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Salhab, N., Karavetian, M., Kooman, J., & Fiaccadori, E. (2018). Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study. Arab Journal of Nutrition and Exercise (AJNE), 3(41), 18-34. https://doi.org/10.18502/ajne.v3i41.1693
https://doi.org/10.18502/ajne.v3i41.1693
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- Cited by 2 articles
authors
-
Nada Salhab
Nada Salhab
Maastricht University
-
Mirey Karavetian
Mirey Karavetian
Zayed University
-
Jeroen Kooman
Jeroen Kooman
University Hospital Maastricht
-
Enrico Fiaccadori
Enrico Fiaccadori
Parma University
Published Date
- Apr 30, 2018
Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study
Abstract
Aim: Intradialytic exercise (IDE) improves hyperphosphatemia management in hemodialysis (HD) patient in addition to other clinical outcomes. The aim of the study is to present the strategies needed to integrate such a protocol in an HD unit in UAE and patients’ baseline characteristics.
Methods: The largest HD unit in Sharjah emirate was chosen. All eligible patients (n=57) in the unit were included. Patients were stable adults HD patients who served as their own controls. The intervention included an aerobic low intensity IDE of 45 minutes per HD session, tailored to each patient’s fitness scale (BORG scale) for 6 months. Patients were educated on the importance of exercise. Outcome measures were barriers to exercise, serum phosphorus (P), urea reduction ratio (URR), malnutrition inflammation score, quality of life (QOL using euroqol5) collected at baseline and post intervention.
Results: A total of 41 patients completed the study, 61% were males; 90.2%, 53.7% and 14.6% suffered from hypertension, diabetes and cardiovascular disease respectively. Hypherphosphatemia was prevalent among 75% of the patients with a mean of 5.76 ± 1.66 mg/dl. Mean age was 48 ± 14.37 years, BMI 24.98 ± 6.09 kg/m2, URR 71.88 ± 8.52%, and Kt/v 1.32 ± 1.09. The main barrier to exercise was identified to be fatigue on HD days by 58.5% of patients, followed by fear of getting hurt (36.6%). Finally, 80.4% of patients were mildly malnourished and QOL scale was 65.02% ± 18.54.
Conclusion: Our study highlighted the widespread of hyperphosphatemia and malnutrition in our sample. The IDE regimen, if proven effective in future studies, could be integrated in the routine practice and may improve patients’ outcomes.
References
Al-Ali, F.S., Bieber, B.A., Pisoni, R.L., Ezzat, H., AlGhonaim, M., AlHejaili, F.,...GCC-DOPPS 5 Study Group, (2016). Nutritional status and outcomes in hemodialysis patients from the gulf cooperation council countries enrolled in the dialysis outcome and practice patters study phase 5 (2012-2015). Saudi J Kidney Dis Transpl. 27(6 Suppl 1), S31-S41.
AlSahow A, AlRukhaimi M, Wakeel JA, Al-Ghamdi S.M.G., AlGhareeb, S., AlAli, F.,... GCC-DOPPS 5 Study Group, (2016). Demographics and key clinical characteristics of hemodialysis patients from the gulf cooperation council countries enrolled in the dialysis outcomes and practice patters study phase 5 (2012-2015). Saudi J Kidney Dis Transpl. 27(6suppl 1), S12-S23.
Al Salmi, I., Al Rukhaimi, A., AlSahow, A., Shaheen, F.A.M., Al-Ghamdi, S.M.G., AlAli, F.,...GCC-DOPPS 5 Study Group, (2016) et al. Mineral bone mineral and its management among hemodialysis patients in the gulf cooperation council: initial findings from the dialysis outcomes and practice patters study (2012-2015). Saudi J Kidney Dis Transpl. 27(6 Suppl 1), S62-S80.
Bayoumi, M.M., & Al Wakeep, J.S. (2015). Impacts of exercise program on hemodialysis patients’ quality of life and physical fitness. Quality in primary care, 23(4), 192-200.
Broers, N. J., Usvyat, L. A., Kooman, J. P., van der Sande, F. M., Lacson, E., Jr., Kotanko, P., & Maddux, F. W. (2015). Quality of Life in Dialysis Patients: A Retrospective Cohort Study. Nephron, 130(2), 105-112. doi:10.1159/000430814
Centers for Disease Control and Prevention. Borg Rating of Perceived Exertion Scale. Retrieved from https://www.cdc.gov/physicalactivity/basics/measuring/exertion.htm. Accessed 17 September 2017.
de Lima, M. C., Cicotoste Cde, L., Cardoso Kda, S., Forgiarini, L. A., Jr., Monteiro, M. B., & Dias, A. S. (2013). Effect of exercise performed during hemodialysis: strength versus aerobic. Ren Fail, 35(5), 697-704. doi:10.3109/0886022x.2013.780977
Delgado, C., & Johansen, K. L. (2012). Barriers to exercise participation among dialysis patients. Nephrol Dial Transplant, 27(3), 1152-1157. doi:10.1093/ndt/gfr404
DOPPS Practice Monitor, Gulf Cooperation Council. Dialysis prescription and dose. March 2017. Retrieved from http://www.dopps.org/DPM/GCC/. Accessed September 13, 2017 .
Dubai FAQs. Population of the UAE. Retrieved from www.dubaifaqs.com/population-of-uae.php. Accessed August 24, 2017.
Dubai Statistics Center, 2016. Percentage Distribution of Unemployed 15 years and over by nationality, sex and educational level – Emirate of Dubai. 2016. Retrieved from https://www.dsc.gov.ae/Report/DSC_LFS_2016_03_03.pdf. Accessed 25 September 2017.
Eckardt, K. U., Coresh, J., Devuyst, O., Johnson, R. J., Kottgen, A., Levey, A. S., & Levin, A. (2013). Evolving importance of kidney disease: from subspecialty to global health burden. Lancet, 382(9887), 158-169. doi:10.1016/s0140-6736(13)60439-0
EuroQol, G. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199-208.
Fiaccadori, E., Sabatino, A., Schito, F., Angella, F., Malagoli, M., Tucci, M., . . . Regolisti, G. (2014). Barriers to physical activity in chronic hemodialysis patients: a single-center pilot study in an Italian dialysis facility. Kidney Blood Press Res, 39(2-3), 169-175. doi:10.1159/000355793
GPower 3.1. Retrieved from https://www.campbellcollaboration.org/escalc/html/EffectSizeCalculator-SMD1.php. Accessed January 15 2017.
Hecking, M., Bieber, B. A., Ethier, J., Kautzky-Willer, A., Sunder-Plassmann, G., Saemann, M. D., . . . Port, F. K. (2014). Sex-specific differences in hemodialysis prevalence and practices and the male-to-female mortality rate: the Dialysis Outcomes and Practice Patterns Study (DOPPS). PLoS Med, 11(10), e1001750. doi:10.1371/journal.pmed.1001750
Hill, N. R., Fatoba, S. T., Oke, J. L., Hirst, J. A., O'Callaghan, C. A., Lasserson, D. S., & Hobbs, F. D. (2016). Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One, 11(7), e0158765. doi:10.1371/journal.pone.0158765
Johansen, K.L., Chertow, G.M., Ng, A.V., Mulligan, K., Carey, S., Schoenfeld, P.Y., & Kent-Braun, J.A. (2000). Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int, 57, 2564-2570. doi:10.1046/j.1523-1755.2000.00116.x
Johansen, K. L., Sakkas, G. K., Doyle, J., Shubert, T., & Dudley, R. A. (2003). Exercise counseling practices among nephrologists caring for patients on dialysis. Am J Kidney Dis, 41(1), 171-178. doi:10.1053/ajkd.2003.50001
Kalantar-Zadeh, K., Kopple, J. D., Humphreys, M. H., & Block, G. (2004). Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant, 19(6), 1507-1519. doi:10.1093/ndt/gfh143
Karavetian, M., Abboud, S., Elzein, H., Haydar, S., & de Vries, N. (2014). Nutritional education for management of osteodystrophy (NEMO) trial: Design and patient characteristics, Lebanon. Nutr Res Pract, 8(1), 103-111. doi:10.4162/nrp.2014.8.1.103
Karavetian, M., Elzein, H., Rizk, R., Jibai, R., & de Vries, N. (2016). Nutritional education for management of osteodystrophy: Impact on serum phosphorus, quality of life, and malnutrition. Hemodial Int, 20(3), 432-440. doi:10.1111/hdi.12405
KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. (2015). Am J Kidney Dis, 66(5), 884-930. doi:10.1053/j.ajkd.2015.07.015
Ketteler, M., Block, G. A., Evenepoel, P., Fukagawa, M., Herzog, C. A., McCann, L., . . . Leonard, M. B. (2017). Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what's changed and why it matters. Kidney Int, 92(1), 26-36. doi:10.1016/j.kint.2017.04.006
Kjellstrand, C. M., Ing, T. S., Kjellstrand, P. T., Odar-Cederlof, I., & Lagg, C. R. (2011). Phosphorus dynamics during hemodialysis. Hemodial Int, 15(2), 226-233. doi:10.1111/j.1542-4758.2011.00538.x
Kliger, A. S., Foley, R. N., Goldfarb, D. S., Goldstein, S. L., Johansen, K., Singh, A., & Szczech, L. (2013). KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. Am J Kidney Dis, 62(5), 849-859. doi:10.1053/j.ajkd.2013.06.008
Kuhlmann, M. K. (2006). Management of hyperphosphatemia. Hemodial Int, 10(4), 338-345. doi:10.1111/j.1542-4758.2006.00126.x
Lopes, A. A., Lantz, B., Morgenstern, H., Wang, M., Bieber, B. A., Gillespie, B. W., . . . Pisoni, R. L. (2014). Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS. Clin J Am Soc Nephrol, 9(10), 1702-1712. doi:10.2215/cjn.12371213
Makhlough, A., Ilali, E., Mohseni, R., & Shahmohammadi, S. (2012). Effect of intradialytic aerobic exercise on serum electrolytes levels in hemodialysis patients. Iran J Kidney Dis, 6(2), 119-123.
Mathewson, A. M., Fouque, D., & Toft, A. J. (2010). Dietary phosphate assessment in dialysis patients. J Ren Nutr, 20(6), 351-358. doi:10.1053/j.jrn.2010.05.014
Moraes, C., Marinho, S. M., da Nobrega, A. C., de Oliveira Bessa, B., Jacobson, L. V., Stockler-Pinto, M. B., . . . Mafra, D. (2014). Resistance exercise: a strategy to attenuate inflammation and protein-energy wasting in hemodialysis patients? Int Urol Nephrol, 46(8), 1655-1662. doi:10.1007/s11255-014-0712-3
Morais, A. A., Silva, M. A., Faintuch, J., Vidigal, E. J., Costa, R. A., Lyrio, D. C., . . . Pitanga, K. K. (2005). Correlation of nutritional status and food intake in hemodialysis patients. Clinics (Sao Paulo), 60(3), 185-192. doi:/S1807-59322005000300002
Musavian, A. S., Soleimani, A., Masoudi Alavi, N., Baseri, A., & Savari, F. (2015). Comparing the effects of active and passive intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life. Nurs Midwifery Stud, 4(1), e25922.
Parker, K. (2016). Intradialytic Exercise is Medicine for Hemodialysis Patients. Curr Sports Med Rep, 15(4), 269-275. doi:10.1249/jsr.0000000000000280
Port, F. K., Pisoni, R. L., Bommer, J., Locatelli, F., Jadoul, M., Eknoyan, G., . . . Young, E. W. (2006). Improving outcomes for dialysis patients in the international Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol, 1(2), 246-255. doi:10.2215/cjn.01050905
Rizk, R., Hiligsmann, M., Karavetian, M., & Evers, S. M. (2016). Economic evaluations of interventions to manage hyperphosphataemia in adult haemodialysis patients: A systematic review. Nephrology (Carlton), 21(3), 178-187. doi:10.1111/nep.12584
Rizk, R., Karavetian, M., Hiligsmann, M., & Evers, S. (2017). Effect of stage-based education provided by dedicated dietitians on hyperphosphataemic haemodialysis patients: results from the Nutrition Education for Management of Osteodystrophy randomised controlled trial. J Hum Nutr Diet, 30(5), 554-562. doi:10.1111/jhn.12472
Sheng, K., Zhang, P., Chen, L., Cheng, J., Wu, C., & Chen, J. (2014). Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis. Am J Nephrol, 40(5), 478-490. doi:10.1159/000368722
Urena Torres, P. A. (2017). [Strategies aiming to control hyperphosphatemia in chronic kidney disease]. Nephrol Ther, 13 Suppl 1, S95-s101. doi:10.1016/j.nephro.2017.01.002
White, A., Odedina, H.X., Campbell, E., & Segal, R. (2006). The economic burden of end-stage renal disease with hyperphosphatemia. Dis Manage Health Outcomes, 14(2), 99-106.
Wong, J., Davis, P., Patidar, A., Zhang, Y., Vilar, E., Finkelman, M., & Farrington, K. (2017). The Effect of Intra-Dialytic Exercise on Inflammation and Blood Endotoxin Levels. Blood Purif, 44(1), 51-59. doi:10.1159/000455059
Zelle, D. M., Klaassen, G., van Adrichem, E., Bakker, S. J., Corpeleijn, E., & Navis, G. (2017). Physical inactivity: a risk factor and target for intervention in renal care. Nat Rev Nephrol, 13(3), 152-168. doi:10.1038/nrneph.2016.187
Zyoud, S. H., Daraghmeh, D. N., Mezyed, D. O., Khdeir, R. L., Sawafta, M. N., Ayaseh, N. A., . . . Al-Jabi, S. W. (2016). Factors affecting quality of life in patients on haemodialysis: a cross-sectional study from Palestine. BMC Nephrol, 17(1), 44. doi:10.1186/s12882-016-0257-z
AlSahow A, AlRukhaimi M, Wakeel JA, Al-Ghamdi S.M.G., AlGhareeb, S., AlAli, F.,... GCC-DOPPS 5 Study Group, (2016). Demographics and key clinical characteristics of hemodialysis patients from the gulf cooperation council countries enrolled in the dialysis outcomes and practice patters study phase 5 (2012-2015). Saudi J Kidney Dis Transpl. 27(6suppl 1), S12-S23.
Al Salmi, I., Al Rukhaimi, A., AlSahow, A., Shaheen, F.A.M., Al-Ghamdi, S.M.G., AlAli, F.,...GCC-DOPPS 5 Study Group, (2016) et al. Mineral bone mineral and its management among hemodialysis patients in the gulf cooperation council: initial findings from the dialysis outcomes and practice patters study (2012-2015). Saudi J Kidney Dis Transpl. 27(6 Suppl 1), S62-S80.
Bayoumi, M.M., & Al Wakeep, J.S. (2015). Impacts of exercise program on hemodialysis patients’ quality of life and physical fitness. Quality in primary care, 23(4), 192-200.
Broers, N. J., Usvyat, L. A., Kooman, J. P., van der Sande, F. M., Lacson, E., Jr., Kotanko, P., & Maddux, F. W. (2015). Quality of Life in Dialysis Patients: A Retrospective Cohort Study. Nephron, 130(2), 105-112. doi:10.1159/000430814
Centers for Disease Control and Prevention. Borg Rating of Perceived Exertion Scale. Retrieved from https://www.cdc.gov/physicalactivity/basics/measuring/exertion.htm. Accessed 17 September 2017.
de Lima, M. C., Cicotoste Cde, L., Cardoso Kda, S., Forgiarini, L. A., Jr., Monteiro, M. B., & Dias, A. S. (2013). Effect of exercise performed during hemodialysis: strength versus aerobic. Ren Fail, 35(5), 697-704. doi:10.3109/0886022x.2013.780977
Delgado, C., & Johansen, K. L. (2012). Barriers to exercise participation among dialysis patients. Nephrol Dial Transplant, 27(3), 1152-1157. doi:10.1093/ndt/gfr404
DOPPS Practice Monitor, Gulf Cooperation Council. Dialysis prescription and dose. March 2017. Retrieved from http://www.dopps.org/DPM/GCC/. Accessed September 13, 2017 .
Dubai FAQs. Population of the UAE. Retrieved from www.dubaifaqs.com/population-of-uae.php. Accessed August 24, 2017.
Dubai Statistics Center, 2016. Percentage Distribution of Unemployed 15 years and over by nationality, sex and educational level – Emirate of Dubai. 2016. Retrieved from https://www.dsc.gov.ae/Report/DSC_LFS_2016_03_03.pdf. Accessed 25 September 2017.
Eckardt, K. U., Coresh, J., Devuyst, O., Johnson, R. J., Kottgen, A., Levey, A. S., & Levin, A. (2013). Evolving importance of kidney disease: from subspecialty to global health burden. Lancet, 382(9887), 158-169. doi:10.1016/s0140-6736(13)60439-0
EuroQol, G. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199-208.
Fiaccadori, E., Sabatino, A., Schito, F., Angella, F., Malagoli, M., Tucci, M., . . . Regolisti, G. (2014). Barriers to physical activity in chronic hemodialysis patients: a single-center pilot study in an Italian dialysis facility. Kidney Blood Press Res, 39(2-3), 169-175. doi:10.1159/000355793
GPower 3.1. Retrieved from https://www.campbellcollaboration.org/escalc/html/EffectSizeCalculator-SMD1.php. Accessed January 15 2017.
Hecking, M., Bieber, B. A., Ethier, J., Kautzky-Willer, A., Sunder-Plassmann, G., Saemann, M. D., . . . Port, F. K. (2014). Sex-specific differences in hemodialysis prevalence and practices and the male-to-female mortality rate: the Dialysis Outcomes and Practice Patterns Study (DOPPS). PLoS Med, 11(10), e1001750. doi:10.1371/journal.pmed.1001750
Hill, N. R., Fatoba, S. T., Oke, J. L., Hirst, J. A., O'Callaghan, C. A., Lasserson, D. S., & Hobbs, F. D. (2016). Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One, 11(7), e0158765. doi:10.1371/journal.pone.0158765
Johansen, K.L., Chertow, G.M., Ng, A.V., Mulligan, K., Carey, S., Schoenfeld, P.Y., & Kent-Braun, J.A. (2000). Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int, 57, 2564-2570. doi:10.1046/j.1523-1755.2000.00116.x
Johansen, K. L., Sakkas, G. K., Doyle, J., Shubert, T., & Dudley, R. A. (2003). Exercise counseling practices among nephrologists caring for patients on dialysis. Am J Kidney Dis, 41(1), 171-178. doi:10.1053/ajkd.2003.50001
Kalantar-Zadeh, K., Kopple, J. D., Humphreys, M. H., & Block, G. (2004). Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant, 19(6), 1507-1519. doi:10.1093/ndt/gfh143
Karavetian, M., Abboud, S., Elzein, H., Haydar, S., & de Vries, N. (2014). Nutritional education for management of osteodystrophy (NEMO) trial: Design and patient characteristics, Lebanon. Nutr Res Pract, 8(1), 103-111. doi:10.4162/nrp.2014.8.1.103
Karavetian, M., Elzein, H., Rizk, R., Jibai, R., & de Vries, N. (2016). Nutritional education for management of osteodystrophy: Impact on serum phosphorus, quality of life, and malnutrition. Hemodial Int, 20(3), 432-440. doi:10.1111/hdi.12405
KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. (2015). Am J Kidney Dis, 66(5), 884-930. doi:10.1053/j.ajkd.2015.07.015
Ketteler, M., Block, G. A., Evenepoel, P., Fukagawa, M., Herzog, C. A., McCann, L., . . . Leonard, M. B. (2017). Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what's changed and why it matters. Kidney Int, 92(1), 26-36. doi:10.1016/j.kint.2017.04.006
Kjellstrand, C. M., Ing, T. S., Kjellstrand, P. T., Odar-Cederlof, I., & Lagg, C. R. (2011). Phosphorus dynamics during hemodialysis. Hemodial Int, 15(2), 226-233. doi:10.1111/j.1542-4758.2011.00538.x
Kliger, A. S., Foley, R. N., Goldfarb, D. S., Goldstein, S. L., Johansen, K., Singh, A., & Szczech, L. (2013). KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. Am J Kidney Dis, 62(5), 849-859. doi:10.1053/j.ajkd.2013.06.008
Kuhlmann, M. K. (2006). Management of hyperphosphatemia. Hemodial Int, 10(4), 338-345. doi:10.1111/j.1542-4758.2006.00126.x
Lopes, A. A., Lantz, B., Morgenstern, H., Wang, M., Bieber, B. A., Gillespie, B. W., . . . Pisoni, R. L. (2014). Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS. Clin J Am Soc Nephrol, 9(10), 1702-1712. doi:10.2215/cjn.12371213
Makhlough, A., Ilali, E., Mohseni, R., & Shahmohammadi, S. (2012). Effect of intradialytic aerobic exercise on serum electrolytes levels in hemodialysis patients. Iran J Kidney Dis, 6(2), 119-123.
Mathewson, A. M., Fouque, D., & Toft, A. J. (2010). Dietary phosphate assessment in dialysis patients. J Ren Nutr, 20(6), 351-358. doi:10.1053/j.jrn.2010.05.014
Moraes, C., Marinho, S. M., da Nobrega, A. C., de Oliveira Bessa, B., Jacobson, L. V., Stockler-Pinto, M. B., . . . Mafra, D. (2014). Resistance exercise: a strategy to attenuate inflammation and protein-energy wasting in hemodialysis patients? Int Urol Nephrol, 46(8), 1655-1662. doi:10.1007/s11255-014-0712-3
Morais, A. A., Silva, M. A., Faintuch, J., Vidigal, E. J., Costa, R. A., Lyrio, D. C., . . . Pitanga, K. K. (2005). Correlation of nutritional status and food intake in hemodialysis patients. Clinics (Sao Paulo), 60(3), 185-192. doi:/S1807-59322005000300002
Musavian, A. S., Soleimani, A., Masoudi Alavi, N., Baseri, A., & Savari, F. (2015). Comparing the effects of active and passive intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life. Nurs Midwifery Stud, 4(1), e25922.
Parker, K. (2016). Intradialytic Exercise is Medicine for Hemodialysis Patients. Curr Sports Med Rep, 15(4), 269-275. doi:10.1249/jsr.0000000000000280
Port, F. K., Pisoni, R. L., Bommer, J., Locatelli, F., Jadoul, M., Eknoyan, G., . . . Young, E. W. (2006). Improving outcomes for dialysis patients in the international Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol, 1(2), 246-255. doi:10.2215/cjn.01050905
Rizk, R., Hiligsmann, M., Karavetian, M., & Evers, S. M. (2016). Economic evaluations of interventions to manage hyperphosphataemia in adult haemodialysis patients: A systematic review. Nephrology (Carlton), 21(3), 178-187. doi:10.1111/nep.12584
Rizk, R., Karavetian, M., Hiligsmann, M., & Evers, S. (2017). Effect of stage-based education provided by dedicated dietitians on hyperphosphataemic haemodialysis patients: results from the Nutrition Education for Management of Osteodystrophy randomised controlled trial. J Hum Nutr Diet, 30(5), 554-562. doi:10.1111/jhn.12472
Sheng, K., Zhang, P., Chen, L., Cheng, J., Wu, C., & Chen, J. (2014). Intradialytic exercise in hemodialysis patients: a systematic review and meta-analysis. Am J Nephrol, 40(5), 478-490. doi:10.1159/000368722
Urena Torres, P. A. (2017). [Strategies aiming to control hyperphosphatemia in chronic kidney disease]. Nephrol Ther, 13 Suppl 1, S95-s101. doi:10.1016/j.nephro.2017.01.002
White, A., Odedina, H.X., Campbell, E., & Segal, R. (2006). The economic burden of end-stage renal disease with hyperphosphatemia. Dis Manage Health Outcomes, 14(2), 99-106.
Wong, J., Davis, P., Patidar, A., Zhang, Y., Vilar, E., Finkelman, M., & Farrington, K. (2017). The Effect of Intra-Dialytic Exercise on Inflammation and Blood Endotoxin Levels. Blood Purif, 44(1), 51-59. doi:10.1159/000455059
Zelle, D. M., Klaassen, G., van Adrichem, E., Bakker, S. J., Corpeleijn, E., & Navis, G. (2017). Physical inactivity: a risk factor and target for intervention in renal care. Nat Rev Nephrol, 13(3), 152-168. doi:10.1038/nrneph.2016.187
Zyoud, S. H., Daraghmeh, D. N., Mezyed, D. O., Khdeir, R. L., Sawafta, M. N., Ayaseh, N. A., . . . Al-Jabi, S. W. (2016). Factors affecting quality of life in patients on haemodialysis: a cross-sectional study from Palestine. BMC Nephrol, 17(1), 44. doi:10.1186/s12882-016-0257-z