Randomized trial-PrEscription of intraDialytic exercise to improve quAlity of Life in patients receiving hemodialysis

Greenwood, S. A. et al. (2021) Randomized trial-PrEscription of intraDialytic exercise to improve quAlity of Life in patients receiving hemodialysis. Kidney International Reports, 6(8), pp. 2159-2170. (doi: 10.1016/j.ekir.2021.05.034) (PMID:34386665) (PMCID:PMC8343798)

Abstract

Introduction: Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. The PrEscription of intraDialytic exercise to improve quAlity of Life PEDAL) study evaluated the clinical benefit and cost-effectiveness of a 6-month intradialytic exercise program. Methods: In a multicenter, single-blinded, randomized, controlled trial, people receiving HD were randomly assigned to (i) intradialytic exercise training (exercise intervention group [EX]) and (ii) usual care (control group [CON]). Primary outcome was change in Kidney Disease Quality of Life Short-Form Physical Component Summary (KDQOL-SF 1.3 PCS) from baseline to 6 months. Cost-effectiveness was determined using health economic analysis; physiological impairment was evaluated by peak oxygen uptake; and harms were recorded. Results: We randomized 379 participants; 335 and 243 patients (EX  = 127; CON  = 116) completed baseline and 6-month assessments, respectively. Mean difference in change PCS from baseline to 6 months between EX and CON was 2.4 (95% confidence interval [CI]: -0.1 to 4.8) arbitrary units ( = 0.055); no improvements were observed in peak oxygen uptake or secondary outcome measures. Participants in the intervention group had poor compliance (47%) and poor adherence (18%) to the exercise prescription. Cost of delivering intervention ranged from US$598 to US$1092 per participant per year. The number of participants with harms was similar between EX ( = 69) and CON ( = 56). A primary limitation was the lack of an attention CON. Many patients also withdrew from the study or were too unwell to complete all physiological outcome assessments. Conclusions: A 6-month intradialytic aerobic exercise program was not clinically beneficial in improving HRQoL as delivered to this cohort of deconditioned patients on HD.

• Item Type: Articles
• Additional Information: This study is funded by a grant from the National Institute for Health Research (grant number: NIHR-HTA 12/23/09).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Thomson, Dr Peter and Ford, Professor Ian and Kean, Ms Sharon and Messow, Dr Martina
• Authors: Greenwood, S. A., Koufaki, P., Macdonald, J. H., Bhandari, S., Burton, J. O., Dasgupta, I., Farrington, K., Ford, I., Kalra, P. A., Kean, S., Kumwenda, M., Macdougall, I. C., Messow, C.-M., Mitra, S., Reid, C., Smith, A. C., Taal, M. W., Thomson, P. C., Wheeler, D. C., White, C., Yaqoob, M., and Mercer, T. H.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Kidney International Reports
• Publisher: Elsevier
• ISSN: 2468-0249
• ISSN (Online): 2468-0249
• Published Online: 30 May 2021
• Copyright Holders: Copyright © 2021 International Society of Nephrology
• First Published: First published in Kidney International Reports 6(8): 2159-2170
• Publisher Policy: Reproduced under a Creative Commons License