search
Back to results

The Effect of Exercise on Dialysis Patients' Survival

Primary Purpose

Kidney Disease, Chronic, End Stage Renal Disease, Hemodialysis

Status
Completed
Phase
Not Applicable
Locations
Iran, Islamic Republic of
Study Type
Interventional
Intervention
Intradialytic Exercise
Sponsored by
Pardis Specialized Wellness Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Kidney Disease, Chronic focused on measuring mortality, exercise during dialysis, physical function, sarcopenia, hematological parameters

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Dialysis history ≥ 1 year
  • Without myocardial infarction within past 3 months
  • Regular dialysis 3 times a week
  • Ability to consent
  • Doctor's consent

Exclusion Criteria:

  • Unstable cardiac status (angina, decompensated congestive heart failure, severe arteriovenous stenosis, uncontrolled arrhythmias, etc.)
  • Active infection or acute medical illness
  • Hemodynamic instability
  • Labile glycemic control
  • Unable to exercise (lower extremity amputation with no prosthesis)
  • having severe musculoskeletal pain at rest or with minimal activity
  • Unable to sit, stand or walk unassisted (walking device such as cane or walker allowed)
  • Having shortness of breath at rest or with activities of daily living (NYHA Class IV)

Sites / Locations

  • Abolfazl medical center
  • Pardis specialized wellness institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Exercise group

Control group

Arm Description

The patients will participate in intradialytic exercise 3 times a week for 24 weeks.

The patients will receive regular care and treatment in every dialysis sessions without any intradialytic exercise.

Outcomes

Primary Outcome Measures

1-year Survival of dialysis patients
Mortality data is gathered using form "CMS-2746" which is specifically for dialysis patients.

Secondary Outcome Measures

Rate of changes of Albumin for 6 months
Rate of changes of Hemoglobin for 6 months
Rate of changes of Hematocrit for 6 months
Rate of changes of Red Blood Cells for 6 months
Rate of changes of Calcium for 6 months
Rate of changes of Phosphorus for 6 months
Rate of changes of Parathyroid Hormone for 6 months
Changes of GNRI for 6 months
The Geriatric Nutritional Risk Index (GNRI) is a screening method that was primarily developed to identify older patients with malnutrition. It consists of serum albumin levels as well as body weight measurements. GNRI is associated with an increasing risk of long-term all-cause mortality in prevalent hemodialysis patients, even after adjusting for age and comorbidity
Changes of the meters walked during the 6MWT for 6 months
Six-minute walk test (6MWT) is a walking endurance assessment measured in meters of total distance completed over 6 minutes

Full Information

First Posted
May 18, 2021
Last Updated
March 27, 2023
Sponsor
Pardis Specialized Wellness Institute
search

1. Study Identification

Unique Protocol Identification Number
NCT04898608
Brief Title
The Effect of Exercise on Dialysis Patients' Survival
Official Title
The Effect of Intradialytic Exercise on Dialysis Patients' Survival: A Randomized Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
May 2021
Overall Recruitment Status
Completed
Study Start Date
January 25, 2020 (Actual)
Primary Completion Date
August 9, 2021 (Actual)
Study Completion Date
August 9, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Pardis Specialized Wellness Institute

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to check if patients' exercise during their dialysis sessions can prevent their early deaths.
Detailed Description
Dialysis patients suffer from a number of problems, one of which is reduced ability, decreased functional capacity, and consequently reduced physical capability. Forced inactivity due to immobility in dialysis sessions and the need to rest and relieve fatigue for a few hours after each session cause patients to become more inactive day by day, and according to various studies, inactivity in these patients along with reduced physical capabilities increase the risk of cardiovascular disease, which is a risk factor for mortality in these patients. On the other hand, inactivity is an independent predictor of hospitalization and mortality in these patients. Studies have shown that exercise can produce many different effects in these patients. However, exercise interventions are often short-term, and even in long-term cases, the aim of studies is only to examine a number of hematological factors or factors such as functional capacity in these patients. A study is currently being designed to directly evaluate the impact of exercise on patients' survival. To test this hypothesis, patients do exercise for 6 months during dialysis. And then will be monitored for a year to determine patients' survival. During 6 months of intervention, hematological parameters, nutrition index and functional capacity of patients are evaluated. In the analyzes, the survival rate of patients in one year follow-up period is compared between patients who took part in intradialytic sessions (intervention group) and patients who did not do any physical activity during dialysis (control group). In addition, by analyzing the variables measured during the 6 months of the intervention, the effect of exercise on parameters relating to survival is evaluated.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Kidney Disease, Chronic, End Stage Renal Disease, Hemodialysis
Keywords
mortality, exercise during dialysis, physical function, sarcopenia, hematological parameters

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Participants will be randomly allocate to intervention group or control group and will be examined in the same way.
Masking
Outcomes Assessor
Masking Description
The lab tech will be blind to whether the sample under evaluation belongs to the intervention group or the control group. A research project collaborator who is not informed about grouping of participants will obtain outcome measurements of the functional test. Outcome adjudicators, and data analysts will be kept blinded to the allocation. Moreover, all investigators, staff, and participants will be kept masked to outcome measurements and trial results.
Allocation
Randomized
Enrollment
74 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Exercise group
Arm Type
Experimental
Arm Description
The patients will participate in intradialytic exercise 3 times a week for 24 weeks.
Arm Title
Control group
Arm Type
No Intervention
Arm Description
The patients will receive regular care and treatment in every dialysis sessions without any intradialytic exercise.
Intervention Type
Other
Intervention Name(s)
Intradialytic Exercise
Intervention Description
Participants will do concurrent exercise (a combination of aerobic exercise and resistance training) for 30-60 minutes during the second hour of their routine hemodialysis sessions. To determine the intensity of the prescribed exercise, maximum heart rate is used for aerobic workout and 1RM for resistance protocols. Exercises will be performed at a moderate exercise intensity (12-14 on the Borg RPE Scale). All protocols are tailor-made based on each individual's needs and physical abilities.
Primary Outcome Measure Information:
Title
1-year Survival of dialysis patients
Description
Mortality data is gathered using form "CMS-2746" which is specifically for dialysis patients.
Time Frame
Follow-up phase (1- year)
Secondary Outcome Measure Information:
Title
Rate of changes of Albumin for 6 months
Time Frame
Pre_test and every 3 months for 6 months
Title
Rate of changes of Hemoglobin for 6 months
Time Frame
Pre_test and every 3 months for 6 months
Title
Rate of changes of Hematocrit for 6 months
Time Frame
Pre_test and every 3 months for 6 months
Title
Rate of changes of Red Blood Cells for 6 months
Time Frame
Pre_test and every 3 months for 6 months
Title
Rate of changes of Calcium for 6 months
Time Frame
Pre_test and every 3 months for 6 months
Title
Rate of changes of Phosphorus for 6 months
Time Frame
Pre_test and every 3 months for 6 months
Title
Rate of changes of Parathyroid Hormone for 6 months
Time Frame
Pre_test and every 3 months for 6 months
Title
Changes of GNRI for 6 months
Description
The Geriatric Nutritional Risk Index (GNRI) is a screening method that was primarily developed to identify older patients with malnutrition. It consists of serum albumin levels as well as body weight measurements. GNRI is associated with an increasing risk of long-term all-cause mortality in prevalent hemodialysis patients, even after adjusting for age and comorbidity
Time Frame
Pre_test and every 3 months for 6 months
Title
Changes of the meters walked during the 6MWT for 6 months
Description
Six-minute walk test (6MWT) is a walking endurance assessment measured in meters of total distance completed over 6 minutes
Time Frame
Pre_test and every 3 months for 6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Dialysis history ≥ 1 year Without myocardial infarction within past 3 months Regular dialysis 3 times a week Ability to consent Doctor's consent Exclusion Criteria: Unstable cardiac status (angina, decompensated congestive heart failure, severe arteriovenous stenosis, uncontrolled arrhythmias, etc.) Active infection or acute medical illness Hemodynamic instability Labile glycemic control Unable to exercise (lower extremity amputation with no prosthesis) having severe musculoskeletal pain at rest or with minimal activity Unable to sit, stand or walk unassisted (walking device such as cane or walker allowed) Having shortness of breath at rest or with activities of daily living (NYHA Class IV)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mohammad Ali Tabibi, Dr
Organizational Affiliation
Pardis Specialized Wellness Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Abolfazl medical center
City
Isfahan
ZIP/Postal Code
813991447
Country
Iran, Islamic Republic of
Facility Name
Pardis specialized wellness institute
City
Isfahan
Country
Iran, Islamic Republic of

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Individual participant data that underlie the results reported in the published article, after deidentification are to be shared.
IPD Sharing Time Frame
The data will be available after the paper is published. No end date.
IPD Sharing Access Criteria
The IPD will be available only for our colleagues in GREX as long as they have acceptable reasons for requiring the data.
Citations:
PubMed Identifier
30566933
Citation
Xiong J, Wang M, Zhang Y, Nie L, He T, Wang Y, Huang Y, Feng B, Zhang J, Zhao J. Association of Geriatric Nutritional Risk Index with Mortality in Hemodialysis Patients: A Meta-Analysis of Cohort Studies. Kidney Blood Press Res. 2018;43(6):1878-1889. doi: 10.1159/000495999. Epub 2018 Dec 14.
Results Reference
background
Citation
Tabibi MA, Ahmadi E, Nasrin S. POS-621 The effect of concurent exercise during dialysis on hemoglobin,red blood cells and hematocrit in hemodialysis patients. Kidney International Reports. 2021; 6(4): 270-271. doi: 10.1016/j.ekir.2021.03.650
Results Reference
background
PubMed Identifier
28482880
Citation
Shimoda T, Matsuzawa R, Yoneki K, Harada M, Watanabe T, Matsumoto M, Yoshida A, Takeuchi Y, Matsunaga A. Changes in physical activity and risk of all-cause mortality in patients on maintence hemodialysis: a retrospective cohort study. BMC Nephrol. 2017 May 8;18(1):154. doi: 10.1186/s12882-017-0569-7.
Results Reference
background
PubMed Identifier
33050111
Citation
Bakaloudi DR, Siargkas A, Poulia KA, Dounousi E, Chourdakis M. The Effect of Exercise on Nutritional Status and Body Composition in Hemodialysis: A Systematic Review. Nutrients. 2020 Oct 8;12(10):3071. doi: 10.3390/nu12103071.
Results Reference
background
PubMed Identifier
27399824
Citation
Parker K. Intradialytic Exercise is Medicine for Hemodialysis Patients. Curr Sports Med Rep. 2016 Jul-Aug;15(4):269-75. doi: 10.1249/JSR.0000000000000280.
Results Reference
background
PubMed Identifier
15806502
Citation
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. No abstract available.
Results Reference
background
PubMed Identifier
27318109
Citation
Milam RH. Exercise Guidelines for Chronic Kidney Disease Patients. J Ren Nutr. 2016 Jul;26(4):e23-5. doi: 10.1053/j.jrn.2016.03.001. No abstract available.
Results Reference
background
PubMed Identifier
30581137
Citation
Scapini KB, Bohlke M, Moraes OA, Rodrigues CG, Inacio JF, Sbruzzi G, Leguisamo CP, Sanches IC, Tourinho Filho H, Irigoyen MC. Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease: systematic review and network meta-analysis. J Physiother. 2019 Jan;65(1):4-15. doi: 10.1016/j.jphys.2018.11.008. Epub 2018 Dec 21.
Results Reference
background
PubMed Identifier
31454822
Citation
Huang M, Lv A, Wang J, Xu N, Ma G, Zhai Z, Zhang B, Gao J, Ni C. Exercise Training and Outcomes in Hemodialysis Patients: Systematic Review and Meta-Analysis. Am J Nephrol. 2019;50(4):240-254. doi: 10.1159/000502447. Epub 2019 Aug 27.
Results Reference
background
PubMed Identifier
30670499
Citation
Pu J, Jiang Z, Wu W, Li L, Zhang L, Li Y, Liu Q, Ou S. Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis. BMJ Open. 2019 Jan 21;9(1):e020633. doi: 10.1136/bmjopen-2017-020633.
Results Reference
background
PubMed Identifier
33570280
Citation
Zhang F, Zhou W, Sun Q, Zhai Y, Zhang Y, Su H, Wang Z. Effects of intradialytic resistance exercises on physical performance, nutrient intake and quality of life among haemodialysis people: A systematic review and meta-analysis. Nurs Open. 2021 Mar;8(2):529-538. doi: 10.1002/nop2.274. Epub 2019 Sep 30.
Results Reference
background
PubMed Identifier
16253734
Citation
Noordzij M, Korevaar JC, Boeschoten EW, Dekker FW, Bos WJ, Krediet RT; Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group. The Kidney Disease Outcomes Quality Initiative (K/DOQI) Guideline for Bone Metabolism and Disease in CKD: association with mortality in dialysis patients. Am J Kidney Dis. 2005 Nov;46(5):925-32. doi: 10.1053/j.ajkd.2005.08.013.
Results Reference
background
PubMed Identifier
14978180
Citation
Stevens LA, Djurdjev O, Cardew S, Cameron EC, Levin A. Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol. 2004 Mar;15(3):770-9. doi: 10.1097/01.asn.0000113243.24155.2f.
Results Reference
background
PubMed Identifier
12427151
Citation
Pifer TB, McCullough KP, Port FK, Goodkin DA, Maroni BJ, Held PJ, Young EW. Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney Int. 2002 Dec;62(6):2238-45. doi: 10.1046/j.1523-1755.2002.00658.x.
Results Reference
background
PubMed Identifier
14531767
Citation
Avram MM, Blaustein D, Fein PA, Goel N, Chattopadhyay J, Mittman N. Hemoglobin predicts long-term survival in dialysis patients: a 15-year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin. Kidney Int Suppl. 2003 Nov;(87):S6-11. doi: 10.1046/j.1523-1755.64.s87.3.x.
Results Reference
background
PubMed Identifier
10972697
Citation
Foley RN, Parfrey PS, Morgan J, Barre PE, Campbell P, Cartier P, Coyle D, Fine A, Handa P, Kingma I, Lau CY, Levin A, Mendelssohn D, Muirhead N, Murphy B, Plante RK, Posen G, Wells GA. Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy. Kidney Int. 2000 Sep;58(3):1325-35. doi: 10.1046/j.1523-1755.2000.00289.x.
Results Reference
background
PubMed Identifier
20383863
Citation
Bohm CJ, Ho J, Duhamel TA. Regular physical activity and exercise therapy in end-stage renal disease: how should we move forward? J Nephrol. 2010 May-Jun;23(3):235-43.
Results Reference
background
PubMed Identifier
25118037
Citation
Aucella F, Gesuete A, Battaglia Y. A "nephrological" approach to physical activity. Kidney Blood Press Res. 2014;39(2-3):189-96. doi: 10.1159/000355796. Epub 2014 Jul 29.
Results Reference
background
PubMed Identifier
31591041
Citation
Wilund K, Thompson S, Bennett PN. A Global Approach to Increasing Physical Activity and Exercise in Kidney Care: The International Society of Renal Nutrition and Metabolism Global Renal Exercise Group. J Ren Nutr. 2019 Nov;29(6):467-470. doi: 10.1053/j.jrn.2019.08.004. Epub 2019 Oct 4. No abstract available.
Results Reference
background
PubMed Identifier
22760895
Citation
Kohl Lde M, Signori LU, Ribeiro RA, Silva AM, Moreira PR, Dipp T, Sbruzzi G, Lukrafka JL, Plentz RD. Prognostic value of the six-minute walk test in end-stage renal disease life expectancy: a prospective cohort study. Clinics (Sao Paulo). 2012;67(6):581-6. doi: 10.6061/clinics/2012(06)06.
Results Reference
background
PubMed Identifier
28238554
Citation
Evangelidis N, Tong A, Manns B, Hemmelgarn B, Wheeler DC, Tugwell P, Crowe S, Harris T, Van Biesen W, Winkelmayer WC, Sautenet B, O'Donoghue D, Tam-Tham H, Youssouf S, Mandayam S, Ju A, Hawley C, Pollock C, Harris DC, Johnson DW, Rifkin DE, Tentori F, Agar J, Polkinghorne KR, Gallagher M, Kerr PG, McDonald SP, Howard K, Howell M, Craig JC; Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative. Developing a Set of Core Outcomes for Trials in Hemodialysis: An International Delphi Survey. Am J Kidney Dis. 2017 Oct;70(4):464-475. doi: 10.1053/j.ajkd.2016.11.029. Epub 2017 Feb 24.
Results Reference
background
PubMed Identifier
24119578
Citation
Chantrel F, de Cornelissen F, Deloumeaux J, Lange C, Lassalle M; registre REIN. [Survival and mortality in ESRD patients]. Nephrol Ther. 2013 Sep;9 Suppl 1:S127-37. doi: 10.1016/S1769-7255(13)70042-7. French.
Results Reference
background

Learn more about this trial

The Effect of Exercise on Dialysis Patients' Survival

We'll reach out to this number within 24 hrs