Department of Infection, Immunity & Inflammation; and John Walls Renal Unit, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.
National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK.
Nephrol Dial Transplant. 2018 Aug 1;33(8):1436-1445. doi: 10.1093/ndt/gfy045.
Intradialytic cycling (IDC), delivered during haemodialysis (HD), has the potential to improve many health issues. This systematic review and meta-analysis examine the evidence on the effects of IDC on exercise capacity, quality of life (QoL), physical function and cardiovascular health.
Twenty-four databases were searched alongside Internet and hand searching, and consultation with experts. Eligibility criteria were cluster randomized, randomized and quasi-randomized controlled trials (RCTs) of IDC versus usual care in prevalent adult HD patients. Primary outcome measures were exercise capacity (VO2 peak and field tests) and QoL. Secondary measures were cardiac and physical function.
Thirteen RCTs were eligible. Eight provided data for use in meta-analyses, which indicated no significant change in VO2 peak (mean difference, MD 1.19 mL/kg/min, 95% confidence interval -1.15 to 3.52, P = 0.3), physical (mean change, MC 1.97, -8.27 to 12.22, P = 0.7) or mental component (MC 3.37, -7.94 to 14.68, P = 0.6) summary scores of the Medical Outcomes Short Form 36, pulse wave velocity (MD -0.57 m/s, -1.55 to 0.41, P = 0.4), systolic (MD -2.28 mmHg, -14.46 to 9.90, P = 0.7) or diastolic blood pressure (MD 2.25 mmHg, -3.01 to 7.50, P = 0.4) following IDC. IDC, however, leads to an improvement in performance on the 6-min walk test (MD 87.84 m, 39.60-136.09, P = 0.0004). All included studies were considered to have high risk of bias.
There is insufficient evidence demonstrating whether cycling exercise during HD improves patient outcomes. High-quality, adequately powered RCTs of IDC are required.
血液透析（HD）期间进行的透析内运动（IDC）有可能改善许多健康问题。本系统评价和荟萃分析旨在研究 IDC 对运动能力、生活质量（QoL）、身体功能和心血管健康影响的证据。
检索了 24 个数据库以及互联网和手工搜索，并咨询了专家。纳入标准为 IDC 与常规治疗相比在成年 HD 患者中进行的簇随机、随机和半随机对照试验（RCT）。主要结局指标为运动能力（VO2 峰值和现场测试）和 QoL。次要指标为心脏和身体功能。
共有 13 项 RCT 符合条件。其中 8 项提供了可用于荟萃分析的数据，结果表明 VO2 峰值无显著变化（平均差值，MD 1.19mL/kg/min，95%置信区间-1.15 至 3.52，P=0.3），身体（平均变化，MC 1.97，-8.27 至 12.22，P=0.7）或精神成分（MC 3.37，-7.94 至 14.68，P=0.6）的 Medical Outcomes Short Form 36 综合评分、脉搏波速度（MD-0.57m/s，-1.55 至 0.41，P=0.4）、收缩压（MD-2.28mmHg，-14.46 至 9.90，P=0.7）或舒张压（MD 2.25mmHg，-3.01 至 7.50，P=0.4）在 IDC 后无显著变化。然而，IDC 可改善 6 分钟步行试验的表现（MD 87.84m，39.60-136.09，P=0.0004）。所有纳入的研究均被认为存在高偏倚风险。
目前尚无充分证据表明 HD 期间进行的骑行运动是否能改善患者的结局。需要进行高质量、充分有力的 IDC RCT。
