SP704TUSCANY PROGRAM FOR EXERCISE IN END STAGE RENAL DISEASE AND RENAL TRANSPLANT PATIENTS

Abstract

INTRODUCTION: Benefits of physical activity at any stage of chronic kidney disease patients are validated by scientific evidence and outlined by KDOQI guidelines. Nevertheless, implementing exercise programs in these patients, especially haemodialysis patients, is challenging due to clinical and organisational barriers. Surprisingly, rather than a limitation, haemodialysis sessions may represent an opportunity of continuative and monitored exercise, leading to considerable improvement of quality of life and physical performance. After a successful pilot study carried out in a Nephrology and Dialysis Unit of our network, we designed a simple and cost-effective exercise program involving all Nephrology and Dialysis Units of our network. We included all end-stage renal disease patients in renal replacement therapy and renal transplant patients. The objective of our program is to improve physical functional scores of our patients by a personalised exercise training. METHOD(S): A specific regional program was designed with the endorsement of the National Health Service. All the 11 Nephrology and Dialysis Units of USL Toscana Centro participated to the project, with a total of 240 nurses, 48 nephrologists, 11 physiotherapists, 2 physiatrists who have been trained in Sep-Dec 2018. We enrolled a total of 1408 patients (pts): 920 haemodialysis pts, 126 peritoneal dialysis pts, 363 renal transplant pts. 12% (130 pts) of dialysis pts are in transplant waiting list. All pts are screened in their setting (haemodialysis or outpatient office) by nephrology nurses through the following tests: Short Form Health Survey, Test Elderly Falls Screening, Short Physical Performance Battery, Handgrip test; Six minutes walking test, Sit to stand test. Evaluations are in progress and will be completed by 31/03/2019. After the nurse assessment, physiotherapists of the Units will assign the pts to 3 different groups on the basis of the physical functional scores: Group 1-Pts with good physical status, who need a general physical maintenance program; Group 2-Pts who are susceptible of improvement will receive a personalised home training program in addition to the general physical maintenance program; Group 3-Pts with functional limitations non susceptible of improvement will be addressed to a basic physical maintenance program. The exercise program will be explained by digital technology including videos and app for smartphone. For hemodialysis pts the program will be performed during the first 20' of each session under nurses supervision. Renal transplant pts and waiting list pts will receive a more intensive program under the direct physiotherapist supervision. Physical functional scores will be re-assessed every 3months by the referring physiotherapist and the exercise program will be confirmed, modified or stopped on the basis of the scores. Every 6 months we will evaluate the percentage of pts with improved physical functional scores, the incidence of death, cardiovascular events, falls, fractures and hospitalisation days. RESULT(S): . CONCLUSION(S): Despite the evidence of benefits of exercise training in ESRD patients, its implementation is limited by multiple barriers. It is our opinion that this program, which enrolled the largest number of patients to our knowledge, may represent the most feasible example of practical application of physical activity in ESRD patients because it is simple, easy to learn, cost-effective, reproducible and acceptable to the patients.