Pre-hemodialysis exercise training improves systemic aerobic capacity and platelet bioenergetic efficiency in...

Platelet mitochondrial bioenergetics contribute to vascular thrombosis in patients with end-stage renal disease (ESRD). This study aimed to elucidate the effect of pre-hemodialysis exercise training (preHD-ET) on platelet mitochondrial bioenergetic efficiency in ESRD patients.

Ninety ESRD patients were enrolled, and eighteen eligible ESRD candidates participated in the preHD-ET program. The ESRD patients underwent 24 weeks of hospital-supervised and 12 weeks of home-based preHD-ET on cycling exercise at 50-60% W_peak for 30 min/day, 3 days/week. Moreover, this study also analyzed 18 age- and gender matched healthy sedentary participants as a healthy sedentary (HS) group. Peak oxygen consumption (VO_2peak) and capacities of oxidative phosphorylation (OXPHOS) and electron transport system (ETC), and bioenergetic health index (BHI) in platelets were measured using an automatic gas analyzer and a high-resolution respirometer, respectively.

The ESRD group exhibited (i) lower W_peak and VO_2peak, (ii) inferior capacities of Complex I and II-dependent OXPHOS and ETC in platelets, and (iii) less platelet BHI, compared to the HS group. However, the preHD-ET significantly (i) elevated W_peak and VO_2peak, (ii) enhanced capacities of OXPHOS and ETC by facilitating Complex I and II-linked pathways in platelets, and (iii) raised platelet BHI in the ESRD patients. Moreover, the changes of VO_2peak were positively correlated to the changes of OXPHOS, ETC and BHI in platelets following the preHD-ET.

The preHD-ET for 36 weeks improves systemic aerobic capacity in ESRD patients. Moreover, this exercise regimen enhances mitochondrial bioenergetics efficiency in platelets, whose responses are associated with increased VO_2peak in ESRD patients. Clinical trials registration No. NCT06417307.