wall regional volumes in hemodialysis patients: a randomized clinical trial. Disabil Rehabil. 2021 Sep; 43(19): 2828.
16.
Dipp T, Macagnan FE, Schardong J, Fernandes RO, Le- mos LC, Plentz RDM. Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomized controlled trial. Braz J Phys Ther. 2020 May-Jun; 24(3): 280-286.
17.
Isoyama N, Qureshi AR, Avesani CM, Lindholm B, Bàrà- ny P, Heimbürger O, Cederholm T, Stenvinkel P, Carre- ro JJ. Comparative associations of muscle mass and muscle strength with mortality in dialysis patients. Clin J Am Soc Nephrol. 2014 Oct; 9(10): 1720-1728.
18.
Howden EJ, Coombes JS, Strand H, Douglas B, Cam- pbell KL, Isbel NM. Exercise training in CKD: efficacy, adherence, and safety. Am J Kidney Dis. 2015 Apr; 65(4): 583-591.
19.
de Medeiros AIC, Brandão DC, Souza RJP, Fuzari HKB, Barros CESR, Barbosa JBN, Leite JC, Cavalcanti FCB, de Andrade AD, de Melo Marinho PÉ. Effects of daily inspiratory muscle training on respiratory muscle strength and chest wall regional volumes in haemodialysis patients: a randomised clinical trial. Disabil Rehabil. 2019 Dec; 41(26): 3173-3180.
20.
Karacan Ö, Tutal E, Uyar M, Eyüboğlu FO, Sezer S, Ozdemir FN. Pulmonary function in uremic patients on long‐term hemodialysis. Renal Fail. 2004 May; 26(3): 273-278.
21.
Sabatino A, Cuppari L, Stenvinkel P, Lindholm B, Avesani CM. Sarcopenia in chronic kidney disease: what have we learned so far. J Nephrol. 2021 Aug; 34(4): 1347-1372.
22.
Bataille S, Serveaux M, Carreno E, Pedinielli N, Darmon P, Robert A. The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients. Clin Nutr. 2017 Dec; 36(6): 1654-1660.
23.
Pessoa IMS, Parreira VF, Fregonezi GAF, Sheel AW, Chung F, Reid WD. Reference values for maximal inspiratory pressure: a systematic review. Can Respir J. 2014 Jan-Feb; 21(1): 43-50.
24.
Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998 Nov; 158(5 Pt 1): 1384-1387.
25.
Pinto AP, Ramos CI, Meireles MS, Kamimura MA, Cuppa- ri L. Impact of hemodialysis session on handgrip strength. J Bras Nefrol. 2015 Oct-Dec; 37(4): 451-457.
26.
Sliwiński P, Yan S, Gauthier AP, Macklem PT. Influence of global inspiratory muscle fatigue on breathing during exercise. J Appl Physiol. (1985) 1996 Apr; 80(4): 1270-1278.
27.
Karacan Ö, Tutal E, Çolak T, Sezer S Eyüboğlu FO, Haberal M. Pulmonary function in renal transplant recipients and end-stage renal disease patients undergoing maintenance dialysis. Transplant Proc. 2006 Mar; 38(2): 396-400.
28.
Montemezzo D, Fregonezi GA, Pereira DA, Britto RR, Reid WD. Influence of inspiratory muscle weakness on inspiratory muscle training responses in chronic heart failure patients: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2014 Jul; 95(7): 1398-1407.
29.
Fogarty MJ, Mantilla CB, Sieck GC. Breathing: motor control of diaphragm muscle. Physiology (Bethesda). 2018 Mar; 33(2): 113-126.
30.
de Medeiros AIC, Fuzari HKB, Rattesa C, Brandão DC, de Melo Marinho PÉ. Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. J Physiother. 2017 Apr; 63(2): 76-83.
31.
Campos NG, Marizeiro DF, Florêncio ACL, Silva ÍC, Meneses GC, Bezerra GF, Martins AMC, Libório AB. Effects of respiratory muscle training on endothelium and oxidative stress biomarkers in hemodialysis patients: a randomized clinical trial. Respir Med. 2018 Jan; 134: 103-109.
32.
Manfredini F, Mallamaci F, D’Arrigo G, Baggetta R, Bolignano D, Torino C, Lamberti N, Bertoli S, Ciurli- no D, Rocca-Rey L, Barillà A, Battaglia Y, Rapanà RM, Zuccalà A, Bonanno G, Fatuzzo P, Rapisarda F, Rastel- li S, Fabrizi F, Messa P, De Paola L, Lombardi L, Cupisti A, Fuiano G, Lucisano G, Summaria C, Felisatti M, Pozza- to E, Malagoni AM, Castellino P, Aucella F, ElHa- feez SA, Provenzano PF, Tripepi G, Catizone L, Zoccali C. Exercise in patients on dialysis: a multicenter, randomized clinical trial. J Am Soc Nephrol. 2017 Apr; 28(4): 1259-1268.
33.
Cupisti A, D’Alessandro C, Finato V, Del Corso C, Cata- nia B, Caselli GM, Egidi MF. Assessment of physical activity, capacity and nutritional status in elderly peritoneal dialysis patients. BMC Nephrol. 2017 May; 18(1): 180.
34.
Yabe H, Okada K, Kono K, Imoto Y, Onoyama A, Ito S, Moriyama Y, Kasuga H, Ito Y. Exercise intolerance and malnutrition associated with all-cause mortality in elderly patients undergoing peritoneal dialysis: a single-center prospective cohort study. Int Urol Nephrol. 2023 May; 55(5): 1365-1372.
35.
Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH. Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med. 1997 Apr; 155 (4): 1278-1282.
36.
O’Brien E, Pickering T, Asmar R, Myers M, Parati G, Staessen J, Mengden T, Imai Y, Waeber B, Palatini P, Gerin W; Working Group on Blood Pressure Monitoring of the European Society of Hypertension International Protocol for validation of blood pressure measuring devices in adults. Blood Press Monit. 2002 Feb; 7(1): 3-17.
37.
Cigarroa I, Barriga R, Michéas C, Zapata-Lamana R, Soto C, Manukian T. Efectos de un programa de ejercicio de fuerza-resistencia muscular en la capacidad funcional, fuerza y calidad de vida de adultos con enfermedad renal crónica en hemodiálisis. Rev Méd Chile. 2016 Jul; 144(7): 844-852.
38.
Shi Y, Zheng D, Zhang L, Yu Z, Yan H, Ni Z, Qian J, Fang W. Six-minute walk test predicts all-cause mortality and technique failure in ambulatory peritoneal dialysis patients. Nephrology (Carlton). 2017 Feb; 22(2): 118-124.
39.
El-Deen HAB, Alanazi FS, Ahmed KT. Effects of inspiratory muscle training on pulmonary functions and muscle strength in sedentary hemodialysis patients. J Phys Ther Sci. 2018 Mar; 30(3): 424-427.
40.
Park WM, Wang S, Kim YH, Wood KB, Sim JA, Li G. Effect of the intra-abdominal pressure and the center of segmental body mass on the lumbar spine mechanics – a computational parametric study. J Biomech Eng. 2012 Jan; 134(1): 011009.
41.
Żurawski A, Śliwiński Z, Nowak-Starz G, Kiebzak W. Monitoring changes in the shape of the spine in children with postural disorders. Medical Studies. 2023; 39(2): 132-139.
42.
Ulubay G, Akman B, Sezer S, Calik K, Oner FE, Ozdemir N, Haberal M. Factors affecting exercise capacity in renal transplantation candidates on continuous ambulatory peritoneal dialysis therapy. Transplant Proc. 2006 Mar; 38(2): 401-405.
Share
RELATED ARTICLE
| eISSN: | 2300-6722 |
| ISSN: | 1899-1874 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
