Effects of Ketoanalogue Supplementation and Intradialytic Resistance Exercise on Functional Performance, Fatigue, and...

Patients on maintenance hemodialysis commonly develop protein-energy wasting, sarcopenia, and disabling fatigue. Whether ketoanalogue (KA) supplementation, low-intensity intradialytic resistance exercise, or the two combined can improve physical function over a short period is uncertain.

In a single-centre, 12-week randomised trial, 100 prevalent hemodialysis patients were allocated 1:1:1:1 to KA only, KA plus exercise, exercise only, or control. The primary outcome was the 30-second sit-to-stand test (STS-30). Secondary outcomes were fatigue (MFIS), handgrip strength, bioimpedance skeletal muscle index (SMI), and quadriceps ultrasound total thickness. Between-group inference used baseline-adjusted 2×2 factorial ANCOVA with a KA-by-exercise interaction term, which tests whether the effect of one intervention depends on whether the other is present. Simple effects were estimated when the interaction was significant.

Ninety-five patients completed follow-up. The four arms were similar at baseline in age, sex, dialysis vintage, comorbidities, and daily protein intake (0.65-0.77 g/kg), confirming successful randomisation. KA had a significant main effect on STS-30 (+1.34 reps; 95% CI 0.41-2.28; p=0.005) and on quadriceps thickness (+2.85; 95% CI 0.98-4.72; p=0.003), with no KA-by-exercise interaction. The exercise's main effect on STS-30 was not significant. For handgrip, KA alone and exercise alone each improved performance, but combining them did not produce additive gains (significant interaction, p<0.001). Fatigue and SMI showed no significant between-group effects; these findings are considered exploratory CONCLUSION: Twelve weeks of KA supplementation was associated with improved functional performance and preservation of quadriceps muscle thickness relative to non-supplemented patients in hemodialysis patients with low baseline protein intake. The low-intensity intradialytic exercise prescription tested did not, on its own, improve STS-30.