Renal Dialysis
Conditions
Keywords
Intra-dialytic exercise, Toxin removal, Hemodiafiltration, Inter-compartmental resistance, Cardiac output
Brief summary
Hemodialysis is a life-saving treatment for end stage renal disease patients. The chief aims of hemodialysis are solute and fluid removal. Solute removal is associated with outcome of dialysis patients. Intra-dialytic exercise has been found to improve the toxin removal and it is suggested that exercise increases the cardiac output, thus increases the blood flow to lower extremities. This leads to increased toxin removal from low blood flow regions. On the other hand, exercise can possibly dilate the vasculature and decrease the compartmental resistance. In this study, the investigators aim to investigate the exercise induced physiological changes which enhances the toxin removal. This information combined with patient specific mathematical models will encourage clinicians to opt for Optimal intra-dialytic exercise protocol. On the other hand, Hemodiafiltration is widely accepted renal replacement therapy for improved toxin removal. Hence, we intend to compare the toxin removal outcome for standalone Hemodiafiltration and intra-dialytic exercise in conventional hemodialysis.
Interventions
PROCEDUREIntra-dialytic exercise
Perform intra-dialytic exercise of three bouts in 4 hours dialysis session. Each patient will perform exercise on Monark 881E rehab trainer (widely used in routine dialysis settings). The exercise intensity will be prescribed based on achievement of 50% of maximum heart rate for each recruited subject.
Sponsors
National University of Singapore
National University Hospital, Singapore
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients male or female (Age \> 21 years) * Minimum dialysis vintage of 6 months * Stable on hemodialysis * Minimum Hemoglobin level of 10 g/dL * Blood access capable of delivering the blood flow rate greater than 250 mL/min * Preserved left ventricular ejection fraction (\>50%) on prior imaging study * Able to complete a 6min-walk-test without abnormal physiological response, excessive fatigue, or musculoskeletal discomfort
Exclusion criteria
* History of recurring or persistent hypotension in past 3 months * Pregnant woman * Severely Hypertensive patients (SBP \> 180 mmHg and/or DBP \> 115 mmHg) * History of recent myocardial infarction or unstable angina (within past 6 months) * Significant valvular disease, i.e. severe aortic stenosis and moderate-severe mitral regurgitation. * Patients with end stage organ disease e.g. COPD, recent or debilitating CVA * Patient with recent stroke (within past 6 months) * Anemic patients * History of known arrhythmia * Participation in another clinical intervention trial * Moderate to severe osteoarthritis of knee(s) * Unable to consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quantify toxin removal | 6 months | Measure/estimate amount of toxin(s) removed and quantify corresponding physiological changes |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Compare exercise regimen with HDF | 6 months | Compare amount of toxin removed for conventional hemodialysis (HD), HD with intra-dialytic exercise, and hemodiafiltration |
Countries
Singapore
Contacts
Primary ContactTitus Lau, MD
Backup ContactVaibhav Maheshwari, B.Tech.
Outcome results
None listed