PubMed · 9828607
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M Estenne. 1998. Lung transplantation for emphysema.. https://pubmed.ncbi.nlm.nih.gov/9828607/
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Patients on dialysis have extremely limited exercise capacity, and poor physical functioning has been linked to low quality of life and high mortality in this population. The reason for the debility of patients on dialysis is far from clear despite years of study. The anemia of chronic renal disease is clearly a contributing factor, but uremic myopathy and resulting decreased muscle oxygen utilization have a significant impact on the physical functioning of patients on dialysis as well. Although it is likely that factors related to uremia adversely affect muscle function, some of the abnormalities demonstrated in uremic muscle are consistent with disuse atrophy. The clear contribution of anemia and the possible role of limited physical activity have led to studies of the effects of erythropoietin and aerobic exercise training on exercise capacity in end-stage renal disease patients. Both of these interventions result in increased exercise capacity. Thus vigorous treatment of anemia and uremia and encouragement of physical activity are important interventions to maximize the physical functioning of patients on dialysis. In addition, more studies are needed to clarify the causes of debility in this population and the impact of interventions on physical functioning, quality of life, and mortality.
Although not traditionally a part of the dialysis team, physical therapists can play an important role in improving the quality of life for dialysis patients. Physical therapists are trained to evaluate the presence of a functional problem such as back pain, muscle weakness, limited range of motion, balance disorder, alteration in gait, joint pain, neuropathic pain, sensory disturbance, loss of functional mobility, or alteration in posture. Many of these conditions are prevalent in the dialysis population. This article describes how a patient is referred to physical therapy, and once referred, how the patient is evaluated and treated, including goal setting and progression. It is thought that early referral of dialysis patients to physical therapy may prevent some of the functional deterioration typically seen in this population. The incorporation of physical therapy as part of the routine treatment plan may help dialysis staff to address many of the regular nonspecific complaints of fatigue, malaise, pain, and discomfort commonly experienced by dialysis patients.
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