Effect of intra-dialytic exercise on hemodialysis session adequacy and solutes clearance and rebound in prevalent hemodialysis patients

Abstract

Background
Intradialytic exercise (IDE) has shown promise in improving health outcomes in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). This study aimed to assess the immediate effects of a single IDE session on HD efficiency, specifically focusing on solute clearance by calculating their reduction rate percentage immediately post-session and their rebound percentage 1 h post-session in ESRD patients after a familiarization period (FP) to ensure patient safety. Dialysis adequacy was assessed using equation for Kt/V.


Results
Forty ESRD patients undergoing regular HD were divided into two equal groups with matched clinical characteristics. After a FP of 4 weeks, the IDE group baseline levels for blood urea nitrogen (BUN), phosphorus (Po₄) and Beta2-microglobulin (B2MG) were significantly less compared to controls. However, no difference in potassium (K) levels were observed. Following the dialysis session, IDE group had significantly higher reduction rate percent for BUN (P < 0.001), K and Po₄ (P < 0.001) and B2MG (P = 0.02) compared to the control group. Also, rebound percentage of uremic toxins BUN and Po₄ 1 h after the end of dialysis session was much higher in the control group (P < 0.001). The exercise group also had significantly higher equilibrated Kt/V compared to controls (P < 0.001).


Conclusion
Moderate-intensity IDE session improved dialysis efficacy, promoting better electrolyte balance and uremic toxin clearance in ESRD patients on HD. IDE shows promise as a complementary therapy, but future studies should assess its effects in exercise-naive populations to better understand and isolate the acute response.