This study will investigate whether inspiratory muscle training in patients with end stage renal failure can improve strength and function.

Patients with chronic renal failure commonly have weak respiratory muscles leading to problems in everyday activities and respiratory infections.

This project aims to investigate if threshold inspiratory muscle training improves the strength, everyday function and participation of patients on haemodialysis. Forty eight patients will be recruited in a randomized controlled trial of inspiratory muscle training vs sham training.

Outcome measures include the maximal inspiratory pressure and the Frenchay activities index. Initial data will be collected by a blinded assessor; the patients will train at 40 % of initial maximal inspiratory pressure for six weeks and be reassessed. If the inspiratory muscle training is effective, it will improve both the physical and functional components of the patient's lives and be recommended for all renal patients.

Inclusion Criteria:

• documented chronic renal failure
• attending either haemodialysis or pre-dialysis clinic
• age 18
• English speaking
• no prior experience with inspiratory training devices.

Exclusion Criteria:

• lung collagen disorders
• renal diseases associated with autoimmune pulmonary diseases
• current pleural effusion
• pulmonary oedema
• decreased conscious level
• behavioural disturbances
• unable or refused to give consent
• taking medications that influence respiratory muscle function (e.g. steroids or cyclophosphamide)