Abstract des Autors

By definition, end-stage renal disease (ESRD) patients are people with disabilities. The debilitating symptoms of anemia have a profound effect on the patient's quality of life. Weakness, dyspnea, headache and fatigue can be reduced by the development of rhEPO therapy which can largely correct the anemia. Levin assessed the quality-of-life studies and showed that rhEPO therapy caused an improved sense of well-being, sexual function, sleep habits, an increased social activity, exercise capacity and a better appetite in 30-90% hemodialysis patients. The beneficial effects of rhEPO on exercise toelrance and myocardial function have been clearly demonstrated and the hormone treatment has been found to improve markedly the subjective symptoms in hemodialysis patients. Aerobic exercise training in healthy individuals has been shown to facilitate muscle oxygen uptake and utilization. So does exercise in ESRD patients and there is evidence that exercise training in conjunction with rhEPO therapy may affect exercise capacity. According to Painter and Clyne, two specialists involved in renal units, each patient with chronic failure should also receive an appropriate dose of exercise training, according to their needs and ability, enabling them to fight against fatigue, to strengthen their muscle power and to enjoy life more fully. Successful incorporation of an exercise programme by the patient is dependent on the support received from the nephrologist. Painter has proposed 4 stages to achieve this goal in dialysis units: (1) incorporation of exercise in the patient care plan (what are you doing for regular exercise?); (2) automatic referral for physical therapy (how to increase strength and endurance); (3) developing contact with community programmes for referral of patients for participation (exercise at home or in a community programme); (4) development of an intercenter programme (dialysis units, stationary exercise instruments). When is it appropriate for hemodialysis patients to train? To exercise immediately prior to the dialysis treatment appears inadequate due to the high plasma potassium level. Training during the hemodialysis procedure seems feasible but limited by the unique type of exercise imposed on the subject. Exercise training immediately after the hemodialysis treatment appears arduous since most patients complain of general fatigue. The main beneficial moment for exercise training seems to be the day between two hemodialysis treatments. Up to now there is no longitudinal study which indicates whether endurance exercise training and a more active life-style would prolong the survival of uremic patients and kidney transplant recipients. However, one may recognize that the quality of life is enhanced. Verf.-Referat