#3055 ASSOCIATION OF MORTALITY WITH INTRADIALYTIC EXERCISE IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Patients with hemodialysis (HD) have an increased risk of mortality, which can be minimized by physical activity (PA). Intradialytic exercises (IDE) are very convenient, potentially increasing adherence to PA and allowing for a sedentary lifestyle. Thus, the purpose of this study was to analyze the association of IDE with mortality in patients with HD. Method A single center, prospective study in adult HD patients eligible for IDE (cycling 3 times a week) was performed. After 1 year of IDE introduction, patients were followed up for up to 3 years. Three groups were created based on the impact of IDE (minutes of exercise per week): no exercise (patients who refused IDE); low load (<87 min/week); high load (≥87 min/week). Kaplan-Meier models (unadjusted analysis) and Cox proportional hazard models (adjusted for age, dialysis experience, vascular access, comorbidity index, CVD, muscle tissue, overhydration, and hospitalizations) were used with a non-exercise group as a reference. In addition, a sub-analysis was conducted, limited to IDE participants, with exposure as a continuous variable. Results 106 patients (no exercise: 58; low exercise: 26; high exercise: 22) were followed for an average of 24.5 months. Uncorrected mortality differed between the three groups: (no exercise: 24.1%; low load: 23.0%; high load: 9.0%; p<0.01). In the adjusted analysis, the high load group had a lower risk of mortality than the no exercise group (RR = 0.42, 95% CI 0.23–0.76, p<0.05), while in the low load group this was not observed (RR). = 1.07, 95% CI 0.66–1.52, p = 0.568). In addition, mortality risk decreased for every 55 minutes of exercise per week in unadjusted (HR = 0.46, 95% CI 0.29–0.76, p = 0.01) and adjusted analyzes (HR = 0.54, 95% CI 0.32–0.91, p<0.05). Conclusion Our findings show that IDE is associated with a reduced risk of mortality in HD patients, but a significant amount of exercise is required. Thus, patients who achieve low load doses may require non-clinical approaches to PA in addition to IDE. These findings complement those of earlier studies and highlight the need for a tailored approach to the exercise.

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