Nephrology Dialysis Transplantation, Vol 13, Issue 3 685-699, Copyright © 1998 by Oxford University Press
E Kouidi, M Albani, K Natsis, A Megalopoulos, P Gigis, O Guiba-Tziampiri, A Tourkantonis and A Deligiannis
Background: Patients with end-stage renal disease on
haemodialysis (HD) have limited work capacity. Many structural and
functional alterations in skeletal muscles contribute to this disability.
Methods: To evaluate the effects of exercise training
on uraemic myopathy, seven HD patients (mean age 44.1±17.2
years) were studied. Open muscle biopsies were taken from their vastus
lateralis muscle before and after a 6 month exercise rehabilitation
programme and examined by routine light- and transmission
electron-microscopy. Histochemical stainings of frozen sections were
performed and morphometric analysis was also applied to estimate the
proportion of each fibre type and the muscle fibre area. Spiroergometric
and neurophysiological testing and peak extension forces of the lower limbs
were measured before and after exercise training.
Results: All patients showed impaired exercise
capacity, which was associated with marked muscular atrophy (mean area
2548±463 &mgr;m2) and reduction in
muscle strength and nerve conduction velocity. All types of fibres were
atrophied but type II were more affected. The ultrastructural study showed
severe degenerative changes in skeletal muscle fibres, mitochondria, and
capillaries. Exercise training had an impressive effect on muscular
atrophy; in particular the proportion of type I fibres increased by 51% and
mean muscle fibre area by 29%. Favourable changes were also seen on the
structure and number of capillaries and mitochondria. These results were
confirmed by a 48% increase in VO2 peak and a 29% in exercise time, as well
as an improvement in the peak muscle strength of the lower limbs and in
nerve conduction. Conclusions: Skeletal muscle atrophy
in HD patients contribute to their poor exercise tolerance. The application
of an exercise training rehabilitation programme improved muscle atrophy
markedly, and therefore had beneficial effects in overall work performance.
Key words: exercise training; haemodialyis; muscle
atrophy; uraemic myopathy; uraemic neuropathy
ORIGINAL ARTICLES
The effects of exercise training on muscle atrophy in haemodialysis patients
Laboratory of Sports Medicine, Department of Physiology, Laboratory of Anatomy, A' Internal Medicine Clinic-Renal Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece; Corresponding author at: Mitropoleos 53, 54623 Thessaloniki, Greece
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