Renal and Cardiovascular Disease Research Laboratory

About

The Wilund lab is deeply engaged in exploring interventions to enhance the health and quality of life in individuals suffering from chronic kidney disease (CKD). The lab's mission revolves around two critical and interrelated domains of CKD patient care: increasing physical activity and improving nutrition.

A key challenge for CKD patients, particularly those undergoing hemodialysis, is chronic volume overload. This issue arises due to the inability to produce sufficient urine, leading to fluid accumulation and subsequent health complications like elevated blood pressure, heart enlargement, and potentially congestive heart failure. The lab focuses on sustainable interventions to manage this volume overload, a major factor in the high hospitalization and mortality rates among dialysis patients.

Additionally, Dr. Wilund's research encompasses the impact of sodium on skeletal muscle dysfunction in CKD patients. The lab is investigating how sodium accumulation in muscles may contribute to various metabolic issues, including insulin resistance and mitochondrial dysfunction. Strategies to address this involve a combination of exercise and dietary sodium restriction.

Dr. Wilund has also established two research-related entities to support this work: The Global Renal Exercise (GREX) Network and The Kidney Wellness Institute of Illinois (KIWII). These organizations aim to enhance the research and implementation of lifestyle-related therapies across the CKD spectrum.

The overall goal of Dr. Wilund's research and the activities of the laboratory is to develop and evaluate novel approaches to improve the health and quality of life of CKD patients, emphasizing the importance of physical activity and nutritional interventions alongside traditional pharmacological therapies. These efforts represent a significant contribution to nephrology, addressing some of the most pressing and complex challenges faced by patients with chronic kidney disease.

Research

The primary focus of this lab for the past decade has been on examining the efficacy of novel approaches to improve the health and quality of life for patients with kidney failure. To this end, we study the individual and combined effects of exercise training and nutrition on patients undergoing maintenance dialysis therapy. Many interventions target the intradialytic period because past research indicates the hemodialysis process is associated with acute inflammation and oxidative stress that contribute to cardiovascular complications, muscle wasting, and other co-morbidities. The research questions and projects in our lab are often multi-disciplinary in nature, so we frequently collaborate with other laboratories in the Department of Kinesiology and Community Health as well as other departments across the University of Illinois campus and at local clinics and hospitals.

Current Projects

Development and Testing of an Innovative Patient-Centered Physical Activity Program for Hemodialysis Patients (Move More)
Individuals with kidney failure receiving maintenance hemodialysis (HD) have very low physical activity levels and poor physical function, and this contributes to a poor quality of life (QOL) and premature mortality. To help address this problem, many have implemented simplistic exercise programs that include mandated exercise prescriptions such as cycling during dialysis, light resistance training, or at home walking programs. But the benefits from these studies are often disappointing, as they are characterized by poor adherence, high dropout rates, and modest effects on physical function or other outcomes related to QOL.

The primary objective of this study is to compare the feasibility and efficacy of a standard intradialytic exercise program to an individualized patient-centered exercise prescription in HD patients. To accomplish this, hemodialysis patients will be randomly assigned to one of two groups for 6 months: 1) Intradialytic exercise; or 2) “Move More” – a personalized exercise program involving both in center and out-of-center exercise. Those in the intradialytic exercise group will undergo a variety of exercises including intradialytic cycling and resistance exercise for 6 months. Those in Move More will be asked to choose from a variety of in center and at home exercises. For Move More, we established a system in which participants will accumulate points by completing various activities of their choosing. This may include “lifestyle” activities (e.g., gardening, housework), endurance exercise, and/or strength training type activities. Points for each activity are derived from metabolic equivalent (MET) scores from the Compendium of Physical Activity. The goal of the point-based system is to apply a progressive physical activity (PA) program in which participants are increasing PA on a weekly basis. The rationale for this point system is that participants are able to choose activities that are important to them, as opposed to prescribed mandated exercises they may not value or benefit from. This may create more intrinsic motivation for patients, thus increasing adherence to their PA prescription. Similar methods have been implemented within healthy populations for dieting and PA interventions but are untested in hemodialysis patients.

Assessment of Food and Cooking Skills in Hemodialysis Patients
Individuals with kidney failure undergoing maintenance hemodialysis (HD) are persistently counseled to limit dietary sodium and fluid intake to reduce interdialytic weight gain (IDWG) and prevent chronic volume overload (VO). However, adherence to these recommendations are poor, and most evidence from clinical trials indicates that dietary education and counseling are ineffective in restricting dietary sodium or IDWG. Our lab recently used an alternative approach to low-sodium counseling by using a low sodium meal provision. For 2 months, patients received two home delivered low-sodium meals per day in the first month and in the second month one per day. All participants in this study also received weekly low-sodium dietary counseling in preparation for life without the meal provision. The full dataset is still being examined but results are showing a return in original IDWG compared to the start of the study. In month one of home-delivered meals there is a slight drop in IDWG which then returns upward in month two. Gaining insight is necessary into why there was not a consistent maintenance of IDWG across the tapering of meals, especially with the ineffectiveness of dietary education and counseling. The survey list we have generated we propose will gather more information if there are barriers such as cooking skills, access to cooking equipment, and food insecurity challenges that the hemodialysis population is facing that is having a significant effect on their food choices and overall health.

Access to food and cooking equipment affect cooking ability and eating behaviors related to food choices made while grocery shopping, eating out, and eating during dialysis in kidney failure patients undergoing hemodialysis treatment. A better understanding of such information can help improve the development of diet education, which can improve the health outcomes of the patients.

The primary objective of this study is to assess the food and cooking barriers of hemodialysis patients.

Publications

  • Please visit Dr. Wilund’s Scholar profile for an updated list of publications.

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