People with chronic kidney disease (CKD) who need renal replacement therapy, such as hemodialysis, often develop uraemic syndrome, associated with impairment of respiratory function, loss of peripheral and respiratory muscle mass and strength, and low cardiorespiratory conditioning. These complications reduce the ability to perform activities of daily living and increase mortality.

A systematic review investigated evidence for the effect of respiratory muscle training in CKD compared to breathing exercises.

• People with CDK on hemodialysis often suffer from anaemic syndrome.
• Anaemic syndrome results in loss of peripheral and respiratory muscle mass and function.
• A systematic review analyzed the evidence for an effect of RMT on CKD.
• Evidence from 4 clinical studies shows that RMT effectively improves respiratory muscle strength, lung function, exercise capacity and quality of life.
• RMT is more effective than breathing exercises with regards to improving respiratory muscle strength and lung function in people with CKD.
• RMT effectively improves respiratory muscle strength, lung function, functional capacity and quality of life in people with CKD.

Method

Seven major databases of scientific literature, an international database for theses and dissertations, and registered clinical trials were searched for articles on randomized controlled trials of respiratory muscle disease in CKD. Articles that met the eligibility criteria were assessed for quality, intervention, participants, outcome measures, and data analysis.

Results

In total, 4 studies were included in the analysis, comprising 110 participants with stage 5 renal disease, aged between 19 and 78 years. Respiratory muscle training  (RMT) improved respiratory muscle strength, exercise capacity, lung function and quality of life. When compared to breathing exercises, RMT improved expiratory muscle strength and forced expiratory volume more significantly than breathing exercises.

Conclusion

Respiratory muscle training effectively improves respiratory muscle strength, lung function, functional capacity, and quality of life. RMT is therefore recommended as worthwhile therapy for people with CKD.

References

Carlos de Medeiros AI, et al. Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. J Phys 2017;319:1-8.

Link: http://www.sciencedirect.com/science/article/pii/S1836955317300309