Kidney Week

Abstract: SA-PO878

The Effects of Intradialytic Exercise on the Improvement of Daily Physical Activity in Online Hemodiafiltration Patients

Session Information

• Dialysis: Cardiovascular, BP, Volume
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Assawasaksakul, Nawaporn, Chulalongkorn university, Bangkok, Thailand

Nawaporn Assawasaksakul,

• Tiranathanagul, Khajohn, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Khajohn Tiranathanagul,

• Sirichana, Worawan, chulalongkorn, Bangkok, Thailand

Worawan Sirichana,

• Kulaputana, Onanong, chulalongkorn university, Bangkok, Thailand

Onanong Kulaputana,

• Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand

Somchai Eiam-Ong,

• Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand

Kearkiat Praditpornsilpa,

Background

The mortality of hemodialysis (HD) patients treated with the novel online hemodiafiltration (OL-HDF) is better than conventional HD but is still higher than the healthy population. A low level of daily physical activity, associated with sarcopenia, uremic toxins, and functional impairment correlates with increased cardiovascular mortality. The effect of adding the intradialytic exercise program to improve daily physical activity and overall health status in patients particularly with online hemodiafiltration technique has yet to be explored.

Methods

Twelve OL-HDF treated patients (age 53.1±14.5 years, BMI 23.23 ± 5.5 kg/m²) were randomly assigned to control or adding intradialytic exercise (IDX) group. The subjects in IDX group were trained with the customized exercise program to exercise, initiated by a multidisciplinary team, on a cycle ergometer (Figure 1) within the first hour of OL-HDF. Physical activity was measured in terms of the number of daily steps counted by a wrist-worn wearable triaxial accelerometer (Fitbit flex2®). The muscle mass and biochemical parameters were measured and compared at baseline and 6 months.

Results

The baseline physical activities measured by daily step count were 5,945±3715 and 6525±5389 steps (NS) in IDX and control groups, respectively. At 6 months, improvement of physical activity level in IDX group was greater than that in the control group (+1956.2 ± 2164.18 vs. -1302.92 ± 1956.03 steps, P = 0.021). The muscle mass changes were slightly higher, though non-significant, in IDX group [0.59 (IQR -0.58, 1.46) vs. -1.49 (-2.14, 0.28) kg., P=0.200]. Hemoglobin (+1.0 (-0.1,2.7) vs. -1.4 (-3.4,0.2) g/dL, P= 0.025) and albumin (+0.30(0.08, 0.50) vs. -0.15(-0.28, 0.05) g/dL, P=0.012) increased in IDX compared with the control group. The phosphate reduction was more favorable in IDX group (-1.95 (-2.80, -0.63) vs. -0.50 (-0.88,0.55), P=0.037).

Conclusion

Intradialytic exercise training as the add-on program for OL-HDF patients could improve daily physical activity as well as muscle mass and other metabolic controls. The regular intradialytic exercise program may contribute to reverse inactive behaviors and further improvement in the quality of life and cardiovascular mortality of dialysis patients.

Funding

• Government Support - Non-U.S.