Exercise training in haemodialysis patients
Chronic kidney disease (CKD) has been increasing in recent decades, affecting 8-16% of the population worldwide, and this is mainly due to the increased prevalence of risk factors, such as diabetes mellitus and hypertension, and as result of an aging population.
End-stage kidney disease patients require haemodialysis. People with end-stage kidney disease have reduced aerobic capacity, muscle strength and exercise tolerance. They are typically sedentary during haemodialysis, which contributes to their higher risk of cardiovascular disease and mortality.
While there is a broad consensus that exercise training promotes beneficial effects in end-stage kidney disease, it is not included routinely in clinical practice and the comparative efficacy of different modes of exercise remains to be determined.
Most published randomised trials of exercise in end-stage kidney disease test aerobic exercise. Resistance or combined aerobic and resistance exercises have been much less investigated. Few studies compare modes of exercise in this population.
In a recent study, a relatively new technique (called network meta-analysis) was used to pool the direct and indirect evidence from existing trials, to determine the relative benefits of different modes of exercise in this population. This enabled utilisation of data from 33 randomised trials involving 1254 participants.
From this, several important findings could be determined. Network meta-analysis showed that both aerobic training and combined (aerobic + resistance) training had superior aerobic capacity compared to control.
For systolic blood pressure, combined was superior to control, while for diastolic blood pressure combined training was superior to aerobic training and control. No modality was superior to control for hemodialysis efficacy.
Therefore, overall, combined training was ranked as the most effective treatment for aerobic capacity and arterial blood pressure control in end-stage kidney disease.
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> From: Scapini et al., J Physiother 65 (2019) 4-15 (Epub ahead of print). All rights reserved to the Australian Physiotherapy Association. Click here for the online summary.