The Effect of Intradialytic Exercise on All-Cause Mortality in Hemodialysis Patients: multicenter observational study

Tetsuya Yamada, Haruka Nakano, Hiroki Yabe, Ren Takahashi, Akiho Kiyota, Daiki Natsume, Yoshifumi Moriyama
Purpose:

The objective of this study was to examine the impact of IDE on all-cause mortality among participants in a multicenter cohort investigation.

Methods:

This research surveyed patients receiving outpatient hemodialysis at 17 Kaikoukai Group facilities as of 2018. The intervention group (IDE group) engaged in strength training using Theraband, while the control group received standard HD treatment. Kaplan-Meier curves and Cox proportional hazards regression analysis were used for survival analysis. Three models were developed to adjust for confounding factors based on data from electronic medical records, estimating hazard ratios (HR) and 95% confidence intervals (95CI) for all-cause mortality after adjustment. (Model 1: Basic information, Model 2: Model 1 + blood data + dialysis information, Model 3: Model 2 + frailty-related items) The study was approved by the Ethics Committee of Nagoya Kyoritsu Hospital (ID: 145-01). Informed consent was obtained through an opt-out format at each facility.

Results:

The research encompassed 1889 participants, with 397 (21%) in the IDE group and 1492 (78%) in the control group. Over the observation period (median of 36 months), mortality was observed in 37 patients (9.7%) from the IDE group and 279 patients (19.0%) from the control group. According to the log-rank test, the survival rate was significantly higher in the IDE group compared to the control group (p0.001). Furthermore, the Cox proportional hazards regression analysis indicated a considerable improvement in survival for the IDE group after adjusting for confounding factors across multiple models (Model 1: HR 0.46, 95% CI 0.32-0.65; Model 2: HR 0.44, 95% CI 0.31-0.64; Model 3: HR 0.50, 95% CI 0.35-0.72). Implementation of IDE was notably associated with reduced all-cause mortality (p0.05).

Conclusion(s):

Even when factoring in patients' backgrounds, dialysis status, and frailty, IDE was linked to about a 48% decrease in overall mortality. These findings highlight the need for increasing IDE participation among hemodialysis patients.

Implications:

The results indicate that IDE could be a beneficial treatment option for enhancing the prognosis of HD patients.

Funding acknowledgements:
No specific funding was received from any funding bodies for this study.
Keywords:
External hemodialysis patients
Intradialytic Exercise
The all-cause mortality rate
Primary topic:
Disability and rehabilitation
Second topic:
Community based rehabilitation
Third topic:
Other
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
The Ethics Committee of Nagoya Kyoritsu Hospital
Provide the ethics approval number:
145-01
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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