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Abstract: TH-OR13

Intradialytic Exercise Is Associated With Lower Mortality Risk in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Martins, Pedro Miguel, Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
  • Leal, Diogo Vaz, Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
  • Wilund, Kenneth Robert, University of Illinois Urbana-Champaign Department of Kinesiology and Community Health, Champaign, Illinois, United States
  • Ferreira, Manuel A., Nephrocare Portugal SA, Lisboa, Lisboa, Portugal
  • Viana, Joao L., Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
Background

HD patients have an increased mortality risk that may be minimized with physical activity (PA). Intradialytic exercise (IDE) is very convenient, potentially increasing adherence to PA and making use of otherwise sedentary time. However, it is not known whether this potential protective role of PA can be achieved through IDE. Thus, the aim of this study was to analyze the association of IDE with mortality in HD patients.

Methods

Multicenter prospective cohort study in adult HD patients eligible to IDE (3 times/week cycling and lower body resistance exercises using ankle weights) from 21 HD units in Portugal. After 1-year of IDE implementation, patients were followed for up to 3 years. Three groups were created based on IDE exposure (exercise minutes/week): no-exercise (patients who refused IDE); low-exercise (<87 min/week); high-exercise (≥87 min/week). Kaplan-Meier (unadjusted analysis) and cox proportional hazard models (adjusted for age, dialysis vintage, vascular access, comorbidity index, cardiovascular disease, lean tissue, overhydration and hospitalizations) were used with no-exercise group as reference. Further, sub-analysis restricted to IDE participants were performed with exposure as a continuous variable.

Results

741 patients (no-exercise: 394; low-exercise: 174; high-exercise: 173) were followed for a median of 33.2 (IQR 11.5) months. Unadjusted mortality incidence was different between the three groups: (no-exercise: 21.6%; low-exercise: 19.0%; high-exercise: 6.4%; p<0.001). In adjusted analysis, the high-exercise group had a lower mortality risk than the no-exercise group (HR=0.38, 95% CI 0.20-0.75, p=0.005), whilst this was not observed in the low-exercise group (HR=1.18, 95% CI 0.77-1.79, p=0.453). Moreover, the mortality risk was reduced for each 50 min of exercise/week in unadjusted (HR=0.43, 95% CI 0.26-0.71, p=0.001) and adjusted analysis (HR=0.47, 95% CI 0.27-0.82, p=0.008).

Conclusion

Our data shows that IDE is associated with a reduction in mortality risk in HD patients, but considerable exercise volume is required. Therefore, patients achieving low-exercise doses may need out-of-clinic PA/exercise approaches to complement IDE.

Funding

  • Commercial Support – Fresenius Medical Care, NeproCare Portugal