Our past studies have helped us move closer to our goal of helping patients achieve their best possible health and wellbeing through appropriate lifestyle management. Here we have summarised details of our key findings and what we have planned next.
Metabolic, Immunological and Pathological factors in kidney disease (MAP-KD)
Many people with kidney disease suffer from multiple and diverse symptoms, which make normal daily activities more difficult. We were interested in understanding what specifically causes these problems to find ways that kidney patients can improve their health and well-being by making adjustments to their lifestyle.
This study investigated the role of various genes, cells, and factors in the blood, which may be involved in the complicated symptom burden and long-term health of kidney patients, and compared these factors to healthy people of the same age, gender and ethnic background.
Intramuscular Response to Acute Exercise in Chronic Disease (I-RACE)
Patients with chronic kidney disease (CKD) often experience muscle wasting and weakness which can impair physical function and quality of life. Exercise can be an effective method of maintaining muscle mass and strength, however little research has been done into how to best prescribe exercise to patients with CKD. Previous research by our group indicates that the response to exercise within muscles of kidney patients is different from that of the general population. This study aims to further understand the intramuscular response of patients with kidney disease to exercise.
Mechanisms of muscle wasting in advanced chronic kidney disease (Explore CKD)
Kidney disease can cause muscle wasting (when the muscles waste away), which leads to weakness, fatigue, and reduced physical functioning. This can start early on in the disease and is thought to play an important role in the way the disease progresses, and even the patients’ ultimate chance of survival. Explore CKD aimed to better understand the mechanisms of muscle wasting in the CKD population by analysing skeletal muscle in the laboratory from patients and comparing it to healthy adults to find out what is different in the muscles of CKD patients and what the cause of their muscle loss may be.
Iron and Muscle. Assessing the impact of IV iron therapy on exercise and physical capacity in CKD patients
We were co-investigators for the multicentre Kidney Research UK-funded Iron and Muscle Study, which investigated the effects of intravenous iron infusion on physical function and muscle health in people with non-dialysis kidney disease. In addition to being one of the 7 recruiting sites for the study, we led a qualitative sub-study to explore the participants’ experiences of being iron-deficient and how iron infusion might affect them. Many of the participants provided muscle biopsies which were analysed in our labs in Leicester to find out how iron infusion works at the intramuscular level. The trial design and baseline characteristics are reported in this open-access article here. The results from the trial are hoped to be published in the future.
PACE-KD
A kidney transplant can transform the health and quality of life of people with kidney disease. Despite this, there is a high rate of heart disease in these patients, which can limit the survival of the new kidney and the length and quality of life. Exercise reduces the rate of heart disease in healthy individuals and patients with kidney disease, however, there is a lack of rigorous research into the role of increased physical activity in the management of cardiovascular risk in kidney transplant patients. Some kidney transplant patients are highly motivated to participate in sports and exercise beyond the level normally advised for general health purposes, such as High Intensity Interval Training (HIIT). However, they struggle to find appropriate advice and support to pursue their fitness aims, and have approached our team asking us to explore these gaps in knowledge. The PACE-KD study aimed to investigate the use of HIIT in kidney transplant patients. 24 participants were recruited between March 2017 and May 2019. Details of the trial can be found here and the study protocol here. Results are published in this open access article.
SONG-HD Fatigue
Fatigue is a common symptom that is associated with cardiovascular events, mortality and decreased quality of life in patients on haemodialysis (HD). The prevalence of this symptom is as high as 97%, and despite this, fatigue remains under-recognised by researchers and under-treated by clinicians. There is no standardised measure of fatigue for researchers to use in the HD population, and consequently fatigue is measured infrequently, inconsistently, and using measures that are not sufficiently validated. Furthermore, the heterogeneity and inconsistency of measures reported for fatigue makes it difficult to compare the effect of interventions across trials. This study aimed to provide preliminary evidence for using a proposed outcome measure (a validated survey) to assess fatigue in patients on HD. The proposed outcome measure to be used in clinical trials involving patients on HD was designed based on shared priorities of patients, caregivers, and health professionals.
Increasing physical activity in chronic kidney disease: the patient perspective (QCKD)
Patients with CKD have a very high risk of developing heart problems, losing muscle mass and experiencing poor mental health and a reduced quality of life. Being more active and taking part in exercise has the potential to improve all of these factors and is recommended in national guidelines as being an important part of treatment for CKD. Despite this patients with CKD tend to lead very inactive lifestyles, the reasons for which have not been widely investigated in the UK population. Our research has demonstrated that regular moderate aerobic exercise (e.g., walking) and strength training using weights are both highly beneficial for people with CKD. We now need to develop effective strategies to help kidney patients be more active. This project is designed to find out how our patients feel and think about taking up exercise and becoming more physically active, so that we can develop programmes that will make it easier for them.
Exercise Training in Chronic Kidney Disease (ExTra CKD)
The aim of this study was to examine the combined effect of an aerobic exercise programme, modelled on cardiac rehabilitation programmes, with traditional high load resistance training. We intended to identify whether the combination of these exercise modalities would improve patients’ cardiorespiratory fitness and protect cardiac function as well as increase muscle mass, or whether the combination is conflicting and no benefit is gained. This helps us determine the best way to deliver programmes such as this to CKD patients.
Patient and Staff Perceptions of Intradialytic Exercise before and after Implementation: A Qualitative Study (The QHD Study)
We interviewed staff and people living with haemodialysis in groups and individually to find out what encourages (and prevents) them from taking part in (or supporting) exercise delivered during haemodialysis (also known as intradialytic exercise or IDE). We interviewed participants before the exercise programme was introduced, and then six months later to see if their perceptions had changed.
Implementing a theory-based intradialytic exercise programme in practice: a quality improvement project
We used the information from the QHD study to develop an exercise programme delivered during haemodialysis treatment. The aim of the programme was to help people living with haemodialysis to feel better and get fitter and stronger. We also aimed to involve staff at the haemodialysis unit in supporting patients to exercise. In this project we evaluated how well we did this in two haemodialysis units.
