Does intradialytic exercise improve removal of solutes by hemodialysis? A systematic review and meta-analysis

Abstract Objective To describe a systematic review and meta-analysis to identify if intradialytic exercise improves the removal of solutes and the hemodialysis adequacy. Data sources A systematic review and meta-analysis of randomized controlled trials (RCT) was performed. The sources were MEDLINE (via PubMed), Web of Science, LILACS and SciELO, from inception until July 2018. Study selection Clinical trials including patients on chronic hemodialysis submitted to the intervention of aerobic intradialytic exercise. Data Extraction evaluating as outcomes the removal of solutes (creatinine, phosphate and potassium) and/or adequacy parameters (Kt/V-urea). Data Synthesis The systematic review included 23 studies (seven evaluating the effect of one exercise session and 16 evaluating the effect of training, lasting from 6 to 25 weeks). Eleven RCT were included in the meta-analyses. It was observed that the aerobic intradialytic exercise increased the Kt/V-urea (0.15, 95% CI 0.08, 0.21) and decreased creatinine (-1.82 mg/dL, 95% CI -2.50, -1.13), despite the high heterogeneity of the analysis. No differences were found in phosphorus and potassium removal. Conclusion: the aerobic intradialytic exercise may be suggested to improve the Kt/V-urea and the creatinine removal during the dialysis.