EFFECT OF INTRADIALYTIC EXERCISE ON VARIOUS HEALTH PARAMETERS IN PATIENTS ON HEMODIALYSIS AT A TERTIARY CARE CENTRE

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EFFECT OF INTRADIALYTIC EXERCISE ON VARIOUS HEALTH PARAMETERS IN PATIENTS ON HEMODIALYSIS AT A TERTIARY CARE CENTRE

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Co-author 1

Deodatta Chafekar nchafy@hotmail.com Dr vasantrao pawar medical College hospital and research centre Nephrology Nashik India *

Co-author 2

Jitendra Kodilkar jitendrakodilkar@gmail.com Dr vasantrao pawar medical College hospital and research centre Internal medicine Nashik India -

Co-author 3

Rizwan Ahmed rizzahmed77@gmail.com Dr vasantrao pawar medical College hospital and research centre Internal medicine Nashik India -

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Introduction

Patients on Maintenance Hemodialysis (MHD) have decreased physical capacity and quality of life (QOL), which is associated with poor clinical outcomes. In these patients muscle wasting is multifactorial, due to anorexia, uremia and catabolic state. Exercise training may improve health parameters in these patients. Intra-Dialytic exercise (IDE) is a feasible and time-efficient intervention to improve outcomes without using additional time outside the dialysis schedule. It helps to counteract muscle wasting significantly. Incorporating intra-dialytic exercise in routine dialysis care may support both physical rehabilitation and nutritional optimization in MHD patients

Methods

patient doing IDE during dialysis

A prospective, single centre, interventional study was conducted on 20 CKD stage 5 patients undergoing MHD at a tertiary care teaching institute from September ‘2024 to November’2024 , to evaluate the effect of a 3-month intra-dialytic cycling program on their cardio-vascular function, laboratory, anthropometric parameters, physical function, and QOL.

Study Population: ESRD patients ≥18 years on MHD, who had given consent were included in the study. Patients having recent MI, unstable cardiovascular status, symptomatic hypotension /hypertension, or other contraindications to exercise were excluded from the study.

Intervention: Participants performed supervised IDE twice weekly on the day of dialysis for 30 minutes during the first 2 hours of dialysis, comprising a 5-min warm-up, 20-min cycling and 5-min cool-down. Vitals such as Heart rate, blood pressure and oxygen saturation were monitored throughout exercise.

Outcome Measures: Pre and post intervention assessment, measured at baseline and after 3 months included sit-to-stand test (Assesses lower limb strength and endurance and involves measuring how many sit-to-stand movements can be completed without fatigue.), 6 minute walk test (Exercise test that measures the distance a person can walk in six minutes to assess their functional exercise capacity.) Kt/V, and LVEF (2D Echo), Hemoglobin level, Serum Calcium, Phosphorous.

Results

Significant improvements were observed in 6-minute walk test (from 210 m to 231.5 m, p=0.01), sit to stand test (from 14.23 to 15.46, p<0.001), No significant changes were seen in Kt/V, hemoglobin (p=0.46), serum calcium (p=0.58), phosphorous (p=0.67) and cardiovascular function.

6 min Walk Test: (M: Meters)

Sit to stand Test (No. of times in initial 5 minutes)

QOL Parameters (KDQOL *Domains) Before and After 3-Month Intra-dialytic Exercise (Scale:

1–5) { Excellent 5, Very good 4 ,Good 3 ,Fair 2 ,Poor 1}

Patient ID	Physical Functioning(Before)	Physical Functioning(After)
1	2	3
2	2	3
3	1	2
4	3	3
5	2	3
6	2	3
7	3	3
8	2	3
9	2	3
10	3	3
11	2	3
12	3	3
13	2	3
14	1	2
15	2	2
16	3	4
17	3	3
18	2	3
19	1	2
20	2	3

Conclusion

Intra-dialytic exercise is a safe, feasible, and effective intervention to improve physical function and quality of life in ESRD patients on hemodialysis. It can be incorporated into routine dialysis care to improve patient outcomes.It is especially helpful in low-resource settings where more complicated rehabilitation protocols may be limited by time, staffing, and space.

Limitation: This study is limited by its small sample size, single center design and the intervention period of 3 months. In addition parameters like PTH & Vitamin D related to CKD MBD have not been studied.

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