P1306EFFECT OF A SUPERVISED PERI- DIALYTIC EXERCISE PROGRAM ON SERUM ASYMMETRIC DIMETHYLARGININE IN MAINTENANCE HEMODIALYSIS PATIENTS

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Abstract Background and Aims End-stage renal disease (ESRD) patients treated with maintenance hemodialysis (MHD) have high cardiovascular disease morbidity and mortality. Accumulation of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, has been strongly implicated in endothelial dysfunction, premature atherosclerosis, vascular events and mortality. Regular physical exercise effectively decreased serum ADMA in several studies. This potential should be explored among MHD patients. Method Forty four middle-aged ESRD patients treated with thrice-weekly MHD for >6 months completed a 6 months regimen of peri-dialytic lower limb exercise comprising pre-dialytic 10-12 stretching cycles and 20-30 minutes of intra-dialytic pedalling cycles. Plasma ADMA, CRP, other laboratory parameters and overall physical activity level were assessed initially and at the end of the study. Results S.ADMA increased from a median of 2375 to 3000 ng/mL (P=0.016). 31 patients sustained an increase in S.ADMA (ADMA_Inc), whereas 13 patients had a declining or stable S.ADMA (ADMA_Dec). Compared with ADMA_Inc, ADMA_Dec patients had significantly higher Kt/V (P=0.02), significantly higher grade of basal general physical activity level (P=0.017) and significantly less intra-dialytic hypotension episodes (IDHs) (P=0.019). The increase in S.ADMA and the post- study S.ADMA level had statistically significant positive correlations with number of IDHs (r=0.401,P=0.007 and r=0.305,P=0.044, respectively). Conclusion A 6 months program of combined aerobic and resistance peri-dialytic exercise failed to reduce S.ADMA in most MHD patients studied. A modest S.ADMA decline, however, occurred in patients with higher basal exercise level, higher Kt/V, and less IDHs. A potential benefit of peri-dialytic exercise in decreasing S.ADMA may be promoted by a multidisciplinary approach targeting increased physical activity, improved dialysis efficiency and prevention of IDHs.