Effect of Intradialytic Resistance Versus Aerobic Exercise on Cardiovascular System in Patients on Regular Hemodialysis

Chronic kidney disease (CKD) is one of the leading causes of global morbidity and mortality. In the 2019 Global Burden of Disease study, CKD was among the top ten risks associated with the highest number of deaths worldwide, with a death toll of 3.16 million deaths.

Patients undergoing dialysis in Egypt in 2020 are mostly men (59%), and half of them are aged ≥55 years. Hypertension is the most common cause of end-stage kidney disease at 41%, followed by diabetes at 14%, whereas glomerulonephritis is the primary diagnosis in 3% of patients undergoing dialysis.

Hemodialysis (HD), continuous ambulatory peritoneal dialysis, and kidney transplantation are the three main modalities of renal replacement therapy. Hypotension is the most reported complication of routine outpatient HD treatments.

Toxic substances, also called uremic toxins, in the blood result in malaise, paraesthesia, mental impairment, peripheral circulatory disturbance, and muscle dysfunction.

While patients exercise during dialysis, those toxins move through the dialyzer with a large flux from the tissue to the vascular compartment. It results in increased muscle blood flow and opened capillary surface area. Besides, the intradialytic exercise showed not only better adoption and adherence but also a lower drop-out and greater compliance.

So, this study will investigate the effect of resistance and aerobic exercises on intradialytic hypotension in patients undergoing hemodialysis. thus, may affect the quality of life in chronic kidney disease dialysis patients. The results of this study may shed light on which of the selected exercises can decrease the risk of Intradialytic hypotension to help dialysis patients. To our knowledge, there are no previous similar studies.

Inclusion criteria

• End-stage renal disease (ESRD) or stage 5 chronic kidney disease (CKD) in which on maintenance regular HD (three sessions/week (on alternate days), for four hours/session for more than a year to five years when starting the study.
• Both gender male and female aged from 45 to 60 years old.
• Patients with intradialytic hypotension sudden drops of systolic pressure of more than 20 mm Hg or diastolic pressure of more than 10 mmHg.
• Receiving hemodialysis (HD) through uncomplicated arm arteriovenous (A-V) fistula.
• Patients with Body Mass Index (BMI): 18,5 < 30kg/m2.
• In a stable medical, clinical, and hemodynamic condition
• Untrained at baseline and did not participate in any regular physical activity before.

Exclusion criteria

• Severe Chest diseases (either obstructive or restrictive).
• Clinical signs of a severe cardiac event. (eg, severe atherosclerosis, congestive heart failure),
• Severe psychiatric or cognitive impairment, who unable to follow comment.
• Neurological disorders affecting respiratory muscles or any muscular dystrophies (cervical disc or bulge).
• Patients with severe self-limiting illness (e.g., cancer).
• Patients with Body Mass Index (BMI) > 30kg/m2.
• Previous renal transplantation patients.
• Pregnant females or became pregnant during the study.
• Patients started HD in less than a year or more than 5 years.
• Hospitalized during the prior month.
• Patients who were irregular in HD or not adherent to the exercise program.