RESUMEN
Photobiomodulation (PBM) has been used in different populations as a strategy to attenuate muscle fatigue and improve exercise performance. Recent findings demonstrated that a single session with specific PBM doses during hemodialysis (HD) increased the upper limb muscle strength of chronic kidney failure (CKF) patients. Now, the primary objective of this study was to evaluate the chronic effect of PBM on the functional capacity of this population. Secondarily, we aimed at investigating the effects of PBM on the patients' strength, muscle thickness and echogenicity, perception of pain, fatigue, and quality of life. A randomized controlled trial was conducted in which the intervention group (IG, n = 14) received 24 sessions of PBM (810 nm, 5 diodes × 200 mW, 30 J/application site) on lower limb during HD. The control group (CG, n = 14) did not receive any physical therapy intervention, it only underwent HD sessions. As a result, there was an increase in the functional capacity (assessed through the six-minute walk test) for the IG compared with the CG [50.7 m (CI95% 15.63; 85.72), p = 0.01, large effect size, d = 1.12], as well as an improvement on lower limb muscle strength (assessed through the sit-and-stand test) [- 7.4 s (CI95% - 4.54; - 10.37), p = 0.00, large effect size, d = 1.99]. For other outcomes evaluated, no significant difference between-group was observed. Finally, PBM applied as monotherapy for 8 weeks in the lower limb improves functional capacity and muscle strength of CKF patients.
Asunto(s)
Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/radioterapia , Terapia por Luz de Baja Intensidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fatiga Muscular/efectos de la radiación , Fuerza Muscular/efectos de la radiación , Modalidades de Fisioterapia , Calidad de VidaRESUMEN
In order to evaluate the progression of renal disease, Munich-Wistar rats were submitted to 5/6 nephrectomy and given whole-body x- or gamma-irradiation with or without remnant kidney protection or were submitted only to remnant kidney irradiation. All groups received a single 6-Gy dose immediately after surgery. Whole-kidney function, glomerular hemodynamics, 24-hour proteinuria and histopathology were assessed 60 days after surgery and irradiation. The irradiated nephrectomized animals presented whole-kidney function parameters comparable to those of normal rats. In addition, they were less hypertensive and had higher hematocrit. They showed glomerular hyperfiltration and hypertension even greater than their respective nephrectomized controls. However, the interrelations among the glomerular filtration determinants were somewhat different in irradiated animals. Their 24-hour proteinuria was significantly lower and the sclerosis index and tubulointerstitial injury score were markedly smaller. Among irradiated animals, the worst sclerosis index was observed in those with a shielded remnant kidney and the best in those without protection of the remnant kidney. This led us to speculate about a possible influence of resident mesangial cells on the early events following renal mass ablation and on the maintenance of subsequent physiopathologic changes. Therefore, radiation undoubtedly provoked a beneficial change in the course of renal disease when the renal mass ablation model was employed. Many factors could have contributed to this favorable feature including lower levels of systemic arterial pressure, less increment in DeltaP, diminished proteinuria, and maintenance of tubulointerstitial space integrity. Our data also suggest that development of glomerulosclerosis seems to be determined by events occurring immediately after injury.