Kirkman Danielle L, Scott Matthew, Kidd Jason, Macdonald Jamie H
Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia.
Department of Internal Medicine, Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia.
Semin Dial. 2019 Jul;32(4):368-378. doi: 10.1111/sdi.12785. Epub 2019 Apr 9.
Dialysis adequacy is an independent predictor of high mortality rates in hemodialysis patients. Intradialytic exercise is a potential strategy to increase uremic solute removal by increasing blood flow to low perfusion tissue beds. The purpose of this review is to establish the efficacy of intradialytic exercise for hemodialysis adequacy. Additionally, this review aims to provide practical information to aid health care professionals implement intradialytic exercise for dialysis adequacy. Database and hand searches identified 15 published interventional studies that implemented intradialytic exercise for dialysis adequacy as a primary outcome measure in adult maintenance hemodialysis patients. Data pertaining to dialytic solute clearance of urea, creatinine, beta microglobulin, phosphate, and potassium were extracted. Mean differences, normalized to percentages, and effect sizes were calculated and reported. The current data pertaining to the use of intradialytic exercise for improving dialysis adequacy in terms of Kt/V or small molecule uremic toxin clearance are equivocal. Limited data showed that intradialytic exercise has no effect middle molecule toxin (beta - microglobulin) clearance. Intradialytic exercise favored increased phosphate removal showing medium to large effects for reduced serum concentrations, reduced rebound and increased clearance. In summary, supervised light to moderate intradialytic aerobic cycling appears to be beneficial for increasing phosphate removal and may be an adjunct therapy for patients failing to meet clinical phosphate targets. Further work is required to establish the effect of intradialytic exercise on Kt/V and other middle molecule and protein bound solutes. Research aimed at establishing the most effective exercise prescription for improved solute clearance is warranted.
透析充分性是血液透析患者高死亡率的独立预测因素。透析期间运动是一种潜在策略，可通过增加低灌注组织床的血流量来提高尿毒症溶质清除率。本综述的目的是确定透析期间运动对透析充分性的疗效。此外，本综述旨在提供实用信息，以帮助医护人员实施透析期间运动以实现透析充分性。通过数据库检索和手工检索，确定了15项已发表的干预性研究，这些研究将透析期间运动作为成人维持性血液透析患者透析充分性的主要结局指标。提取了与尿素、肌酐、β-微球蛋白、磷酸盐和钾的透析溶质清除率相关的数据。计算并报告了以百分比标准化的平均差异和效应量。目前关于透析期间运动在改善Kt/V或小分子尿毒症毒素清除率方面提高透析充分性的数据并不明确。有限的数据表明，透析期间运动对中分子毒素（β-微球蛋白）清除率没有影响。透析期间运动有利于增加磷酸盐清除，对降低血清浓度、减少反弹和增加清除率显示出中等到较大的效果。总之，在监督下进行轻度至中度的透析期间有氧运动似乎有利于增加磷酸盐清除，对于未达到临床磷酸盐目标的患者可能是一种辅助治疗方法。需要进一步开展工作来确定透析期间运动对Kt/V以及其他中分子和蛋白结合溶质的影响。有必要开展旨在确定最有效的运动处方以改善溶质清除率的研究。
