Chronic kidney disease (CKD) negatively impacts quality of life and increases mortality risks, while the financial costs of nephrology care and dialysis therapy strain the healthcare system and patients. Haemodialysis is one of the renal replacement therapy options for CKD patients with established kidney failure. Dialysis therapy- and disease-related complications contribute to patients' sedentary behaviour and poor muscle functions (MF), which increases their frailty. This is associated with increased risks of hospitalisation, complications and mortality. Promotion of physical activity has a strong potential to suppress the deterioration in patients' muscle functions.
In this thesis of Aurel Zelko, we explored the effects of intradialytic exercise (IDE) on patients' muscle functions, and the roles of age, sex and gene expression profile on these effects. We further surveyed healthcare providers' perceptions on the benefits, risks and barriers of intradialytic exercise. We found that intradialytic exercise prevented loss of muscle functions, particularly in middle-aged and female patients, and in patients with higher expression of a specific microribonucleic acid (miRNA-206).
Healthcare providers' perceptions were that benefits mostly related to patients' physical and psychosocial functioning, and that risks predominantly regarded exercise-related damage to the vascular access points. Limitations in financial and personal resources for intradialytic exercise were frequently reported as barriers. Our findings show that intradialytic exercise might be effective in preventing muscle functions deterioration, especially if intradialytic exercise prescriptions are personalised regarding the patient's socio-demographic and genetic factors. Safe and sustainable implementation of intradialytic exercise requires adjustments to minimise the risk of injury, alignment of planned physical activities with the patient's clinical profile, and adequate availability of resources.
