Browsing by Person "Greenwood, Sharlene"

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Body Composition and Intradialytic Exercise in Kidney Disease: A Combined Analysis of the PEDAL and CYCLE‐HD Randomised Controlled Trials
(2025-03-03) Ng, Khai Ping; Macdonald, Jamie H.; Young, Robin; March, Daniel S.; Graham‐Brown, Matthew P. M.; Mercer, Tom; Greenwood, Sharlene; Burton, James O.; Dasgupta, Indranil
Background: Haemodialysis patients are at high risk of myopenic obesity, necessitating effective nutritional status monitoring and intervention strategies. This combined analysis of two clinical trials (PEDAL trial and CYCLE‐HD study) aimed to (i) determine the clinical utility of body mass index (BMI) in comparison to fat tissue index (FTI) and lean tissue index (LTI) and (ii) assess the effect of a 6‐month intradialytic exercise intervention compared to usual care on FTI and LTI. Methods: A priori secondary endpoints in both trials included BMI, FTI and LTI. BMI was classified by World Health Organisation definitions (underweight, healthy, overweight or obese). FTI and LTI were determined by Bioelectrical Impedance Spectroscopy and classified by previous research evidence (FTI of 4–15 kg/m2 and LTI of 15–20 kg/m2 being associated with best survival). For aim (i), BMI was compared to FTI and LTI by correlation and classification. For aim (ii), changes over 6 months in FTI and LTI were compared between exercise intervention and control groups. Results: Across both studies, 298 and 209 participants had bioelectrical impedance spectroscopy measurement at baseline and 6 months, respectively. Mean (SD) age: 58 (15) years; BMI: 28.2(6.3) kg/m2; male: 65%. At baseline, only 47 of 298 participants (16%) had an FTI and LTI associated with best survival. BMI correlated with FTI (r = 0.79; p < 0.0001). However, 34% of participants were misclassified by BMI (e.g., 9% of patients were classified as obese by BMI yet FTI revealed their body composition was healthy). BMI did not correlate with LTI (p = 0.15), and 86% of participants were misclassified by BMI (e.g., 73% of patients were classified as healthy, overweight or obese by BMI yet LTI revealed they were myopenic). There was no difference between exercise intervention and control groups in mean change (95% CI) over 6 months for LTI (−0.3 [−1.1 to 0.4] kg/m2; p = 0.4) or FTI (0.2 [−0.7 to 1.0] kg/m2; p = 0.7). Conclusions: Worryingly, only a minority (16%) of haemodialysis patients had both LTI and FTI within the range associated with best survival. Body composition misclassification using conventional BMI cut‐offs was common: despite having healthy, overweight or even obese BMI, the majority (73%) of patients had hidden myopenia according to LTI. Six months of intradialytic aerobic exercise did not improve body composition. This study identified that common measures of nutritional status in haemodialysis patients such as BMI are misleading and that interventions other than intradialytic cycling are urgently required to target myopenic obesity.
Clinical practice guideline: Haemodialysis
(The Renal Association, 2019-07-31) Ashby, Damien; Borman, Natalie; Burton, James; Corbett, Richard; Davenport, Andrew; Farrington, Ken; Flowers, Katey; Fotheringham, James; Fox, Andrea; Franklin, Gail; Gardiner, Claire; Gerrish, Martin; Greenwood, Sharlene; Hothi, Daljit; Khares, Abdul; Koufaki, Pelagia; Levy, Jeremy; Lindley, Elizabeth; Macdonald, Jamie; Mafrici, Bruno; Mooney, Andrew; Tattersall, James; Tyerman, Kay; Villar, Enric; Wilkie, Marin
Haemodialysis continues to expand in the UK with over 25 000 patients now being treated, representing a 10% increase since publication of the previous Renal Association guideline for haemodialysis. In addition the patient group continues to develop: the typical patient is now 67 years old with a median history of 3.2 years on renal replacement therapy. The authors of this guideline aimed principally to update the previous guideline according to the latest research and experience, but also to expand the scope into areas not previously covered but relevant to haemodialysis practice.
Exercise Testing in Chronic Kidney Disease
(Routledge, 2022-03-14) Koufaki, Pelagia; Greenwood, Sharlene; Macdonald, Jamie H; Davison, R.C. Richard; Smith, Paul M; Hopker, James; Price, Michael J; Hettinga, Florentina; Tew, Garry; Bottoms, Lindsay
Physical Activity, Function, and Exercise-Based Rehabilitation for Dialysis Patients
(Elsevier Inc., 2016-11-08) Greenwood, Sharlene; Koufaki, Pelagia
Renal Association clinical practice guideline on haemodialysis
(SpringerNature, 2019-10-17) Ashby, Damien; Borman, Natalie; Burton, James; Corbett, Richard; Davenport, Andrew; Farrington, Ken; Flowers, Katey; Fotheringham, James; Fox, Andrea; Franklin, Gail; Gardiner, Claire; Gerrish, Martin; Greenwood, Sharlene; Hothi, Daljit; Khares, Abdul; Koufaki, Pelagia; Levy, Jeremy; Lindley, Elizabeth; Macdonald, Jamie; Mafrici, Bruno; Mooney, Andrew; Tattersall, James; Tyerman, Kay; Villar, Enric; Wilkie, Martin
This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: "what does good quality haemodialysis look like?"The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to - most of this is freely available online, at least in summary form.A few notes on the individual sections: 1. This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines "enough" dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term "eKt/V" is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient. 2. This section deals with "non-standard" dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week - this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here. 3. This section deals with membranes (the type of "filter" used in the dialysis machine) and "HDF" (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it's as good as but not better than regular dialysis. 4. This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this. 5. This section deals with dialysate, which is the fluid used to "pull" toxins out of the blood (it is sometimes called the "bath"). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasionally needs to be added into the dialysate. 6. This section is about anticoagulation (blood thinning) which is needed to stop the circuit from clotting, but sometimes causes side effects. 7. This section is about certain safety aspects of dialysis, not seeking to replace well-established local protocols, but focussing on just a few where we thought some national-level guidance would be useful. 8. This section draws together a few aspects of dialysis which don't easily fit elsewhere, and which impact on how dialysis feels to patients, rather than the medical outcome, though of course these are linked. This is where home haemodialysis and exercise are covered. There is an appendix at the end which covers a few aspects in more detail, especially the mathematical ideas. Several aspects of dialysis are not included in this guideline since they are covered elsewhere, often because they are aspects which affect non-dialysis patients too. This includes: anaemia, calcium and bone health, high blood pressure, nutrition, infection control, vascular access, transplant planning, and when dialysis should be started.