Function In Hemodialysis Patients Research Articles

Association between serum soluble (pro)renin receptor level and worsening of cardiac function in hemodialysis patients: A prospective observational study.

The (pro)renin receptor ((P)RR) is cleaved to generate soluble (P)RR (s(P)RR), which reflects the status of the tissue renin-angiotensin system. Hemodialysis (HD) patients have a poor prognosis due to the increased prevalence of cardiovascular diseases. The present study aimed to investigate whether serum s(P)RR level is associated with the worsening of cardiac function in HD patients. A total of 258 maintenance HD patients were recruited and serum s(P)RR concentration was measured. Background factors in patients who survived (S group) and patients who died (D group) during the 12-month follow-up period and relationships between serum s(P)RR level and changes in cardiac function during the follow-up period in the S group were investigated. The median serum s(P)RR value at baseline was 29.8 ng/ml. Twenty-four patients died during the follow-up period. Cardiothoracic ratio, human atrial natriuretic peptide (hANP), brain natriuretic peptide (BNP), and E over e-prime were significantly higher in the D group. In the S group, changes in hANP or BNP were significantly greater in the higher serum s(P)RR group than in the lower serum s(P)RR group. High serum s(P)RR level was significantly correlated with changes in BNP, independent of other factors. High serum s(P)RR level was associated with increases in BNP, independent of other risk factors, suggesting that an increased expression of (P)RR may be associated with a progression of heart failure in HD patients and that serum s(P)RR concentration could be used as a biomarker for selecting patients requiring intensive care.

Associations of Bone Turnover Markers with Cognitive Function in Patients Undergoing Hemodialysis.

Background Patients undergoing hemodialysis experience a greater risk of cognitive impairment than the general population, but limited data elucidates the biomarkers on this. We evaluated the association of bone turnover markers on cognitive function among 251 prevalent hemodialysis enrollees in a cross-sectional study. Methods 251 hemodialysis patients (median age = 57.8, 55% men) and 37 control subjects (mean age = 61.2, 56% men) without a prior stroke or dementia diagnosis were enrolled. Serum concentrations of 8 bone markers were analyzed as the association of cognitive function (Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI)) using linear regression analysis. Results A lower cognitive function was noted in hemodialysis patients compared to control subjects. The receptor activator of nuclear factor kappa-B ligand (RANKL) was the only bone marker found to be associated with cognitive function (MoCA and CASI tests) in hemodialysis patients without a prior stroke or dementia diagnosis. In stepwise multiple linear regression analysis, the association remained significant in MoCA (β = 1.14, 95% CI 0.17 to 2.11) and CASI (β = 3.06, 95% CI 0.24 to 5.88). Short-term memory (β = 0.52, 95% CI 0.01 to 1.02), mental manipulation (β = 0.51, 95% CI 0.05 to 0.96), and abstract thinking (β = 0.57, 95% CI 0.06 to 1.09) were the significant subdomains in the CASI score related to RANKL. Conclusions Serum RANKL levels were potentially associated with better cognitive function in hemodialysis patients. Further large-scale and prospective studies are needed to confirm our findings.

Arm and hand function in hemodialysis patients. A cross sectional analytical study

Aims: To investigate the arm and hand function in hemodialysis patients.Methods: Upper limb function using validated questionnaires such as Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Cochin and Boston were applied to 57 chronic renal failure patients on hemodialysis and 60 healthy controls. Epidemiological data, data on pain and paresthesia in the upper limb and handgrip strength were obtained.Results: The three questionnaires showed worse performance of upper limb function in chronic renal failure patients than controls: DASH questionnaire with P = 0.05; Cochin questionnaire with P = 0.0004 and Boston questionnaire with P = 0.03. The questionnaire scores were affected by presence of pain (P = 0.05 for DASH and < 0.0001 for Boston questionnaires) and paresthesia (DASH with P = 0.003; Cochin with P = 0.01 and Boston questionnaire with P < 0.0001). Handgripstrength was lower in hemodialysis patients when compared with controls (P = 0.02) but did not affect the performance of any of the studied questionnaires.Conclusions: Upper limb function is impaired in hemodialysis patients and the main associations found were with pain and paresthesia.

Malnutrition and inflammation in hemodialysis patients: Comparative evaluation of neutrophil reactive oxygen formation

Impaired phagocytic function has been established in uremic patients. Chemotaxis, particle ingestion, and free radical and metabolic activity were all found to be disturbed in dialysis patients. Malnutrition is common among hemodialysis (HD) patients, with an estimated prevalence of 40% to 70%. Malnutrition-Inflammation Score (MIS) appears to be a useful tool for risk stratification of chronic HD patients. We assessed the correlation between MIS and phagocyte function in HD patients. Forty-four chronic HD patients were enrolled from the dialysis unit. The patients were divided into two groups according to the MIS: 1 to 12 (normal-mild) and 13 to 30 (severely malnourished). Hydrogen peroxide release by polymorphonuclear leukocytes was evaluated using the dihydrorhodamine 123 method. Phagocytic activity of neutrophils was evaluated after stimulation with Escherichia coli bacteria and phorbol 12-myristate 13-acetate (PMA) (positive control). Neutrophil oxidative activity in all HD patients versus healthy controls was significantly lower in median fluorescence intensity (MdFI)-E. coli and MdFI-PMA. We found significant correlations among MdFI-PMA and calculated MIS and other nutritional parameters in chronic HD patients. Impaired phagocytic function was identified in chronic HD patients. The severity of the impairment was associated with nutrition and inflammation parameters, as well as Malnutrition-Inflammation Score.

SUN-195 ORAL SYMPTOMS AND SALIVARY FUNCTION AND ASSOCIATION WITH MORTALITY IN HEMODIALYSIS PATIENTS: A PROSPECTIVE COHORT ANALYSIS (ORAL-D SUBSTUDY)

SUN-195 ORAL SYMPTOMS AND SALIVARY FUNCTION AND ASSOCIATION WITH MORTALITY IN HEMODIALYSIS PATIENTS: A PROSPECTIVE COHORT ANALYSIS (ORAL-D SUBSTUDY)

Early detection of cardiac involvement in hemodialysis patients

Cardiac involvement in hemodialysis patients is a serious condition with poor prognosis. The impact of chronic kidney disease and hemodialysis on heart function is not well understood. The transthoracic echocardiography (TTE) is performed when cardiac involvement is suspected. Recently, the development of (2D) strain imaging facilitated the simple and independent measurement of left ventricular (LV) deformation parameters in the longitudinal, circumferential and radial directions. To analyse LV systolic function in hemodialysis patients in two-dimensional (2D) TTE and with 2D speckle tracking (2D-STI) Twenty-eight chronic hemodialysis patients were included prospectively from November 2017 to December 2017 at the Nephrology department. Twenty-one patients comprised the control group. Conventional 2D-TTE was performed followed by two-dimensional strain imaging (2D-STI). A complete TTE was conducted, including LVEF by Simpson biplane method, calculation of indexed left ventricular mass, analysis of Diastolic function with evaluation of filling pressures and finally the study of the longitudinal deformation of the LV (GLS) by the speckle tracking technique. The average age of patients in our sample was 49.7 ± 9.7 years with a sex ratio of 2,5. All patients were dialyzed 3 times a week with a mean duration of hemodiaylyse of 60 months. All patients had a conserved LVEF with a mean value of 60.3 ± 7%. The prevalence of LVH was 60.7%. Segmental kinetic disorders were found in 3 patients. The average value of GLS was −14.9 ± 3.2, which was impaired compared to that of the control group. GLS is decreased in 40% of the population. The evaluation of longitudinal function by 2D strain gives a new insight into myocardial function in hemodialysis patients, which could improve pathophysiological understanding and identify patients at high risk of heart failure who can benefit from preventive strategies.

Effect of belt electrode skeletal muscle electrical stimulation during hemodialysis on the endothelial function in hemodialysis patients

Effect of belt electrode skeletal muscle electrical stimulation during hemodialysis on the endothelial function in hemodialysis patients

Echocardiographic Assessment of Right Ventricular Function in Haemodialysis Patients

Echocardiographic Assessment of Right Ventricular Function in Haemodialysis Patients

Interest of Beta-2-Microglobilin Plasma Assay in Iterative Haemodialysis in the Nephrology and Haemodialysis Department of University Teaching Hospital of Point G, Bamako, Mali

Beta-2-microglobulin (B2M) is a low molecular weight polypeptide (11,800 Da) that exists in a free form and a form bound to cell membranes (light chains of HLA class I molecules). Their dosage is used in the exploration and monitoring of renal function in haemodialysis patients, hence the interest of this study, the objective of which is to study the different players involved in the increase of beta-2-microglobulin. Materials and Methods: This was a prospective and descriptive study from January 1st, 2017 to August 31, 2017 (08 months). All patients with chronic hemodialysis for 3 years or more were included. We analyzed sociodemographic, clinical and paraclinical data. Results: We collected 50 patients. The mean age was 50 ± 4.6 years with extremes of 30 and 82 years. The female sex predominated (52%). Chronic end-stage renal failure was hypertensive (86%), diabetic (4%). All patients benefited from intermittent hemodialysis for 8 hours per week using a low permeability membrane (cuprophane). The average duration of hemodialysis was 68 ± 6.4 months with extremes of 36 and 204 months. Twenty percent (20%) and four percent (4%) of chronic dialysis patients had joint pain and sensory deficit. Phalen’s sign was positive in 2% (1 case), Tinel’s sign in 2% (1 case) and carpal tunnel syndrome in 2% (1 case). The mean serum beta-2-microglobulin level was 58.34 ng/l with extremes of 16.99 and 112.24 ng/l. There was a correlation between hypertensive nephropathies and beta-2-microglobulin levels above 50 ng/l (P < 0.001). The mortality rate was 6%. Conclusion: Our study has objectified factors such as inadequate dialysis (8 hours/week), use of low permeability membrane in the increase of beta-2-microglobulin. The increase in serum beta-2-microglobulin levels in our patients is evidence of poor purification of medium molecules. Its reduction can be established by improving the quality of dialysis, in particular by using a high-permeability membrane.

Long-Term Levocarnitine Ameliorates Left Ventricular Diastolic as Well as Systolic Dysfunction in Hemodialysis Patients - Multi-Center Study.

Background: Levocarnitine has been reported to improve the left ventricular (LV) systolic function and decrease LV hypertrophy in hemodialysis (HD) patients. Its effect on LV diastolic dysfunction, however, has not yet been clarified.Methods and Results: HD patients (n=88) were given levocarnitine i.v. 1,000 mg for 12 months at the end of every dialysis session through the dialysis circuit of the venous site. LV ejection fraction (EF), E/A, E/e’, left atrial volume index (LAVI) and LV mass index (LVMI) were measured before and 3, 6, 9, and 12 months after the start of levocarnitine on echocardiography. We regarded E/A≤0.8, E/e’>14 and LAVI>34 mL/m2 as LV diastolic dysfunction, and LVEF<55% as LV systolic dysfunction. We also investigated the effect of levocarnitine on HFpEF. Plasma brain natriuretic peptide, total carnitine, free carnitine, and acyl-carnitine and biochemistry parameters were measured. Levocarnitine significantly improved LV diastolic function in HD patients with LV diastolic dysfunction, but did not affect LV diastolic function in those with normal LV diastolic function. Levocarnitine significantly improved HFpEF. Levocarnitine significantly improved the LV systolic function in HD patients with LV systolic dysfunction but did not affect the LV systolic function in those with normal LV systolic function. Levocarnitine significantly decreased LVMI and increased plasma total, free, and acyl-carnitine.Conclusions: Levocarnitine ameliorates LV diastolic as well as LV systolic dysfunction in HD patients.

Ultrafiltration Rate Effects Declines in Residual Kidney Function in Hemodialysis Patients

Background: High ultrafiltration rate (UFR) has been associated with increased mortality in hemodialysis (HD) patients. However, the impact of UFR on decline of residual kidney function (RKF) has not been elucidated among patients receiving conventional HD. Methods: We performed a retrospective cohort study of 7,753 patients who initiated conventional HD from 2007 to 2011 and survived the first year of dialysis with baseline UFR and renal urea clearance (KRU) data at baseline and 1 year (5th patient-quarter). The primary exposure was average UFR at the 1st patient-quarter from dialysis initiation (<4, 4 to <6, 6 to <9, 9 to <13, and ≥13 mL/h/kg). Decline in RKF was defined as the percent change in KRU and decline in urine output during the first year after initiation of dialysis. We used a logistic regression model for rapid decline in RKF and a linear regression model for change in urine volume. Results: In our HD cohort, mean baseline UFR was 7.0 ± 3.1 mL/h/kg, and median (interquartile range) baseline KRU was 3.5 (2.1–5.3) mL/min/1.73 m². There was a graded association between UFR and a rapid decline in RKF; the expanded case mix-adjusted ORs and 95% CIs were 1.21 (1.04–1.40), 1.34 (1.16–1.55), 1.73 (1.46–2.04), and 1.93 (1.48–2.52) for baseline UFR 4 to <6, 6 to <9, 9 to <13, and ≥13 mL/h/kg, respectively (reference: <4 mL/h/kg). KRU trajectories showed a greater KRU decline over time in higher UFR categories. Higher UFR was also associated with a greater decline in urine output after 1 year. Conclusion: Higher UFR was associated with a rapid decline in RKF among conventional HD patients. Further clinical trials are needed to elucidate a causal effect of UFR on RKF among HD patients.

Impact of hydrating status on residual renal function in hemodialysis patients (first report)

Residual kidney function (RKF) is a powerful indicator of residual renal functional capacity that eliminates uremic toxins and fluid in hemodialysis patients.&#x0D; The purpose of our study was to investigate the influence of hydrating status on residual renal function in patients with CKD 5HD.&#x0D; Methods. A prospective observational study included 60 hemodialysis patients with CKD VD. All patients were examined - taken general and biochemical blood tests, determined the level of urea and creatinine in the daily urine. RKF was evaluated by urine volume, residual KT / V and KRU. Water balance was measured and evaluated using BCM-monitor.&#x0D; Results.During the analysis of BCM data, hyperhydration (OH / ECW above 15%) was revealed in 15 among all patients included in the study, which amounted to 25%. A statistically significant difference between patients who were hyperhydrated and normohydrated was found in relative (OH / ECW) and absolute hydration (OH), ECW, and ultrafiltration rates. Thus, in the group of hyperhydrated patients, the average relative hydration rate was 14.3% lower compared to normohydrated patients (p &lt; 0.001) and absolute hydration by 2.6 l (p &lt; 0.001).&#x0D; In further analysis, no significant difference between two groups was found in the indicators characterizing the RKF, namely, between the level of urine output, KRU, KT / Vren. The level of ultrafiltration in the group with normal hydration is 900 ml lower than that with hyperhydration (p &lt; 0.005). In study the influence of indicators of hydration status such as OH, OH / ECW, TBW, ECW, ICW on RKF indices no reliable correlation of the above mentioned values ​​with diuresis, KRU, KT / Vren (p &gt; 0.05) was found. A positive correlation was found between KRU, diuresis and KT / Vren, indicating that with increasing diuresis the KRU value and KT / Vren increase (p &lt; 0.001). The same relationship was found between diuresis and KT / Vren, p &lt; 0.001. An analysis of the relationship between absolute and relative hydration with dialysis efficacy (eKT / V) revealed that dialysis efficacy decreases with increase of hydratation in CKD 5HD patients (p &lt; 0.05).&#x0D; Conclusions. The results obtained in our study indicate that the indicators of hydration status at baseline do not allow to find out an influence of them on the baseline level of RKF (diuresis, KRU and KT / Vren) in patients with CKD 5HD. Issues of the influence of hydration status on changes in RKF during the observation will be addressed in the following reports.

A Low Ankle-Brachial Index and High Brachial-Ankle Pulse Wave Velocity Are Associated with Poor Cognitive Function in Patients Undergoing Hemodialysis.

Patients with end-stage renal disease (ESRD) have an increased risk of both impaired cognitive function and peripheral artery disease (PAD) than the general population. The association between PAD and dementia is recognized, but there are limited studies in patients with ESRD. The aim of this study was to evaluate the relationship between ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) and cognitive impairment in patients receiving hemodialysis (HD). We enrolled 136 prevalent HD patients (mean age 59.3 ± 10.5 years, 55.9% male). Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI) by trained psychiatrists. Associations between the cognitive function and ABI and baPWV were assessed using multiple linear regression analysis. Compared with HD patients with ABI ≥ 0.9, patients with ABI < 0.9 had lower MoCA score (p = 0.027) and lower CASI score but did not achieve significant level (p = 0.056). In the multivariate stepwise linear regression analysis, ABI (per 0.1) was independently positively associated with the MoCA score (β coefficient = 0.62, p = 0.011) and the CASI score (β coefficient = 1.43, p = 0.026). There is a negative association between baPWV (per 100 cm/s) and CASI (β coefficient = −0.70, p = 0.009). In conclusion, a low ABI or high baPWV was associated with a lower cognitive function in HD patients.

Effect of a Single Dialysis on Cognitive Function in Chronic Kidney Disease Stage 5 Hemodialysis Patients

Abstract Background: The incidence of cognitive impairment (CI) has been widely reported in various studies among chronic kidney disease (CKD) patients. Many factors influence cognitive function including hemodialysis (HD) process itself. There is much evidence that a single HD session brings about changes in the cognitive status of patients, but just a few studies assessing whether cognitive performance varies with dialysis. Aim: To know the effect of single dialysis session on cognitive function in HD patients. Method: Sixty medically stable CKD stage 5 patients on HD maintenance at least for three months were enrolled. Cognitive testing performed thrice, 1-2 hour prior dialysis (T1), 3-4 hour into the session (T2) and 24 hour after the session (T3) using a well-validated neuropsychological test battery, Montreal Cognitive Assessment (MoCA) Indonesian version which assess the domain of cognitive function including visuospatial, executive function, naming, memory, attention, language, abstraction, recall, and orientation. Result: among 60 patients complete testing, mean age 45,45 ± 11,28 years, dialysis vintage 10,12 ± 11,88 months, 44 patients (73,3%) had CI at baseline. Cognitive function decline during dialysis (T2) (MoCA INA score 21,65 to 19,67, p < 0.001) and visuospatial, executive function, attention, language and recall was impaired during dialysis. While cognitive function reached its best 24 hour after dialysis (MoCA INA score 23,65, p < 0.001) and all the domain of cognitive function was improved except naming that didn’t change over the dialysis session. Age and dialysis adequacy were associated with the decline. Conclusion: There is effect of a single HD session on global cognitive function where cognitive function was deteriorated during HD and reached its best 24 hour after HD. Keywords: cognitive function, chronic kidney disease, hemodialysis

Effect of Blood and Fistula Flow Rates on Dialysis Adequacy, Phosphate Removal and Cardiac Function in Hemodialysis Patients

Background: dialysis adequacy refers to the delivery of a dose of dialysis considered high enough to promote an optimal long term outcome. Quantification of the dialysis dose is an essential element because the adequacy has a profound effect on patient morbidity and mortality. Aim of the study: assessment the effect of blood and fistula flow rates on dialysis adequacy, phosphate removal and cardiac function in hemodialysis patients. Patients and Methods: this study was conducted on eighty patients with regular hemodialysis (HD) selected from Al-Azhar University Hemodialysis Unite in New Damietta. The studied patients were divided into two main groups according to blood flow rate (BFR) as follows: Group A 40 patients on BFR 250 mL/min and Group B 40 patients on BFR 350 mL/min. Results: there was statistically significant decrease of pre dialysis phosphate in group A in comparison to group B. There was statistically significant increase of KT/V, UUR and PRR in group B in comparison to group A. Arteriovenous fistula (AVF) Qa had negative correlation with TAPSE while it had positive correlation to all echocardiography findings except EF and heart rate (HR), kt/V and URR in group A. AVF Qa had positive correlation to all echocardiography findings except (EF, HR and TAPSE), kt/V, URR and PRP in group B Conclusion: increasing of blood and fistula flow rates are effective in increasing dialysis adequacy and phosphate reduction ration and it is more evident where using high-flux hemodialysis.

Effect of Blood and Fistula Flow Rates on Dialysis Adequacy, Phosphate Removal and Cardiac Function in Hemodialysis Patients

Effect of Blood and Fistula Flow Rates on Dialysis Adequacy, Phosphate Removal and Cardiac Function in Hemodialysis Patients

ٍEvaluation of attention and memory function in hemodialysis patients; a study based on hemodialysis duration

Introduction: End-stage renal disease (ESRD) is one of the health problems in today’s world. Neuropsychological problems are more common in hemodialysis (HD) patients than in healthy individuals. Objectives: The aim of this study was to investigate the effect of long-term HD on memory function of these patients. Patients and Methods: Our study, included 80 HD patients of whom 39 were under 6 months of HD and 41 patients as another group which had a history of HD more than 6 months. Results: The population had a mean age of 51.60 years old (27.5% female). The scores of patients who have been hemodialyzed for a long-time (median time of HD was up to 4 years) had lower score in forward digit (FD), backward digit score test (BD), letter digit modality task (LDMT), letter symbol digit modality task (LSDMT) (5.49; 3.61; 21.12; 17.66) than the HD patients who underwent HD for a shorter term, with the median time of 3 to 5 months (7.38; 4.79; 39.77; 43.38) (P&lt;0.001). Conclusion: The present study demonstrated that end-stage HD patients who were under HD for a long time had significantly lower scores in the memory and attention tests. However, additional researches are needed in this area.

Impact of Dietary Counselling to Improve Nutritional Status of Hemodialysis Patients

Proper nutrition may reverse the malnutrition and can modulate renal function in hemodialysis patients. In majority of the dialysis units in Pakistan, nutritional advice is given by health professionals working in dialysis. We compared the impact of dietary counseling by a renal dietitian, on nutritional status with that by health professionals working in dialysis units in patients undergoing maintenance hemodialysis. Nutritional assessments were made using subjective global assessment (SGA) scale, which combines assessment of intake, physical findings, and functional status. Two hundred and seventy‑seven patients undergoing hemodialysis from two renal care units in Hayatabad Medical Complex Peshawar and Lahore Gernal Hospital Lahore Pakistan, were enrolled (138 patients in control group, 139 in experimental group). In the experimental group, patients were given repeated dietary counseling by a renal dietician, whereas control group patients were provided with the necessary nutritional information by another health professional. Detailed nutritional, biochemical, and SGA assessment were done on all of them at the beginning and completion of study after 6 months. Patients were categorized as well‑nourished (WN) (SGA = 1–14), mild to moderate malnourishment (MMM) (SGA = 15–35), and severe malnutrition (SM) (SGA = 36–49). In the present study, the overall malnutrition rate at baseline was 95.3%, and it dropped down to 91.7% after 6 months after nutritional counseling. In the experimental group, malnutrition status decreased from 97.2% to 89.8%, whereas in the control group, malnutrition situation remained same. Compared to baseline, in the control group, there was no improvement in the WN group. However, a shift has been observed from MMM group to SM group suggesting more number of patients are becoming malnourished. Contrarily, in the experimental group, an improvement of +7.2% in WN group and +14.3% in MMM group and a drop of −21.6% in severe malnourished group suggesting more number of patients gaining nutrition. The present study observed a significant improvement in nutritional status of patients who received counseling by the renal dietician. The reduction in SGA score was independent of reductions in serum creatinine and blood urea levels Keywords : Dietary Counselling, Nutritional Status, Hemodialysis Patients DOI : 10.7176/JMPB/55-16 Publication date :May 31 st 2019

The Importance of the Volume Status, Dry Weight and Residual Renal Function in Hemodialysis Patients

The Importance of the Volume Status, Dry Weight and Residual Renal Function in Hemodialysis Patients

Results from the randomized controlled IHOPE trial suggest no effects of oral protein supplementation and exercise training on physical function in hemodialysis patients

Few long-term studies have assessed whether changes in both diet and exercise can improve the health and quality oflife (QOL) of hemodialysis (HD) patients. Here we examined whether 12 months of intradialytic protein supplementation and endurance exercise improves physical function, risk of cardiovascular disease (CVD), and QOL in HD patients in a randomized controlled trial (RCT). A total of 138 HD patients (average age 58 years) were assigned for 12 months to control, intradialytic protein, or protein plus exercise groups. The protein and protein plus exercise groups consumed an oral protein supplement (30 grams of whey) three days/week during dialysis. The protein plus exercise group cycled for 30-45 minutes during dialysis treatment. The primary outcome was change in physical function at 12 months, assessed by a shuttle walk test. Secondary outcomes included arterial stiffness, blood pressure, body composition, muscle strength, markers of nutritional status, and QOL. Assessments were conducted at baseline, 6 and 12 months. In total, 101 patients completed the intervention. There were no significant differences between groups in shuttle walk test performance from baseline to 12 months. There were trends for improvements in some secondary measures of physical function and strength in the protein and protein plus exercise groups at six or 12 months, but these did not reach statistical significance. Thus, our trial did not demonstrate significant improvements in markers of physical function, risk of CVD or QOL after one year of intradialytic oral OPS and aerobic exercise training. More comprehensive lifestyle management may be needed to uncover robust improvements in the health and QOL of HD patients.