POS-519 ARE THERE "HIDDEN" BENEFITS OF INTRADIALYTIC EXERCISE? A META-ANALYTICAL STUDY OF ITS PSYCHOSOCIAL EFFECTS FOR PATIENTS WITH END-STAGE RENAL DISEASE

Abstract

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines formally recommend that patients with end-stage renal disease (ESRD) should be advised and encouraged to increase their levels of physical activity. Intradialytic exercise (IDE) has the advantage of being integrated into the routine care plans of dialysis units. Previous research has suggested that IDE improves patients’ dialysis adequacy and functional capacity. However, little attention has been given to the psychosocial benefits of IDE. This meta-analysis aimed to explore the psychosocial benefits of IDE for patients with ESRD. The search was performed from November 10 to November 17, 2020, on Web of Science, Scopus, and PubMed. Studies were included if they were randomized clinical trials assessing the psychosocial benefits of IDE for patients with ESRD, measured by patient-reported outcomes. Standardized mean differences with 95% confidence intervals (CI) were estimated. Since the studies comprised different IDE interventions (aerobic, resistance, and combined exercise), the DerSimonian and Laird’s method was applied to account for heterogeneity which was evaluated using the I-squared statistic. The meta-analysis was conducted with the R “meta” package (version 4.13-0). The database search provided a total of 70 records. From these, 15 studies met the inclusion criteria. Meta-analytical results suggested that the aggregated effect sizes for depression (k=7,d=0.75, 95%CI=0.14-1.37; I2=80%), vitality (k=3,d=0.60; 95%CI= 0.25; 0.95; I2=0%), and mental function (k=9; d=0.59; 95%CI=0.06-1.12; I2=81%) were medium and statistical significant. A small but significant effect size was found for emotional role functioning (k=3;d=0.33; 95%CI=0.02-0.69; I2=0%), while for social role functioning the results were non-significant (k=3;d=0.02; 95%CI=-0.36-0.33; I2=0%). The results of this meta-analytical study showed that IDE improves patients' mental function and vitality while decreasing symptoms of depression. Given its mental health benefits, IDE can help reduce the burden of medication in patients with ESRD and be a viable alternative to psychopharmacotherapy. Future studies should explore this hypothesis. Nevertheless, the results reinforced the NKF KDOQI guidelines suggesting that IDE should be integrated as a common practice in dialysis care.