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Randomized Trial—PrEscription of intraDialytic exercise to improve quAlity of Life in Patients Receiving Hemodialysis

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posted on 2021-09-06, 12:55 authored by SA Greenwood, P Koufaki, JH Macdonald, S Bhandari, JO Burton, I Dasgupta, K Farrington, I Ford, PA Kalra, S Kean, M Kumwenda, IC Macdougall, CM Messow, S Mitra, C Reid, AC Smith, MW Taal, PC Thomson, DC Wheeler, C White, M Yaqoob, TH Mercer
Introduction
Whether clinically implementable exercise interventions in people receiving hemodialysis (HD) therapy improve health-related quality of life (HRQoL) remains unknown. The PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) study evaluated the clinical benefit and cost-effectiveness of a 6-month intradialytic exercise program.

Methods
In a multicenter, single-blinded, randomized, controlled trial, people receiving HD were randomly assigned to (i) intradialytic exercise training (exercise intervention group [EX]) and (ii) usual care (control group [CON]). Primary outcome was change in Kidney Disease Quality of Life Short-Form Physical Component Summary (KDQOL-SF 1.3 PCS) from baseline to 6 months. Cost-effectiveness was determined using health economic analysis; physiological impairment was evaluated by peak oxygen uptake; and harms were recorded.

Results
We randomized 379 participants; 335 and 243 patients (EX n = 127; CON n = 116) completed baseline and 6-month assessments, respectively. Mean difference in change PCS from baseline to 6 months between EX and CON was 2.4 (95% confidence interval [CI]: −0.1 to 4.8) arbitrary units (P = 0.055); no improvements were observed in peak oxygen uptake or secondary outcome measures. Participants in the intervention group had poor compliance (47%) and poor adherence (18%) to the exercise prescription. Cost of delivering intervention ranged from US$598 to US$1092 per participant per year. The number of participants with harms was similar between EX (n = 69) and CON (n = 56). A primary limitation was the lack of an attention CON. Many patients also withdrew from the study or were too unwell to complete all physiological outcome assessments.

Conclusions
A 6-month intradialytic aerobic exercise program was not clinically beneficial in improving HRQoL as delivered to this cohort of deconditioned patients on HD.

Funding

National Institute for Health Research (grant number: NIHR-HTA 12/23/09)

History

Citation

Kidney International Reports Volume 6, Issue 8, August 2021, Pages 2159-2170

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

Version

  • VoR (Version of Record)

Published in

Kidney International Reports

Volume

6

Issue

8

Pagination

2159 - 2170

Publisher

Elsevier BV

issn

2468-0249

Acceptance date

2021-05-24

Copyright date

2021

Available date

2021-09-06

Language

en

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