Chronic kidney disease leads to serious complications related to the disability of patients. This gives reason to discuss and work to improve their quality of life. In recent years, attention has been focused on physical activity and renal rehabilitation, in order to overcome movement disorders.
In the Nephrology Clinic at St. Marina University Hospital, Varna, the influence of cardio-cycling exercises on the clinical status of hemodialysis (HD) patients was assessed, objectified by examining laboratory indicators, such as serum phosphorus, serum calcium, iPTH, and CRP.
We studied a total of 69 patients-divided into two groups: control (n = 32) and experimental (n = 37), conducting cardio-cycling exercises. The values of serum phosphorus, calcium, and CRP were examined in both groups at the beginning, at the 3rd and at the 6th month, and the values of iPTH—at the beginning and at the 6th month.
The analyzed data showed that in HD patients performing intradialytic exercises, bone mineral indices improve in terms of Ca and P, but not those for PTH. The highest correlation was found for serum Ca.
In patients with CKD on HD treatment, in whom various techniques of renal rehabilitation were applied, good results were reported in the volume and cycling. The cooperation of patients is important. This requires convincing them of the positive effect of the test and its implementation in order to improve their tone and physical activity.
Canaud B, Tong L, Tentori F, Akiba T, Karaboyas A, Gillespie B, et al. Clinical practices and outcomes in elderly hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol. 2011 Jul;6(7):1651-62. doi: 10.2215/CJN.03530410.
Josse M, Patrier L, Isnard M, Turc-Baron C, Grandperrin A, Nottin S, et al. Cardioprotective Effect of Acute Intradialytic Exercise: A Comprehensive Speckle-Tracking Echocardiography Analysis. J Am Soc Nephrol. 2023 Aug 1;34(8):1445-55. doi: 10.1681/ASN.0000000000000149.
Moinuddin I, Leehey DJ. A comparison of aerobic exercise and resistance training in patients with and without chronic kidney disease. Adv Chronic Kidney Dis. 2008 Jan;15(1):83-96. doi: 10.1053/j.ackd.2007.10.004.
Yamada S, Tsuruya K, Kitazono T, Nakano T. Emerging cross-talks between chronic kidney disease-mineral and bone disorder (CKD-MBD) and malnutrition-inflammation complex syndrome (MICS) in patients receiving dialysis. Clin Exp Nephrol. 2022 Jul;26(7):613-629. doi: 10.1007/s10157-022-02216-x.
Yonova D. Disorders of bone and mineral metabolism in chronic kidney disease, dialysis and kidney transplantation. In: Paskalev E, editor. Nephrology. Ed. Sofia, Bulgarresurs; 2015. pp. 725-46.
Afsar B, Siriopol D, Aslan G, Eren OC, Dagel T, Kilic U, et al. The impact of exercise on physical function, cardiovascular outcomes and quality of life in chronic kidney disease patients: a systematic review. Int Urol Nephrol. 2018;50(5):885. doi: 10.1007/s11255-018-1790-4.
Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. 2000 Jul;58(1):396-9. doi: 10.1046/j.1523-1755.2000.00178.x.
Arbor. DOPPS Practice Monitor -- Content Navigator [Internet]. Dopps.org. 2023. Available from: https://www.dopps.org/DPM-HD/DPMSlideBrowser.aspx
Jung TD, Park SH. Intradialytic exercise programs for hemodialysis patients. Chonnam Med J. 2011 Aug;47(2):61-5. doi: 10.4068/cmj.2011.47.2.61.
K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005 Apr;45(4 Suppl 3):S1-153.
Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014 Mar 19;9:433-41. doi: 10.2147/CIA.S45300.
Chigira Y, Oda T, Izumi M, Yoshimura T. Effects of exercise therapy during dialysis for elderly patients undergoing maintenance dialysis. J Phys Ther Sci. 2017 Jan;29(1):20-3. doi: 10.1589/jpts.29.20.
Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014 Oct;25(10):2359-81. doi: 10.1007/s00198-014-2794-2.
Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary Calcium Score and Cardiovascular Risk. J Am Coll Cardiol. 2018 Jul 24;72(4):434-47. doi: 10.1016/j.jacc.2018.05.027.
Yamada S, Tsuruya K, Taniguchi M, Tokumoto M, Fujisaki K, Hirakata H, et al. Association Between Serum Phosphate Levels and Stroke Risk in Patients Undergoing Hemodialysis: The Q-Cohort Study. Stroke. 2016 Sep;47(9):2189-96. doi: 10.1161/STROKEAHA.116.013195.
Christodoulou M, Aspray TJ, Schoenmakers I. Vitamin D Supplementation for Patients with Chronic Kidney Disease: A Systematic Review and Meta-analyses of Trials Investigating the Response to Supplementation and an Overview of Guidelines. Calcif Tissue Int. 2021 Aug;109(2):157-178. doi: 10.1007/s00223-021-00844-1.
Cobo G, Lindholm B, Stenvinkel P. Chronic inflammation in end-stage renal disease and dialysis. Nephrol Dial Transplant. 2018 Oct 1;33(suppl_3):iii35-iii40. doi: 10.1093/ndt/gfy175.
Zamojska S, Szklarek M, Niewodniczy M, Nowicki M. Correlates of habitual physical activity in chronic haemodialysis patients. Nephrol Dial Transplant. 2006 May;21(5):1323-7. doi: 10.1093/ndt/gfi323.
Manfredini F, Mallamaci F, D'Arrigo G, Baggetta R, Bolignano D, Torino C, et al. Exercise in Patients on Dialysis: A Multicenter, Randomized Clinical Trial. J Am Soc Nephrol. 2017 Apr;28(4):1259-68. doi: 10.1681/ASN.2016030378.
Mohseni R, Emami Zeydi A, Ilali E, Adib-Hajbaghery M, Makhlough A. The effect of intradialytic aerobic exercise on dialysis efficacy in hemodialysis patients: a randomized controlled trial. Oman Med J. 2013 Sep;28(5):345-9. doi: 10.5001/omj.2013.99.
Rogers M, Goettsch C, Aikawa E. Medial and intimal calcification in chronic kidney disease: stressing the contributions. J Am Heart Assoc. 2013 Sep 23;2(5):e000481. doi: 10.1161/JAHA.113.000481.
Stewart P. Exercise and a cycle of life: help us help ourselves. Adv Ren Replace Ther. 1999 Apr;6(2):184-6. doi: 10.1016/s1073-4449(99)70049-x.
Nakanishi T, Nanami M, Kuragano T. The pathogenesis of CKD complications; Attack of dysregulated iron and phosphate metabolism. Free Radic Biol Med. 2020 Sep;157:55-62. doi: 10.1016/j.freeradbiomed.2020.01.024.
Rodelo-Haad C, Rodríguez-Ortiz ME, Martin-Malo A, Pendon-Ruiz de Mier MV, Agüera ML, Muñoz-Castañeda JR, et al. Phosphate control in reducing FGF23 levels in hemodialysis patients. PLoS One. 2018 Aug 7;13(8):e0201537. doi: 10.1371/journal.pone.0201537.
Roetker NS, Peng Y, Ashfaq A, Gilbertson DT, Wetmore JB. Adherence to Kidney Disease: Improving Global Outcomes Mineral and Bone Guidelines for Monitoring Biochemical Parameters. Am J Nephrol. 2019;49(3):225-232. doi: 10.1159/000497477.
Greenwood SA, Koufaki P, Macdonald JH, Bulley C, Bhandari S, Burton JO, et al. Exercise programme to improve quality of life for patients with end-stage kidney disease receiving haemodialysis: the PEDAL RCT. Health Technol Assess. 2021 Jun;25(40):1-52. doi: 10.3310/hta25400.
Greenwood SA, Koufaki P, Macdonald JH, Bhandari S, Burton JO, Dasgupta I, et al. Randomized Trial-PrEscription of intraDialytic exercise to improve quAlity of Life in Patients Receiving Hemodialysis. Kidney Int Rep. 2021 May 30;6(8):2159-70. doi: 10.1016/j.ekir.2021.05.034.
Groussard C, Rouchon-Isnard M, Coutard C, Romain F, Malardé L, Lemoine-Morel S, et al. Beneficial effects of an intradialytic cycling training program in patients with end-stage kidney disease. Appl Physiol Nutr Metab. 2015 Jun;40(6):550-6. doi: 10.1139/apnm-2014-0357.
Smart N, Steele M. Exercise training in haemodialysis patients: a systematic review and meta-analysis. Nephrology (Carlton). 2011 Sep;16(7):626-32. doi: 10.1111/j.1440-1797.2011.01471.x.
Storer TW, Casaburi R, Sawelson S, Kopple JD. Endurance exercise training during haemodialysis improves strength, power, fatigability and physical performance in maintenance haemodialysis patients. Nephrol Dial Transplant. 2005 Jul;20(7):1429-37. doi: 10.1093/ndt/gfh784.
Alfaadhel TA, Soroka SD, Kiberd BA, Landry D, Moorhouse P, Tennankore KK. Frailty and mortality in dialysis: evaluation of a clinical frailty scale. Clin J Am Soc Nephrol. 2015 May 7;10(5):832-40. doi: 10.2215/CJN.07760814.
Choi RB, Robling AG. The Wnt pathway: An important control mechanism in bone's response to mechanical loading. Bone. 2021 Dec;153:116087. doi: 10.1016/j.bone.2021.116087.
Mallamaci F, Pisano A, Tripepi G. Physical activity in chronic kidney disease and the EXerCise Introduction To Enhance trial. Nephrol Dial Transplant. 2020 Mar 1;35(Suppl 2):ii18-ii22. doi: 10.1093/ndt/gfaa012.
Email this article (Login required) 
