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Research

The focus of the research in our lab is to investigate the efficacy of lifestyle modifications (exercise and dietary factors) on co-morbidities associated with chronic kidney disease (CKD). CKD is a progressive disorder associated with severe metabolic disturbances that greatly increase the risk for cardiovascular disease (CVD), osteoporosis, muscle wasting, and other disorders that contribute to extremely low physical functioning in this population. Current pharmacological therapies have failed to significantly improve the health and quality of life (QOL) of this rapidly growing patient population, therefore investigating the efficacy of alternative or supplemental therapies is clearly needed. Our research will provide novel information regarding the effects of novel and easy to administer lifestyle interventions on clinical outcomes and QOL in dialysis patients. Results from our work will enable nephrologists to make more informed decisions regarding the extent to which these low-cost treatment strategies should be included as a component of the standard care in their clinics. Ultimately, this could lead to greater use of these treatment strategies and result in significant improvements in the health and QOL of this critically ill patient population.

Studies currently underway include:

1. Intra Hemodialytic Oral Protein and Exercise (IHOPE Trial)
2. Efficacy of Pomegranate Supplementation in CDK Patients (POM Trial)
3. Efficacy of Occlusion Training in CKD and MS Patients (Kaatsu Studies)
4. Efficacy of Functional Electrical Stimulation (FES)-Enhanced Ergometry in CKD Patients (FES study).

IHOPE is our primary study and is an NIH-funded multi-center clinical trial (NIH trial #1R01DK084016-01A2). In this study, hemodialysis patients will be randomized to the following groups for 12 months: 1) usual care/control (CON); 2) intradialytic protein supplementation (PRO); or 3) intradialytic protein supplementation + exercise training (PRO+EX). At baseline, 6, and 12 months, we will measure the effect of our interventions on a variety of metrics related to physical function (Aim 1), CVD risk (Aim 2), and Bone health (Aim 3). Enrollment for IHOPE started January 2011, and the study is scheduled to be completed in 2015.

View more information on IHOPE

POM is a pilot study aiming to evaluate the effects of pomegranate extract supplementation on CVD risk, physical function, body composition, mental performance and QOL in patients with CKD. Excessive oxidative stress and inflammation is believed to underlie many of the cardiovascular complications in patients with CKD. This suggests that antioxidant therapy, such as that from pomegranate, could be efficacious to attenuate these complications. In addition, it is well-known that higher levels of oxidative stress and inflammation are associated with increased severity and progression of CKD. Due to differences in the pathophysiology of different stages of CKD, we are recruiting both pre-dialysis and dialysis patients in this study. We believe this will help us determine if the efficacy of pomegranate extract differs between patients with different stages of CKD.

View more information on POM.

Kaatsu training, or occlusion training, is as an alternative lower-intensity exercise method. This type of exercise is done by inflating a cuff around the exercising limb, partially restricting blood flow to the muscle. Kaatsu has been shown to result in gains in muscle size and strength similar to high load training, however, Kaatsu is done at intensities of 20-40 percent of an individual’s one-repetition maximum. Therefore, it may be an effective form of exercise in populations that cannot exercise at high intensities. The purpose of our current Kaatsu training studies are to: 1) determine the effects of Kaatsu cycling on lean mass, strength, physical function and cardiovascular disease risk in CKD patients, 2) determine the effects of Kaatsu strength training on lean mass, strength, balance, and QOL in multiple sclerosis (MS) patients, and 3) determine subjects’ response to Kaatsu training and try to determine a way by which Kaatsu can be performed, and still be effective, however, with less discomfort to the subjects.

Functional electrical stimulation (FES)-enhanced cycling is a new form of exercise using a motor-assisted cycle coupled with electrical stimulation that stimulates leg muscles to pedal. FES exercise has been shown to be beneficial and has been safely used as an activity based rehabilitation therapy in patients with severe disabilities such as spinal cord injury or stroke patients. The objective of FES study is to evaluate the effects of FES-cycling training on measures related to physical function, heart disease, bone health and QOL in dialysis patients with relatively low levels of physical function.