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Exercise during Hemodialysis in Patients with Chronic Kidney Failure
Kirsten Anding-Rost1,2,3, Gero von Gersdorff4, Pia von Korn1,5
1Department of Prevention and Sports Medicine, Faculty of Medicine, University Hospital 'Klinikum rechts der Isar,' Technical University Munich, Munich, Germany.
NEJM Evidence
|February 6, 2024
Summary
Exercise during hemodialysis significantly improved physical function in kidney failure patients. This intervention enhanced the 60-second sit-to-stand test and reduced hospitalizations compared to usual care.
Area of Science:
- Nephrology
- Exercise Physiology
- Clinical Trials
Background:
- Patients with kidney failure on hemodialysis often experience physical deconditioning and multiple health issues (multimorbidity).
- The effectiveness of exercise interventions in mitigating these conditions within the clinical setting remains uncertain.
Purpose of the Study:
- To evaluate the impact of combined endurance and resistance exercise training during hemodialysis on physical functioning and quality of life in patients with chronic kidney failure.
- To compare the outcomes of intradialytic exercise versus usual care regarding physical function, quality of life, hospitalizations, and survival.
Main Methods:
- A multicenter, cluster randomized controlled trial involving 917 patients with chronic kidney failure undergoing hemodialysis.
- Intervention group received combined endurance and resistance exercise during dialysis sessions; control group received usual care.
- Primary outcome measured was the change in the 60-second sit-to-stand test (STS60) from baseline to 12 months.
Main Results:
- The exercise group showed a significant improvement in STS60 repetitions at 12 months (3.85 repetitions difference; P<0.0001) compared to the usual care group.
- Improvements were also observed in the timed up-and-go test and 6-minute walk test for the exercise group.
- The physical summary score and vitality subscale of the 36-item Short Form Health Survey improved, while hospitalizations were reduced (median 2 days vs. 5 days annually).
Conclusions:
- Twelve months of intradialytic exercise is a safe and effective intervention for improving physical functioning in patients with kidney failure undergoing hemodialysis.
- The intervention demonstrated significant benefits in sit-to-stand test performance and reduced hospital resource utilization without increasing adverse events.
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