在线血液透析滤过患者透析中周期性运动对日常体力活动、身体适应性、身体成分和临床参数的影响：一项初步随机对照试验。
Effects of intradialytic cycling exercise on daily physical activity, physical fitness, body composition, and clinical parameters in high-volume online hemodiafiltration patients: a pilot randomized-controlled trial.
机构信息
Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
出版信息
Int Urol Nephrol. 2021 Feb;53(2):359-371. doi: 10.1007/s11255-020-02677-7. Epub 2020 Oct 31.
PURPOSE
The mortality of dialysis patients treated with high-volume online hemodiafiltration (OL-HDF) is better than hemodialysis, but is still higher than healthy population. Low daily physical activity increases cardiovascular mortality. Addition of intradialytic exercise (IDX) program might improve physical activity and health status in OL-HDF patients. This pilot open-labeled randomized-controlled trial was conducted to evaluate the effects of IDX on physical activity and other clinical parameters in OL-HDF patients.
METHODS
Twelve OL-HDF patients were randomized into control (n = 6) or IDX (n = 6) groups. The subjects in IDX group were trained to exercise using a cycle ergometer for 60 min during each OL-HDF session. Physical activity measured as daily step count using a wrist-worn triaxial accelerometer, physical fitness, or cardiorespiratory fitness assessed by VOmax and other physical performance tests, lean body mass determined by the Dual-energy X-ray absorptiometry (DXA), quality of life (QOL), and various parameters were compared between baseline and 6 months.
RESULTS
The baseline physical activity status was comparable. Following 6-month IDX, the physical activity was significantly improved in IDX group [+ 1048.79 (+ 741.50, + 2792.54) vs. - 362.06 (- 1626.82, - 167.47) steps/day, p = 0.01], while physical fitness and QOL were unchanged. The lean body mass parameters were preserved in the IDX group while seemed to decrease in the control group. Serum albumin was significantly increased in the IDX group (p = 0.01). The hemoglobin changes were significantly better (p = 0.01) and the erythropoietin resistance index was significantly lower in the IDX group (p = 0.03). Phosphate reduction was significantly greater in the IDX group (p = 0.04).
CONCLUSIONS
IDX could improve physical activity and other metabolic parameters in OL-HDF patients and these might contribute to further improvement in clinical and survival outcomes.
TRIAL REGISTRATION
ClinicalTrials.gov Registration: NCT03353844.
目的
接受高容量在线血液透析滤过（OL-HDF）治疗的透析患者的死亡率优于血液透析，但仍高于健康人群。日常低体力活动会增加心血管死亡率。添加透析内运动（IDX）方案可能会改善 OL-HDF 患者的体力活动和健康状况。本研究进行了一项开放标签、随机对照试验，以评估 IDX 对 OL-HDF 患者体力活动和其他临床参数的影响。
方法
将 12 名 OL-HDF 患者随机分为对照组（n=6）或 IDX 组（n=6）。IDX 组的患者在每次 OL-HDF 治疗期间接受使用自行车功率计进行 60 分钟的运动训练。使用手腕三轴加速度计测量的日常步数来评估体力活动，通过 VOmax 和其他身体表现测试评估体力、心肺功能，通过双能 X 射线吸收法（DXA）测定瘦体重，通过生活质量（QOL）评估，以及比较基线和 6 个月时的其他各种参数。
结果
基线体力活动状态相当。经过 6 个月的 IDX，IDX 组的体力活动显著改善[+1048.79（+741.50，+2792.54）与-362.06（-1626.82，-167.47）步/天，p=0.01]，而身体状况和 QOL 没有变化。IDX 组的瘦体重参数保持不变，而对照组似乎有所下降。IDX 组的血清白蛋白显著增加（p=0.01）。血红蛋白变化明显更好（p=0.01），IDX 组的促红细胞生成素抵抗指数明显更低（p=0.03）。IDX 组磷酸盐的减少量明显更大（p=0.04）。
结论
IDX 可改善 OL-HDF 患者的体力活动和其他代谢参数，这可能有助于进一步改善临床和生存结局。
试验注册
ClinicalTrials.gov 注册号：NCT03353844。
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