Effect of different exercise types on level of inflammation in hemodialysis patients: a systematic review and network...

Although numerous pairwise meta-analyses have demonstrated the benefits of exercise on inflammation in hemodialysis patients, the comparative effectiveness of different exercise types on inflammation in this population remains unclear. This study aims to compare the effectiveness of intradialytic aerobic exercise (IAE), non-intradialytic aerobic exercise (NAE), intradialytic combined aerobic and resistance exercise (ICE), intradialytic resistance exercise (IRE), non-intradialytic aerobic exercise + intradialytic resistance exercise (NAE + IRE), and non-intradialytic resistance exercise (NRE) on inflammatory marker levels of hemodialysis patients using network meta-analysis (NMA) and to rank them subsequently.

We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (VIP), and China Biomedical Literature Database (CBM) from inception to August 13, 2025. We conducted an NMA using Stata 18.0. The interventions were ranked according to their effectiveness in reducing inflammation in hemodialysis patients using the surface under the cumulative ranking curve (SUCRA). Finally, the grading of recommendations, assessment, development, and evaluation (GRADE) framework was utilized to evaluate the reliability of evidence.

This study included 46 studies across 9 countries involving 3073 hemodialysis patients. For the reduction of C-reactive protein, NAE + IRE (SUCRA = 85.3) and IRE (SUCRA = 59.6) were ranked first and second. For the reduction of interleukin-6, NAE + IRE (SUCRA = 93.0) and NRE (SUCRA = 66.5) were ranked first and second. For the reduction of tumor necrosis factor-α, NAE (SUCRA = 99.9) and NAE + IRE (SUCRA = 66.1) were ranked first and second. The GRADE evidence levels for the three outcome measures ranged from very low to low.

NAE + IRE consistently ranked among the top two interventions across all inflammatory markers, making it the optimal exercise strategy to reduce inflammation in hemodialysis patients.