Abstract
Aim: Intradialytic exercise (IDE) improves hyperphosphatemia management in hemodialysis (HD) patient in addition to other clinical outcomes. The aim of the study is to present the strategies needed to integrate such a protocol in an HD unit in UAE and patients’ baseline characteristics.Methods: The largest HD unit in Sharjah emirate was chosen. All eligible patients (n=57) in the unit were included. Patients were stable adults HD patients who served as their own controls. The intervention included an aerobic low intensity IDE of 45 minutes per HD session, tailored to each patient’s fitness scale (BORG scale) for 6 months. Patients were educated on the importance of exercise. Outcome measures were barriers to exercise, serum phosphorus (P), urea reduction ratio (URR), malnutrition inflammation score, quality of life (QOL using euroqol5) collected at baseline and post intervention.Results: A total of 41 patients completed the study, 61% were males; 90.2%, 53.7% and 14.6% suffered from hypertension, diabetes and cardiovascular disease respectively. Hypherphosphatemia was prevalent among 75% of the patients with a mean of 5.76 ± 1.66 mg/dl. Mean age was 48 ± 14.37 years, BMI 24.98 ± 6.09 kg/m2, URR 71.88 ± 8.52%, and Kt/v 1.32 ± 1.09. The main barrier to exercise was identified to be fatigue on HD days by 58.5% of patients, followed by fear of getting hurt (36.6%). Finally, 80.4% of patients were mildly malnourished and QOL scale was 65.02% ± 18.54. Conclusion: Our study highlighted the widespread of hyperphosphatemia and malnutrition in our sample. The IDE regimen, if proven effective in future studies, could be integrated in the routine practice and may improve patients’ outcomes.
Highlights
Chronic kidney disease (CKD) has been recently recognized as a global health concern [1] with a prevalence of 13.4% worldwide [2]
The Kidney Disease Improving Global Outcomes (KDIGO) 2017 guidelines recommend lowering the phosphate levels toward the normal range; hyperphosphatemia management includes dialysis, limiting dietary phosphate intake, and the usage of phosphate binder, while restricting the dose of calcium-based phosphate binders [6]
It is documented that a weekly dialysis of more than 30 hours is required for a complete clearance of serum phosphate (P) without the use of P-binders [7]; yet, in the United Arab Emirates (UAE), the reality remains that HD sessions in routine practice accumulate to a maximum of 12 hours per week [8]
Summary
Chronic kidney disease (CKD) has been recently recognized as a global health concern [1] with a prevalence of 13.4% worldwide [2]. Arab Journal of Nutrition and Exercise number of dialysis patients in 2014 was 1870, out of which 94% are on hemodialysis (HD), with a prevalence rate of 210 per million population [4]. Sedentary lifestyle is widespread in HD patients, and stage 4 and 5 CKD cases report to have the lowest physical activity (PA) levels [10]. This is despite the fact that the literature is clear on the positive effect of PA on the management of hyperphosphatemia [11], and the negative effect of low PA on quality of life (QOL) [12] and nutritional status [13]. Finding an adjunctive therapy to facilitate hyperphosphatemia management and increase PA levels becomes crucial
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