Ken Wilund, PhD

Introduction:

The research in my lab is focused on developing novel strategies to improve the health and quality of life of patients with chronic kidney disease (CKD).  CKD patients suffer from a myriad of co-morbidities that adversely impact their health and quality of life.  While pharmacological therapies are often prioritized in their care, exercise and nutrition-related strategies receive less emphasis, despite tremendous potential benefits.  We have developed two parallel lines of research focused on: A) increasing physical activity levels in patients with chronic kidney disease; and B) reducing cardiovascular disease risk in patients with renal failure, primarily through improved management of chronic volume overload and hypertension.  These are two of the most challenging and clinically significant problems in Nephrology and should be prioritized in the rehabilitation plans for this critically ill patient population. 

To help facilitate this work, I recently founded the Global Renal Exercise (GREX) Network, an international group of over 400 researchers, clinicians, and patient partners whose goal is improve the research base and implementation of lifestyle-related therapies across the spectrum of chronic kidney disease.  See: https://grexercise.arizona.edu/  for more information on our work with GREX.  This site includes a link to our online course “Exercise in CKD – a Training Program for Exercise and Health Professionals”.  The goal of this GREX training program is to provide guidance and instruction to anyone who is interested in developing exercise or physical activity plans for individuals with CKD.  The training includes two main parts: 1) an online component that includes 8 different learning modules that are freely available on the GREX website and 2) an internship program that is designed to provide an opportunity for hands-on training to reinforce some of the most important concepts from the online modules.  See: https://grexercise.arizona.edu/renal-exercise-education-resources/exercise-ckd-course for more information or to enroll in this course.

Summary of ongoing and planned research projects in our lab include the following:

1. “Move-More:  Development and Testing of a Personalized Exercise Prescription for Hemodialysis Patients”. The purpose of this study is to compare the efficacy of a standard intradialytic exercise program (exercise during dialysis) to our individualized, patient-centered “Move-More” physical activity intervention, which provides HD patients the autonomy to choose the types of physical activity that they are willing and able to engage in.  Our primary hypothesis is that patients randomized to the “Move-More” intervention will increase their physical activity levels more than those in the intradialytic exercise group.  Physical activity levels will be assessed using weekly minutes of physical activity or exercise at baseline, at 3 months, and final testing (at 6 months).  In secondary analyses, we will assess if the physical activity increases using our point system, as well as the “Low physical activity questionnaire” (LoPAQ).  We will also assess whether our “Move-More” intervention improves physical function (assessed by the short physical performance battery), fatigue (SONG survey), and depression (Promis Short form 8a), compared to the intradialytic exercise group. 

2. “Understanding Barriers to Cooking and Better Nutrition in Hemodialysis Patients”.    The purpose of this study is to identify the primary barriers that many dialysis patients face when trying to eat a low sodium diet.  Primary research questions we are exploring include: a) what are the primary challenges hemodialysis patients face regarding food selection and cooking?; and b) How do these barriers impact their ability to adhere to dietary recommendations?  To address these questions, we will provide a battery of surveys to participants to better understand what barriers they may have to eating a low sodium diet. Our goal is to better understand the unique barriers HD patients face regarding food selection and cooking, which negatively impact their dietary adherence.  Addressing these specific barriers can lead to improved dietary adherence and better health outcomes for these patients.

3. “Cook for Your Kidneys:  Empowering Kidney Failure Patients Through Low-Sodium Cooking: A Pilot Educational Program.  The purpose of this pilot study is to develop a culinary medicine course focused on low-sodium cooking classes for patients with kidney failure. We will also examine the feasibility and acceptability of delivering the program and evaluate its impact on participant’s knowledge and willingness to prepare low-sodium meals, and will evaluate the effects of our intervention on different clinical/cardiovascular outcomes. Our central hypothesis is that through experiential learning and immersion in an instructional kitchen, knowledge of low-sodium eating is more likely to be transferred to participants’ homes compared to traditional dietary counseling and education approaches. 

4. “Feasibility and Efficacy of Integrating the Expanded Food and Nutrition Education Program (EFNEP) into Hemodialysis and Kidney Transplant Care Plans.”  This study will explore the feasibility and efficacy of integrating EFNEP into the care plans of individuals with kidney failure who are either undergoing HD or who have had a kidney transplant. By participating in EFNEP, the study seeks to enhance participants' nutritional knowledge and dietary behaviors, particularly in managing sodium intake, a critical factor for improving cardiovascular outcomes and overall health in both populations. The study will also evaluate the potential benefits of EFNEP on blood pressure and fluid management (Interdialytic weight gain and chronic VO).

5. “Cool Beans:  Effects Of Increasing Pulse Consumption On Cardiovascular Disease Risk Factors: A Randomized Controlled Trial”. The purpose of this USDA funded trial is to assess the effects of consuming two doses of pulses (1.5 cups/wk and 3 cups/wk) on: 1) CVD risk factors (blood lipids, blood pressure, and HbA1c); 2) measure changes in overall diet quality; and 3) determine if pulse consumption alters self-reported satisfaction with life and food in adults. The overarching aim is to determine whether there is justification to increase the pulse serving recommendation in future iterations of the Dietary Guidelines for Americans.

6. “Evaluating the acceptability and feasibility of an immersive Virtual Reality (VR) nutrition educational program in a hemodialysis setting.”  This proposed study aims to assess the initial acceptability, feasibility, and safety of an immersive VR-based nutrition  education program during maintenance hemodialysis treatment sessions from the perspective of patients.  The program is focused on teaching HD patients how to shop for unprocessed/low-sodium foods during a virtual “grocery shopping tour”.