Reduction of Arterial Stiffness Assessed by Cardio-Ankle Vascular Index Through Intra-Dialytic Aerobic Training

Background: Increased arterial stiffness elevates mortality in chronic kidney disease. Limited available data suggest that regular exercise can reduce arterial stiffness in hemodialysis patients. This pilot study aimed to investigate the effects of intra-dialytic aerobic training on arterial stiffness in hemodialysis patients. Methods: Outpatients undergoing hemodialysis were randomized to a 20-week intra-dialytic aerobic training group (bedside ergometer exercise) or a control group receiving standard care. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI). CAVI measurements, functional fitness tests, laboratory analyses, and quality-of-life assessments were performed at baseline and at the end of the study. Results: A significant decrease in CAVI was observed in the intra-dialytic aerobic training group (-5%; p = 0.037). Concurrently, significant improvements occurred in VO2peak/kg (+31%; p = 0.015), 6 min walk test (6 MWT) distance (+18%; p = 0.005), clearance (URR +2%; p < 0.001; Kt/V +6%; p = 0.001), and select quality-of-life parameters (social support +9%; p = 0.022; general health +25%; p = 0.008; well-being +3%; p < 0.001). No significant changes were found in the control group. Conclusions: The reduction in arterial stiffness confirms the efficacy of intra-dialytic aerobic training in improving overall health status. Consequently, CAVI appears to be a valuable tool for monitoring arterial stiffness changes in hemodialysis patients.