#3142 Study of intradialysis physical activity and quality of life in patients on hemodialysis

Abstract Background and Aims The purpose of our study is to examine the effect of intradialytic PA on subjective assessment of quality of life during hemodialysis. Method The present study included 103 patients with CKD 5D and 20 healthy volunteers of the corresponding age. All patients were examined during 2 HD sessions, each after a 3-day break. The first session was conducted before the session (standard HD 0) and an hour after the end of the session, testing was carried out using the SAM questionnaire and the six-minute walk test (SMT). Control testing of SAM and SMT was carried out 3 days after HD. The second HD session was carried out using intradialytic exercise for 30 minutes of the first hour of HD. Quality of life (QOL) was assessed using the SAM (well-being, activity, mood) questionnaire developed by the staff of the First Moscow State Medical University named after Sechenov. The questionnaire includes 30 items, each of which contains 2 polar features, one of which (characterizing a high quality of life) is estimated at 7 points, the second (characterizing a low quality of life)—1 point. The subject estimates each item in points depending on the proximity to one or another pole. All items are grouped into 3 scales—well-being, activity, mood, each of which is the sum of points of the corresponding items, divided by 10. Results The primary study showed a significantly lower score for all three scales of the questionnaire in CKD patients compared to the CG without a significant difference in the indicators in CKD patients, depending on the age of the patients. One hour after the end of HD, all patients showed a significant decrease in the score of all scales of the questionnaire (Fig. 1), which is explained by sharp hemodynamic and metabolic shifts associated with hemodialysis. Thus, the C score decreased by 3.18% from the initial one, A—by 4.72%, H—by 21.13% (P < 0.001). During HD with intradialytic FN, a decrease in all SAM scores was also noted (Fig. 2), while the relative dynamics were comparable with the dynamics during standard HD (on scale C—well-being, the relative dynamics was −3.71%, against −3.18% during standard HD, on scale A—activity −0.92% and −4.72%, respectively, on scale H—mood −12.85% and −21.13%), however, by the 3rd day after HD, the SAM scores increased significantly above the scores achieved after the standard procedure and pre-dialysis data. Thus, the relative dynamics of C with pre-dialysis data was +31.44% versus −0.57 with standard HD (P < 0.001), A on the A scale—+51.06% versus −2.56% (P < 0.001), on the H scale—+24.82% versus −1.19% (P < 0.01). Distribution of the results of the SAM assessment during HD with FE depending on the age of patients revealed: by the end of HD with FE, the point score on the C scale decreased significantly less in patients of the younger group (P < 0.05), while the decrease in the A and H scores was comparable, regardless of the age group. On the 3rd day after HD with FE, a higher score on the A scale was achieved in the young group compared to older patients (P < 0.05), the scores of the C and H scales were comparable. Comparison with the dynamics against the background of standard HD revealed that by the end of HD with FN, the score of H in both age groups retained higher values ​​(P < 0.001 reliability of the difference with standard HD in the young group and P < 0.01 in the group of older patients), the score of the C scale in the older group, and the score of A in the young group also demonstrated a more favorable profile compared to the change during standard HD. By the 3rd day after HD with FN, in both age groups, the scores C and A reached higher values ​​compared to standard HD. Conclusion In CKD patients the QOL score according to the SAM system is reduced (8.27 points vs. 17.98 points, P < 0.001). HD contributes to further deterioration of these health aspects, with restoration to the initial level by the beginning of the next session. Intradialytic physical activity helps limit the degree of deterioration in quality of life by the end of the HD procedure and improves QOL in the interdialytic period.

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