Denna sida
på svenska

Naomi Clyne - Leader of Research Group

Project

 

Chronic kidney disease and the effects of exercise training

Naomi Clyne

Patients with chronic kidney disease (CKD) have a markedly increased morbidity and mortality in cardiovascular disease and infections compared with the normal population. In fact, data from the US renal registry showed that for patients of all ages on maintenance hemodialysis the cardiovascular mortality rate is at a level of 80 year olds in the normal population. Moreover, as renal function declines, patients experience a progressive increase in fatigue and a decrease in physical function with levels at about half the expected norm by the time they are on dialysis. The causes are multi-factorial including insufficient blood-pressure control, anemia, deranged calcium-phosphate-vitamin D-parathyroid status, metabolic acidosis, increased inflammatory activity and a sedentary lifestyle. CKD is a condition, which depending on the cause but also depending on lifestyle, recognition and control of a number of risk factors and complications can have a faster or slower progression towards end-stage renal failure. Once maintenance dialysis becomes necessary complications can be managed more or less successfully. Dialysis dose and control of the above mentioned uremic complications impact on patient survival. Renal transplantation usually restores adequate renal function, however, the majority of patients experience some degree of osteoporosis due to cortisone treatment and level of secondary hyperparathyroidism prior to transplantation. An increased incidence of skeletal fractures is not uncommon among patients with renal transplants.

Our research interests comprise patients in CKD 3, 4 and 5, on dialysis and after renal transplantation. Our focus is the effects of exercise training on cardiovascular risk factors, inflammation, skeletal muscle, bone and health related quality of life.

Our general aims

• To study the long-term effects of exercise training on uremic complications in CKD 4-5
• To study the effects of resistance training on the development of osteoporosis after renal transplantation
• To enhance health related quality of life in CKD patients
• To facilitate maximal levels of independence and self-care
• To slow progression towards end-stage renal disease

We work in multiprofessional teams both in the clinic and in our research, comprising nephrologists, statisticians, physiotherapists and laboratory based exercise physiologists. This enables us to work at several levels and study epidemiology, treatment and prevention.

The research group

Naomi Clyne MD,PhD, associate professor; Naomi.Clyne@med.lu.se
Peter Höglund MD, PhD, associate professor; Peter.Hoglund@med.lu.se
Shahriar Akaberi MD, doctoral student; Shahriar.Akaberi@med.lu.se
Helena Rydell MD, doctoral student; helena.rydell_johnsen@med.lu.se 
Matthias Hellberg MD, doctoral student; Matthias.Hellberg@med.lu.se
Eva Maria Wiberg MSc, physiotherapist; Eva.Wiberg@skane.se
Huda Abdulahi, physiotherapist, master’s student; Huda.Abdulahi@skane.se
Emma Ottoson, physiotherapist; Emma.Ottoson@skane.se 

Relevant publications

1. Clyne N, Jogestrand T, Lins L-E, Pehrsson S K. Factors limiting physical working capacity in predialytic uraemic patients. Acta Med Scand 1987; 222: 183-90. 
2. Clyne N, Jogestrand T, Lins L-E, Pehrsson S K. Factors influencing physical working capacity in renal transplant patients. Scand J Urol Nephrol 1989; 23: 145-150. 
3. Clyne N, Jogestrand T, Lins L-E, Ekholm J, Pehrsson S K. Effects of exercise training in predialytic uremic patients. Nephron 1991; 59; 84-89. 
4. Clyne N, Jogestrand T, Effect of erythropoietin treatment on physical exercise capacity and on renal function in predialytic uremic patients. Nephron 1992; 60: 390-396. 
5. Clyne N, Esbjörnsson M, Jogestrand T, Lins L-E, Pehrsson S K. Effects of renal failure on skeletal muscle. Nephron 1993; 63: 395-399. 
6. Clyne N, Jogesrand T, Lins L-E, Pehrsson S K. Progressive decline in renal function induces a gradual decrease in total hemoglobin and exercise Capacity. Nephron 1994; 67: 322-326. 
7. Klang B, Björvell H, Clyne N. Quality of life in predialytic uremic patients. Quality of Life Research 1996; 5: 109-116. 
8. Klang B, Björvell H, Clyne N. Sense of well-being in predialytic uremic patients. ANNA  1996; 23(2): 223-230. 
9. Klang B, Clyne N. Well-being and functional ability in uremic patients before and after having started dialysis treatment. Scand J of Caring Sciences 1997; 11: 159-166. 
10. Klang B, Björvell H, Berglund J, Sundstedt C, Clyne N. Predialysis patient education: effects on dialysis patients functioning and well-being. J of Advanced Nursing 1998; 28(1): 36-44. 
11. Klang B, Björvell H, Clyne N. Predialysis education helps patients choose dialysis modality and increases disease specific knowledge. J of Advanced Nursing 1999; 29(4): 869-876. 
12. Heiwe S, Tollbäck A, Clyne N. Twelve weeks of exercise training increases muscle function and walking capacity in elderly predialysis patients and healthy subjects. Nephron. 2001;(1): 48-56. 
13. Hagren B, Lützén KI, Pettersen IM, Severingsson EI, Clyne N. Patients’experiences of suffering in hemodialysis care. J Adv Nursing, 2001;34(2): 196-202. 
14. Heiwe S, Clyne N, Abrandt Dahlgren M. Living with chronic renal failure: patients’ experiences of their physical and functional capacity. Physiother Research Int 2003; 8(4): 167-77.
15. Clyne N. Physical working capacity and muscle strength in chronic renal failure are improved by exercise. Lakartidningen. 2004 Dec 9; 101(50): 4111-5. Review. Swedish. 
16. Clyne N. The importance of exercise training in predialysis patients with chronic kidney disease. Clin Nephrol. 2004 May; 61 Suppl 1:S10-3. Review. 
17. Hagren B, Pettersen IM, Severinsson E, Lützén K, Clyne N. Maintenance haemodialysis: patients’ experiences of their life situation. J Clin Nurs. 2005 Mar; 14(3): 294-300. 
18. Heiwe S, Clyne N, Tollback A, Borg K. Effects of Training on muscle histopathology and morphometry in elderly patients with chronic kidney disease. Am J Phys Med Rebah, 2005 Nov; 84(11): 865-74. 
19. Braunschweig F, Kjellstrom B, Söderhäll M, Clyne N, Linde C. Dynamic changes in right ventricular pressures during haemodialysis recorded with an implantable haemodynamic monitor Nephrol Dial Transplant. 2006 Jan; 21(1): 176-83. 
20. Drüeke TB, Locatelli F, Clyne N, Eckadt KU, MacDougall I, Tsakiris D, Burger HU, Scherhag A. Normalization of hemoglobin levelsin patients with chronic kidney disease and anemia. N Engl J Med. 2006;355(20):2071-84. 
21. Akaberi S, Lindergård B, Simonsen O, Nyberg G.Impact of parathyroid hormone on bone density in long-term renal transplant patients with good graft function.Transplantation. 2006 Sep 27;82(6):749-52. 
22. Akaberi S, Simonsen O, Lindergård B, Nyberg G. Can DXA predict fractures in renal transplant patients? Am J Transplant. 2008 Dec;8(12):2647-51. Epub 2008 Oct 6. 
23. Eckardt KU, Scherhag A, MacDougall I, Tsakiris, Clyne N, Locatelli F, Zaug M, Burger U, Drüeke T. Left ventricular geometry predicts cardiovascular oucomes associated with anemia in CKD. JASN 2009:20(12). 
24. Locatelli F, Eckardt KU, MacDougall IC, Tsakiris D, Clyne N, Burger HU, Scherhag A, Drüke T. Value of natriuretic peptide as a prognostic marker in patients with CKD: results from the CREATE study. Curr Med Res Opin 2010:26(11):2543-52. 
25. Clyne N. Exercise Training in Chronic Kidney Disease. US Nephrology 2011:5(2). 
26. Rydell H, Krützen L, Simonsen S, Clyne N, Segelmark M. Excellent long time survival for Swedish patients starting home-hemodialysis with and without subsequent renal transplantations. In manuscript.