2. Universidad Cardenal Herrera-CEU

Renal fibrosis is characterized by glomerulosclerosis and tubulointerstitial fibrosis and its pathoge-nesis is associated with the activity of mesenchymal cells (fibroblasts), being essentiallycharacterized by a process of excessive accumulation resulting from the deposition of extracellularmatrix components. The aim of this study was to characterize the morphological presentation ofchronic and fibrotic lesions in the glomerular, tubular, interstitial, and vascular compartments infeline CKD, as well as the possible participation of myofibroblasts in renal fibrotic processes in thisspecies. Cat kidneys were collected and processed according to the conventional techniques forlight microscopy, circular polarization, immunohistochemistry, and electron microscopy. Fibroticalterations were present in all compartments analyzed. The main findings in the glomerular com-partment were different degrees of glomerular sclerosis, synechia formation, Bowman’s capsulecalcification, in addition to glomerular basement membrane thickening and pericapsular fibrosis.The tubulointerstitial compartment had intense tubular degeneration and the immunostaining intubular cells for mesenchymal cell markers demonstrated the possibility of mesenchymal epithelialtransition and consequent involvement of myofibroblasts in the development of interstitial tubuledamage. Infiltration of inflammatory cells, added to vessel thickening and fibrosis, demonstratedthe severity and role of inflammation in the development and perpetuation of damage. Thus, wemay conclude that fibrotic lesions play a relevant role in feline CKD and the mechanism of perpet-uation of these lesions need further elucidation regarding the origin and participation ofmyofibroblasts and consequent mesenchymal epithelial transition in this species.

Background: Exercise programs in patients with kidney disease improve functional capacity and health-related quality of life, but the implementation of exercise programs in nephrology services is not an easy task. Aim: To evaluate the effectiveness of a home-based exercise program in patients with chronic kidney disease (CKD) stages 4–5 (with or without dialysis). Methods: A 12-week prospective observational cohort design study was carried out with patients with renal failure who undertook a home-based exercise program. Registered data included: (a) biochemical parameters; (b) functional capacity tests, that is, short physical performance battery, sit to stand to sit 10, and 6-min walking test; (c) handgrip strength; (d) health-related quality of life; (e) satisfaction; and (f) adherence. The quantitative variables were expressed by means and standard deviation, and qualitative variables, by percentage. The comparison of quantitative data between baseline and at 12 weeks of the same group was carried out using the Wilcoxon test for nonparametric-related variables and the chi-square test for categorical variables using contingency tables. Results: Fifty-three patients were included (mean age = 67.4 years). The functional capacity tests showed a significant improvement in the short physical performance battery (8.3 ± 2.8 vs. 9.5 ± 2.6 points), the sit to stand to sit 10 (35.8 ± 17.7 vs. 31.8 ± 15.3 s), and the 6-min walking test (355.0 ± 106.1 vs. 386.4 ± 113.6 meters), mainly in CKD stage 5. There were no significant differences in handgrip and health-related quality of life. Regarding the degree of program satisfaction, 70% of the patients were very satisfied with being able to participate in the program, and 64% considered that they had more strength after completing the home-based exercise program. Linking Evidence to Action: The implementation of a home-based exercise program results in improved functional capacity in patients with CKD stage 5. Moreover, this exercise program is safe, and patients were satisfied.

Background: Intradialysis exercise programs in renal patients result in improved functional capacity, muscle strength, symptoms of depression, and health-related quality of life. Home-based exercise programs are an alternative to overcome logistical and human resource problems. However, the implementation of these programs is not an easy task and there is a lack of knowledge regarding the benefits associated with home-based exercise programs. Aim: To determine whether home-based exercise programs improve functional capacity, health-related quality of life, muscle strength, and symptoms of depression among patients with stage III–V chronic kidney disease. Methods: A systematic review and meta-analyses following PRISMA guidelines were utilized. Relevant articles were collected and independently assessed for their inclusion eligibility. Effects of home-based exercise were summarized by the standardized mean differences and represented by forest plots (Review Manager 5.4). Results: Eight studies were included, none of which reported any adverse effects. The intervention was usually aerobic, 76% of these programs lasted 3–6 months, and exercise adherence was 60–87.5%. Four studies measured health-related quality of life and found significant improvements in several subscales. Regarding functional capacity, five studies used the six-minute walking test (44.9 meters; 95% CI [30.45, 59.30]; p ≤ .001), three studies used the sit-to-stand-to-sit test (−0.45 seconds; 95% CI [−0.46, −0.26]; p ≤ .001), and two studies used the timed up-and-go test (−0.76 seconds; 95% CI [−1.38, −0.15]; p ≤ .001) and the handgrip strength test (1.16 kg; 95% CI [−2.88, 5.20]; p ≤ .001). LINKING EVIDENCE TO ACTION: Home-based exercise programs are beneficial to renal patients. These interventions are safe and effective to improve health-related quality of life and functional capacity and reduce symptoms of depression among patients with chronic kidney disease.