Effect of blood volume change related to intensity of intradialytic aerobic exercise on hemodialysis adequacy: a pilot study

Abstract

Intradialytic exercise may improve dialysis efficiency; however, the association between changes in blood volume (BV) related to exercise intensity and solute removal kinetics remains unknown. We herein investigated the relationship between changes in BV with exercise and removal of solute molecules during hemodialysis. Each of the 21 hemodialysis patients underwent cardiopulmonary exercise test to measure anaerobic threshold (AT). According to the exercise intensity, patients were classified into two groups, the low group (n\u2009=\u200912), whose intensity was below the AT, and the high group (n\u2009=\u20099), whose intensity was at the AT level. Each patient completed two trial arms of resting and discontinuous exercise dialysis sessions in a randomized manner. The change in BV with the exercise dialysis session in the high group decreased during exercise (p\u2009=\u20090.028) and remained decreased after exercise (p\u2009=\u20090.016), compared with the low group. In the low group, compared with routine sessions, the removal of potassium (p\u2009=\u20090.030), phosphate (p\u2009=\u20090.024), and urea nitrogen (p\u2009=\u20090.065) increased during exercise, but the total removal of these solutes did not change. In the high group, the removal of phosphate (p\u2009<\u20090.001) and urea nitrogen (p\u2009=\u20090.018) after exercise and even total phosphate (p\u2009=\u20090.027) decreased. These findings suggest that the removal of small solute molecules is improved during exercise in intradialytic low-intensity exercise with no change in BV, and decreased after exercise in high-intensity exercise with a decrease in BV. Trial retrospectively registered at the UMIN Clinical Trials Registry: study number UMIN000038629 (Registration date: September 7, 2019).