Report from the Second International Congress on Quality of Life in End-stage Renal Disease, Thessaloniki, Greece, March 8–9, 2002

Asterios Deligiannis

Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Greece

This congress was organized by the European Working Group on Renal Rehabilitation and Exercise Physiology, the A' Internal Medicine Clinic and the Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Greece.

The main topics of the Congress were: functional capacity of renal patients; morbidity and mortality in end-stage renal disease (ESRD); psychological distress in ESRD; exercise training in ESRD; renal rehabilitation and quality of life in ESRD; erythropoietin and quality of life in renal patients; new trends in haemodialysis.

The aim of the Congress was to advance treatment and improve care in ESRD patients by promoting research and education and to provide an opportunity for discussion. A major focus of the Congress was to promote renal rehabilitation in clinical practice and research.

The Congress brought together nephrologists, exercise physiologists, physiotherapists, dieticians and nurses. Attendees had the opportunity to learn about the newest methods and devices used in the treatment of renal patients in the field of renal rehabilitation and to interact with experts.

During the opening ceremony, Professor A. Davison gave a state of the art lecture about the past, present and future of haemodialysis. He pointed out that in the past 40 years dialysis technology has advanced significantly, but improvements remain to be made to enhance rehabilitation and quality of life. Professor D. Grekas outlined the high risk factors for mortality in ESRD patients and Professor R. Vanholder showed how uraemic toxins affect patient survival. His lecture emphasized the relationship in uraemic patients between inflammation, malnutrition, cardiovascular disease and mortality. He concluded that both small and middle molecule removal has an impact on survival, so that membranes capable of removing more than urea only should be used. The beneficial effects of correcting anaemia with erythropoietin on patients’ quality of life was demonstrated by Professor N. Dombros.

However, despite the huge technical advances in the last decades, the quality of life of ESRD patients remains poor. During this period, groups in Germany, Sweden, Greece and the UK have prescribed exercise training to pre-dialysis and dialysis patients. At the congress the results of some of the studies on the effects of exercise training in uraemic patients were presented by experts from the European Working Group on Renal Rehabilitation and Exercise Physiology. Today, only a minority of dialysis patients participate in a renal rehabilitation programme, mainly because of lack of experience and facilities. The importance of starting exercise training in pre-dialysis and dialysis patients was highlighted as patients lose 40–50% of their maximal exercise capacity and muscle strength during the pre-dialysis stage. This decrease in exercise capacity and muscle strength can be prevented by exercise rehabilitation programmes during the pre-dialysis stage in young, middle-aged and elderly patients (Dr N. Clyne). In haemodialysis patients, 6 months of aerobic training either during or between dialysis sessions have positive effects on functional capacity, cardiac function, muscle strength and muscle composition. Moreover, haemodialysis patients achieve a greater degree of heart rate variability after 6 months of exercise training, thus exercise training most likely has a positive impact on cardiac parasympathetic activity (Dr E. Kouidi). Exercise training also has positive effects on dialysis patients’ psychosocial profile, degree of depression and thus their quality of life (Dr R. Krause). Today, the majority of dialysis patients are elderly, however, these patients were able to participate in bed-bicycle ergometer training during haemodialysis and thus increase their physical exercise and functional capacity (Dr A. Daul).

The chairmen concluded that the Congress increased knowledge about the effects of new treatment strategies in renal rehabilitation and that exercise training should become an integral part of the routine treatment of ESRD patients, with the specific aim to improve their functional status and health related quality of life (Professors A. Tourkantonis and A. Deligiannis).

The European Working Group on Renal Rehabilitation and Exercise Physiology is a newly formed working group of the ERA–EDTA. Please visit our web site (http://www.renalrehab.com) for further information.





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