Effect of Intradialytic Exercise on Hyperphosphatemia and Malnutrition

Abstract

Intradialytic exercise (IDE) is not routinely prescribed in hemodialysis (HD) units despite its potential benefits on patients’ outcomes. This study was the first in the United Arab Emirates to examine the effect of aerobic IDE on hyperphosphatemia, malnutrition, and other health outcomes among HD patients. Participants were chosen from the largest HD unit in Sharjah Emirate for a quasi-experimental intervention with pre and post evaluation. The study lasted for 12 months. Study parameters were collected at baseline, post intervention, and follow-up. The intervention included a moderate-intensity aerobic IDE of 45 min per HD session; intensity was assessed using the Borg Scale. Patients were educated on the importance of exercise. Study outcomes were serum phosphorus (P), malnutrition inflammation score (MIS), quality of life (QOL), and pertinent blood tests. Forty-one eligible consenting HD patients were included in the study. Results at follow-up showed a non-significant reduction in P (p = 0.06) in patients who were hyperphosphatemic at baseline, but not in the sample as whole. MIS did not deteriorate throughout the study (p = 0.97). IDE resulted in a non-significant increase in the QOL visual analogue scale (p = 0.34). To conclude, aerobic IDE for 45 min is safe and could be beneficial, especially for hyperphosphatemic patients.

"The effect of Exercise during hemodialysis on serum levels of Albumin, calcium, phosphorus and parathyroid hormone: a randomized clinical trial"

“…The results were consistent with the study by Makhlough et al (2012) who reported that a simplified exercise program can improve serum levels of phosphate, but have had no significant effect on improving serum levels of Calcium [3]. The results are also in line with the results of the study conducted by Salhab et al (2019), where they showed that exercise during dialysis could be beneficial for hyperphosphatemic patients under hemidialysis [9]. Vaithilingam et al (2003), however, showed that exercises during hemodialysis could decrease serum levels phosphate, but the decline was not significant; these authors, however, mentioned that although exercise decreased the level of phosphorus, the significant decrease could be observed in long-term and perhaps more intense exercise might be needed for some patients [13].…”

“…Results of a study on exercise in hemodialysis patients suggest that exercise could decrease serum levels of Phosphate in the patients, but it did not have significant effect on serum calcium of the patients [3]. Another study also presents that hyperphosphatemia in the patients can be improved by exercise [9]. On the other hand, a study by Paluchamy et al (2018) showed that an exercise program can improve both serum levels of Phosphorous and Calcium in patients [10].…”

Benefits of resistant starch type 2 for patients with end-stage renal disease under maintenance hemodialysis: a systematic review and meta-analysis

“…However, the change of hsCRP was insignificant (SMD = 0.17, 95% CI: -0.22 to 0.56, I 2 = 14%, P = 0.40, Figure 5 b ). Malnutrition and hyperphosphatemia are two major complications of MHD 31 . Serum levels of albumin reflect the nutrition status of patients.…”

Dietary Protein and Physical Activity Interventions to Support Muscle Maintenance in End-Stage Renal Disease Patients on Hemodialysis

“…In support, it has been reported that a single bout of resistance-type exercise performed prior to HD increases amino acid uptake by muscle tissue following intradialytic protein ingestion [106]. Intradialytic resistance-type exercise programs have shown to increase skeletal muscle strength, thereby improving physical function outcome measures such as the 6-min walk test [99,[107][108][109][110]. In a systematic review of nine trials that assessed progressive resistance-type exercise training in ESRD patients on HD, Chan and Cheema concluded that resistance-type exercise training can effectively induce regional skeletal muscle hypertrophy [111].…”