De Vos Celine, Lemarcq Laure, Dhondt Annemieke, Glorieux Griet, Van Biesen Wim, Eloot Sunny
University Hospital Ghent, Gent, Belgium.
Int J Artif Organs. 2021 Mar;44(3):156-164. doi: 10.1177/0391398820949880. Epub 2020 Aug 21.
The evidence on impact of intradialytic exercise on the removal of urea, is conflictive. Impact of exercise on kinetics of serum levels of protein-bound uraemic toxins, known to exert toxicity and to have kinetics dissimilar of those of urea, has so far not been explored. Furthermore, if any effect, the most optimal intensity, time point and/or required duration of intradialytic exercise to maximise removal remain obscure. We therefore studied the impact of different intradialytic cycling schedules on the removal of protein-bound uraemic toxins during haemodialysis (HD).This randomised cross-over study included seven stable patients who were dialysed with an FX800 dialyser during three consecutive midweek HD sessions of 240 min: (A) without cycling; (B) cycling for 60 min between 60th and 120th minutes of dialysis; and (C) cycling for 60 min between 150th and 210th minutes, with the same cycling load as in session B. Blood and dialysate flows were respectively 300 and 500 mL/min. Blood was sampled from the blood inlet at different time points, and dialysate was partially collected (300 mL/h). Small water soluble solutes and protein-bound toxins were quantified and intradialytic reduction ratios (RR) and overall removal were calculated per solute.Total solute removal and reduction ratios were not different between the three test sessions, except for the reduction ratios RR and RR for potassium.In conclusion, we add evidence to the existing literature that, regardless of the timing within the dialysis session, intradialytic exercise has no impact on small solute clearance, and demonstrated also a lack of impact for protein-bound solutes.
关于透析中运动对尿素清除的影响，证据存在冲突。运动对血清中与蛋白结合的尿毒症毒素动力学的影响，已知这些毒素具有毒性且动力学与尿素不同，目前尚未进行研究。此外，若有任何影响，为使清除最大化，透析中运动的最适宜强度、时间点和/或所需时长仍不明确。因此，我们研究了不同的透析中骑行方案对血液透析（HD）期间与蛋白结合的尿毒症毒素清除的影响。这项随机交叉研究纳入了7名稳定患者，他们在连续三个周三的240分钟HD治疗期间使用FX800透析器进行透析：（A）不骑行；（B）在透析的第60至120分钟之间骑行60分钟；（C）在第150至210分钟之间骑行60分钟，骑行负荷与B组相同。血液和透析液流速分别为300和500 mL/分钟。在不同时间点从血液入口采集血液，并部分收集透析液（300 mL/小时）。对小水溶性溶质和与蛋白结合的毒素进行定量，并计算每种溶质的透析中清除率（RR）和总清除量。除钾的清除率RR和RR外，三个测试阶段的总溶质清除量和清除率没有差异。总之，我们为现有文献增添了证据，即无论在透析过程中的何时进行，透析中运动对小溶质清除没有影响，并且对与蛋白结合的溶质也没有影响。
