Pioneering dialysis kinesiology in Sabah
Published on: Friday, January 11, 2019
By: David Thien

KOTA KINABALU: Dialysis kinesiology or intradialytic exercise is about doing some exercise by a chronic kidney disease or kidney failure patient, for example, using his or her legs to cycle a stationary equipment for some of the time duration during his or her haemodialysis session or intradialytic cycling.

Dialysis kinesiology can involve specific physiotherapy on dialysis for specific muscle groups.

After a public health lecture on ‘Powerful Treatment for Kidney Failure’ at E.West banquet hall at Luyang on January 5, speaker Dr Kenneth Wu Soon Tak (pic) of KPJ Specialist Hospital here was asked by an attendee, if it was alright that during hemodialysis session, as the attendee had read somewhere, that one can eat as much as one wanted as well as drink beer.

An advocate of doing light exercises during dialysis session also known as dialysis kinesiology which he is pioneering in Sabah and Malaysia with the right exercise equipment, Dr Kenneth Wu strongly disagreed with the drinking beer suggestion. “If the doctor recommends that the patient needs to eat something light due to low blood glucose condition, then it should be acceptable.”

Lack of exercise besides poor diet and an aging population contribute to chronic kidney disease. 

“Fast food slows you down,” said Dr Wu as he called on Malaysians to create tremendous awareness on the dangers of diabetes and high blood pressure or hypertension, to consume less salt and sugar in their diet.

“Prevention for diabetes involves exercise. Exercise for 150 minutes or two and half hours a week as obesity is on the rise,”   he said.

According to Dr Thiruventhiren, who is the vice-chairman of the National Kidney Foundation (NKF) of Malaysia’s board of directors, the latest statistics show that there are about 7,000 new patients entering the dialysis programme on a yearly basis.

Stationary cycling is most feasible and such exercise training has the potential to preserve kidney function and improve cardiovascular risk factors in predialysis patients with chronic kidney disease.

A research had found that it improved patients’ blood vessel health and exercise capacity.

Exercise may have an array of health benefits to these patients ranging from keeping their diabetes under control, maintaining healthy muscles and blood vessels to controlling weight gains after a transplant that are associated with prescribed medications.

Equally as important, patients reported improvements in their everyday quality of life as a result of becoming more active.

Before Dr Wu who hails from Papar returned to serve at the Queen Elizabeth Hospital for one and half years as a specialist before moving on to private hospitals, many doctors and nurses including nephrologists were unaware, or sceptical about the benefits of exercise in dialysis patients as exercise wasn’t very appealing when a patient had extreme fatigue and nausea from a chronic illness such as kidney failure.

Even exercise equipment suppliers common in Western countries revealed that there were no orders ever before received from Asian countries for their equipment used for exercise during dialysis session.

So now, when a patient finds out lower-intensity exercise can make a difference with such equipment, it can be a big relief to them if bored during their hours spent during haemodialysis.

Just how much exercise is needed during haemodialysis, a treatment that uses a machine to filter the body’s blood and remove toxins when the kidneys are not functioning, is up to the doctor or a kinesiologist like Dr Wu to recommend.

Intradialytic exercise has been shown to benefit dialysis efficacy. Such exercise as a therapy for patients is utilized in KPJ hospital dialysis programmes. 

Benefits for patients include improvements in aerobic capacity, leg muscle strength, quality of life, as well as lower markers of inflammation and hospital usage. Dr Wu also calls at KPJ hospital in Sarawak upon request to treat patients.

Another important benefit is enhanced solute removal and efficacy of the dialysis treatment itself.

Compared with dialysis at rest, it increases blood flow and perfusion of the exercising musculature, thereby increasing the surface area of exchange between the blood and the muscle tissue.

Subsequently, more waste products (e.g., urea) can diffuse from the muscle into circulation — to be removed via dialysis — during exercising compared with dialysis at rest.

“Exercise is important. Avoid unknown drugs. Go for regular health screenings,” Dr Wu exhorted.

Dr Wu warned the audience not to abuse painkiller usage without doctor’s prescription, which can damage liver and kidney, two important organs needed to detoxify blood.

He noticed that Ponstan usage is high in Sabah besides others. Brand mentioned include Ibuprofen, Diclofenac, Celecoxib besides avoiding other unknown drugs and supplements.

“Drink two litres of water every day,” he told the audience on a way to prevent formation of kidney stones from insufficient fluid intake.

The formation of kidney stones, he said, could lead to pain experience by men as intense as those experienced by women in labour giving birth.

In Malaysia, for total dialysis patients, prevalence has increased rapidly. There were 7,800 in year 2000, 23,000 in year 2010, and more than 40,000 now according to a preliminary survey. - David Thien


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