Previous studies have suggested that exercise during hemodialysis (HD) could increase the efficacy of solute removal, although this hypothesis has not been conclusively evaluated. The goal of this study was to compare the removal of low-molecular weight solutes between HD sessions, with and without aerobic exercise. It was a controlled clinical trial, including HD patients in a randomly cross-over design, such that each patient received a HD session with exercise (intervention) and the next one without exercise (control), three times each. In the exercise sessions, patients pedaled on a cycle ergometer for 60 minutes. The total mass of removed urea, potassium, creatinine, and phosphate were calculated from the solutes concentration in dialysate (continuous spent sampling of dialysate). This was evaluated in a total of 132 HD sessions of patients with a mean age of 54 ± 15 years, 75% male and HD vintage of 3 (2-13) years. Phosphate removal in dialysate during intervention sessions was significantly higher (5.6 [2.5-18.9] vs. 5.1 [1.5-11.2] mg/min) than during control sessions, P = 0.04. The median mass of phosphate removed during control HD session was 1226 (367.8-2697.2) vs. 1348.6 (613.0-4536.2) mg/session during intervention sessions. The exercise did not modify the removal of urea (control 122.6 [61.3-286.0] vs. exercise 112.4 [51.1-250.3] mg/min, P = 0.44), creatinine (control 5.6 [2.5-13.8] vs. exercise 5.6 [2.5-12.8] mg/min, P = 0.49), or potassium (control 13.3 [11.2-15.8] vs. exercise 13.8 [6.6-15.8] mEq/min, P = 0.49). Aerobic exercise during HD increases the efficacy of phosphate removal, without changing urea, creatinine and potassium removal. The implications of this finding in mineral and bone disease and cardiovascular disease need to be evaluated on future clinical trials.
Introduction: Hemodialysis (HD) increases the lifespan of chronic kidney disease (CKD) patients. However, HD is only partially effective in replacing renal function. The aim of this study is to compare HD adequacy between sessions with intradialytic exercise with or without blood flow restriction (BFR) with sessions without exercise.Methods: A crossover study including 22 adult CKD patients on HD. The patients were assigned to BFR (n = 11) or exercise alone group (n = 11). Each patient was submitted to four HD sessions (two with exercise and two control sessions). HD adequacy was assessed by equilibrated Kt/V-urea (eKT/V), single-pool Kt/V-urea (sp-Kt/V), urea and phosphorus rebound, urea reduction ratio (URR) and removal of urea and phosphorus in dialysate.Findings: BFR exercise improved eKt/V and sp-Kt/V (1.32 AE 0.21 vs. 1.10 AE 0.16 for control, P < 0.001; 1.53 AE 0.26 vs. 1.27 AE 0.19 for control, P < 0.001, respectively) and URR (72.5 AE 5.4% vs. 66.1 AE 7.7% for control, P < 0.001). No difference in eKt/V, sp-Kt/V or URR could be detected between exercise alone and control HD sessions. Urea rebound was lower in BFR exercise vs. control sessions (−8.9 AE 9.1% vs. 30.7 AE 12.8%, P < 0.01) and exercise alone vs. control sessions (13.3 AE 29.0% vs. 42.4 AE 15.3%, P < 0.01). Phosphorus rebound was marginally lower in exercise vs. control sessions (14.4 AE 19.1% vs. 28.4 AE 22.1%, P = 0.18). Urea and phosphorus mass removal in dialysate were marginally higher in exercise vs. control sessions (42.2 AE 19.4 g vs. 35.7 AE 12.5 g, P = 0.24; 912.1 AE 360.9 mg vs. 778.6 AE 245.1 mg, P = 0.28).Conclusions: Intradialytic exercise with BFR was more effective than standard exercise in increasing HD adequacy.
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