Abstract
Intradialytic exercise (IDE) is not routinely prescribed in hemodialysis (HD) units despite its potential benefits on patients’ outcomes. This study was the first in the United Arab Emirates to examine the effect of aerobic IDE on hyperphosphatemia, malnutrition, and other health outcomes among HD patients. Participants were chosen from the largest HD unit in Sharjah Emirate for a quasi-experimental intervention with pre and post evaluation. The study lasted for 12 months. Study parameters were collected at baseline, post intervention, and follow-up. The intervention included a moderate-intensity aerobic IDE of 45 min per HD session; intensity was assessed using the Borg Scale. Patients were educated on the importance of exercise. Study outcomes were serum phosphorus (P), malnutrition inflammation score (MIS), quality of life (QOL), and pertinent blood tests. Forty-one eligible consenting HD patients were included in the study. Results at follow-up showed a non-significant reduction in P (p = 0.06) in patients who were hyperphosphatemic at baseline, but not in the sample as whole. MIS did not deteriorate throughout the study (p = 0.97). IDE resulted in a non-significant increase in the QOL visual analogue scale (p = 0.34). To conclude, aerobic IDE for 45 min is safe and could be beneficial, especially for hyperphosphatemic patients.
Highlights
Hyperphosphatemia, described as the “silent killer” for hemodialysis (HD) patients [1], is prevalent among almost half of this population [2] and is a determinant to decreased quality of life (QOL) [3].The Kidney Disease Improving Global Outcomes (KDIGO) guidelines (2017) recommend lowering the serum phosphorus (P) levels towards the range that is considered normal for healthy populations.Standard HD regimes of 4-h three times a week cannot remove the entire P load; other serum P controlling interventions are used such as limiting dietary P intake and administration of P-binding medications [4]
Over the course of the intervention phase, 6 patients were not satisfied with the cycle used or the intradialytic exercise (IDE) itself; one patient was transferred to another HD unit at week 12, 2 patients did a transplant at week 6 and 11, and 1 patient passed away at week 10
Our results revealed the clinically positive effect of IDE on most domains of QOL post-intervention; more patients revealed no problem in the self-care, in performing daily activities, and in mobility; fewer patients reported suffering from anxiety, depression, pain, and discomfort
Summary
Standard HD regimes of 4-h three times a week cannot remove the entire P load; other serum P controlling interventions are used such as limiting dietary P intake and administration of P-binding medications [4]. Nutrients 2019, 11, 2464 protein energy malnutrition [5], and P-binders can cause gastrointestinal side effects [6], which may increase the cost of health care [7]. This is a specific concern because there is no conclusive evidence about P-binder cost-effectiveness as first-line intervention for hyperphosphatemia management [8]. 2 meta-analyses showed that exercise does not appear to have a significant impact on serum P compared to controls; most of the studies included in these reviews were relatively short term [9,10]
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