The effect of intradialytic exercise on dialysis patient survival: a randomized controlled trial

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Abstract

Background

Patients with kidney failure have a high mortality rate. This study aimed to evaluate the effect of intradialytic exercise on survival in patients receiving hemodialysis (HD) .

Methods

In this randomized controlled trial conducted in a HD center in Iran, adult patients receiving chronic HD were randomized to intradialytic exercise (60 min) in the second hour of thrice weekly dialysis for 6 months (intervention) or no intradialytic exercise (control). The primary outcome was survival rate at 12 months. Secondary outcomes were serum albumin, hemoglobin, hematocrit, red blood cell count, serum calcium, serum phosphorous, parathyroid hormone, physical function (6-min walk test) and nutritional status (Geriatric Nutritional Risk Index) during the first 6 months. The trial follow-up period was 12 months.

Results

The study included 74 participants (44 males) with an age average of 64 ± 12 years old and a dialysis history of 27 ± 12 months, randomized to intervention ( n = 37) or control ( n = 37). Compared with controls, 1-year survival was higher in the intervention group (94% vs 73%, P = 0.01). The hazard ratio in univariate analysis in intervention group was 0.17 (95% CI 0.04–0.8; P = 0.02) compared to that in control group. During the 6-month intervention period, significant between-group changes were observed in all secondary outcomes between the intervention and control groups.

Conclusion

Intradialytic exercise performed for at least 60 min during thrice weekly dialysis sessions improves survival in adult patients receiving HD.

Trial registration

ClinicalTrials.gov Identifier: NCT04898608. Retrospectively registered on 24/05/2021. Registered trial name: The Effect of Intradialytic Exercise on Dialysis Patients Survival.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-023-03158-6.

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Most cited references 40

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ATS statement: guidelines for the six-minute walk test.

(2002)

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Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients.

Olivier Bouillanne, Gilles Morineau, Claire Dupont … (2006)

Patients at risk of malnutrition and related morbidity and mortality can be identified with the Nutritional Risk Index (NRI). However, this index remains limited for elderly patients because of difficulties in establishing their normal weight. Therefore, we replaced the usual weight in this formula by ideal weight according to the Lorentz formula (WLo), creating a new index called the Geriatric Nutritional Risk Index (GNRI). First, a prospective study enrolled 181 hospitalized elderly patients. Nutritional status [albumin, prealbumin, and body mass index (BMI)] and GNRI were assessed. GNRI correlated with a severity score taking into account complications (bedsores or infections) and 6-mo mortality. Second, the GNRI was measured prospectively in 2474 patients admitted to a geriatric rehabilitation care unit over a 3-y period. The severity score correlated with albumin and GNRI but not with BMI or weight:WLo. Risk of mortality (odds ratio) and risk of complications were, respectively, 29 (95% CI: 5.2, 161.4) and 4.4 (95% CI: 1.3, 14.9) for major nutrition-related risk (GNRI: <82), 6.6 (95% CI: 1.3, 33.0), 4.9 (95% CI: 1.9, 12.5) for moderate nutrition-related risk (GNRI: 82 to <92), and 5.6 (95% CI: 1.2, 26.6) and 3.3 (95% CI: 1.4, 8.0) for a low nutrition-related risk (GNRI: 92 to < or =98). Accordingly, 12.2%, 31.4%, 29.4%, and 27.0% of the 2474 patients had major, moderate, low, and no nutrition-related risk, respectively. GNRI is a simple and accurate tool for predicting the risk of morbidity and mortality in hospitalized elderly patients and should be recorded systematically on admission.

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Functional status of elderly adults before and after initiation of dialysis.

Manjula Kurella Tamura, Kenneth E. Covinsky, Glenn Chertow … (2009)

It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD). Using a national registry of patients undergoing dialysis, which was linked to a national registry of nursing home residents, we identified all 3702 nursing home residents in the United States who were starting treatment with dialysis between June 1998 and October 2000 and for whom at least one measurement of functional status was available before the initiation of dialysis. Functional status was measured by assessing the degree of dependence in seven activities of daily living (on the Minimum Data Set-Activities of Daily Living [MDS-ADL] scale of 0 to 28 points, with higher scores indicating greater functional difficulty). The median MDS-ADL score increased from 12 during the 3 months before the initiation of dialysis to 16 during the 3 months after the initiation of dialysis. Three months after the initiation of dialysis, functional status had been maintained in 39% of nursing home residents, but by 12 months after the initiation of dialysis, 58% had died and predialysis functional status had been maintained in only 13%. In a random-effects model, the initiation of dialysis was associated with a sharp decline in functional status, indicated by an increase of 2.8 points in the MDS-ADL score (95% confidence interval [CI], 2.5 to 3.0); this decline was independent of age, sex, race, and functional-status trajectory before the initiation of dialysis. The decline in functional status associated with the initiation of dialysis remained substantial (1.7 points; 95% CI, 1.4 to 2.1), even after adjustment for the presence or absence of an accelerated functional decline during the 3-month period before the initiation of dialysis. Among nursing home residents with ESRD, the initiation of dialysis is associated with a substantial and sustained decline in functional status. 2009 Massachusetts Medical Society

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Author and article information

Contributors

Mohammad Ali Tabibi: m.tabibi@ut.ac.ir

Journal

Journal ID (nlm-ta): BMC Nephrol

Journal ID (iso-abbrev): BMC Nephrol

Title: BMC Nephrology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2369

Publication date (Electronic): 17 April 2023

Publication date PMC-release: 17 April 2023

Publication date Collection: 2023

Volume: 24

Electronic Location Identifier: 100

Affiliations

[1 ]Department of Exercise Physiology, Pardis Specialized Wellness Institute, Isfahan, Iran

[2 ]GRID grid.1029.a, ISNI 0000 0000 9939 5719, School of Health Sciences, , Western Sydney University, ; Campbelltow, NSW 2560 Australia

[3 ]GRID grid.1029.a, ISNI 0000 0000 9939 5719, National Institute of Complementary Medicine Health Research Institute, Western Sydney University, ; Westmead, NSW 2145 Australia

[4 ]GRID grid.1029.a, ISNI 0000 0000 9939 5719, Translational Health Research Institute, Western Sydney University, ; Campbelltown, NSW 2560 Australia

[5 ]Department of Research and Development, Pardis Specialized Wellness Institute, Isfahan, Iran

[6 ]GRID grid.411952.a, ISNI 0000 0001 1882 0945, Graduate Program of Physical Education, , Catholic University of Brasilia, ; Distrito Federal, Brazil

[7 ]Department of Health and Palliative Care, Pardis Specialized Wellness Institute, Isfahan, Iran

Article

Publisher ID: 3158

DOI: 10.1186/s12882-023-03158-6

PMC ID: 10108498

PubMed ID: 37069527

SO-VID: 8715ba3e-6b48-495a-bbc2-bb046f7a3785

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 9 December 2022

Date accepted : 7 April 2023

Custom metadata

ScienceOpen disciplines: Nephrology

Keywords: mortality,exercise during dialysis,physical function,nutritional status,hematological parameters,survival

Data availability:

ScienceOpen disciplines: Nephrology

Keywords: mortality, exercise during dialysis, physical function, nutritional status, hematological parameters, survival

The effect of intradialytic exercise on dialysis patient survival: a randomized controlled trial

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Abstract

Background

Methods

Results

Conclusion

Trial registration

Supplementary Information

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Karger: Nephrology

Most cited references 40

ATS statement: guidelines for the six-minute walk test.

Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients.

Functional status of elderly adults before and after initiation of dialysis.

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