Effects of intradialytic cycling exercise on daily physical activity,physical fitness,body composition,and clinical parameters in high-volume online hemodiafiltration patients: a pilot randomized-controlled trial

Purpose

The mortality of dialysis patients treated with high-volume online hemodiafiltration (OL-HDF) is better than hemodialysis, but is still higher than healthy population. Low daily physical activity increases cardiovascular mortality. Addition of intradialytic exercise (IDX) program might improve physical activity and health status in OL-HDF patients. This pilot open-labeled randomized-controlled trial was conducted to evaluate the effects of IDX on physical activity and other clinical parameters in OL-HDF patients.

Methods

Twelve OL-HDF patients were randomized into control (n?=?6) or IDX (n?=?6) groups. The subjects in IDX group were trained to exercise using a cycle ergometer for 60 min during each OL-HDF session. Physical activity measured as daily step count using a wrist-worn triaxial accelerometer, physical fitness, or cardiorespiratory fitness assessed by VO₂max and other physical performance tests, lean body mass determined by the Dual-energy X-ray absorptiometry (DXA), quality of life (QOL), and various parameters were compared between baseline and 6 months.

Results

The baseline physical activity status was comparable. Following 6-month IDX, the physical activity was significantly improved in IDX group [+?1048.79 (+?741.50,?+?2792.54) vs. ? 362.06 (? 1626.82, ? 167.47) steps/day, p?=?0.01], while physical fitness and QOL were unchanged. The lean body mass parameters were preserved in the IDX group while seemed to decrease in the control group. Serum albumin was significantly increased in the IDX group (p?=?0.01). The hemoglobin changes were significantly better (p?=?0.01) and the erythropoietin resistance index was significantly lower in the IDX group (p?=?0.03). Phosphate reduction was significantly greater in the IDX group (p?=?0.04).

Conclusions

IDX could improve physical activity and other metabolic parameters in OL-HDF patients and these might contribute to further improvement in clinical and survival outcomes.

Trial registration

ClinicalTrials.gov Registration: NCT03353844.

     

Usefulness of 99mTc-pertechnetate whole body scan with neck and chest SPECT/CT for detection of post-surgical thyroid remnant and metastasis in differentiated thyroid cancer patients

Objective

The aim of the study was to evaluate the usefulness of ^99mTc-pertechnetate whole body scan (WBS) with neck and chest SPECT/CT for detection of post-surgical thyroid remnant and metastasis in differentiated thyroid cancer (DTC) patients.

Methods

Fifty-six post total thyroidectomy patients were included. All patients were prospectively imaged with ^99mTc-pertechnetate WBS with neck and chest SPECT/CT before ¹³¹I ablation. The post-ablative ¹³¹I WBS with SPECT/CT was performed at 5–7 days after receiving ¹³¹I. Both scans were directly compared to determine the concordance of sites and number of remnant and metastasis.

Results

Overall per-patient analysis, the percentage of concordance between two scans was 96.4 %. In thyroid bed, lymph node, lung and bone subgroups, the percentage of concordance between two scans was 96.4, 92.9, 98.2 and 100 %, respectively. All of them show good correlation with unweighted kappa between 0.7 and 1. Overall per-lesion analysis, the percentage of concordance between two scans was 84 %. In thyroid bed, lymph node, lung and bone subgroups, the percentage of concordance between two scans was 89.5, 55, 82.6 and 50 %, respectively.

Conclusions

Pre-ablative pertechnetate WBS with neck and chest SPECT/CT has good correlation for the detection of post-surgical thyroid remnant, cervical node and discrete lung nodule metastasis as compared to ¹³¹I WBS with SPECT/CT per-patient basis. Because ¹³¹I therapeutic activity is desired base on metastatic site and less concerning about the number of lesions, pre-ablative ^99mTc-pertechnetate WBS with SPECT/CT was a good alternative tool to avoid radioiodine stunning in post-surgical DTC patients.