title: The association between intradialytic exercise and hospital usage among hemodialysis patients.
abstract: Hemodialysis (HD) patients have high hospitalization rates. Benefits of intradialytic exercise have been proven in numerous studies yet exercise programs are still rarely used in the treatment of end-stage kidney disease (ESKD). Our objective was to determine if there was an association between a 6-month intradialytic bicycling program and hospitalization rates and length of stay (LOS) in ESKD patients. This was a retrospective cohort study that took place 6 months prior to and 6 months during an intradialtyic exercise program at an outpatient HD unit in Calgary, Alberta, Canada. Participants comprised 102 patients who had commenced HD <6 months (incident) or >6 months (prevalent) prior to starting exercise. The intervention comprised a 6-month intradialytic bicycling program. Main outcome measures were hospitalization rate, cause of hospitalization, and LOS. Patients were predominantly male (67.6%) aged 65.6 ± 13.5 years and median HD vintage 1 year (range: 0-12). Comorbidities included diabetes mellitus (50%) and cardiac disease (38.2%). The hospitalization incidence rate ratio (IRR) was 0.48 (0.23-0.98; P = 0.04) in incident and 0.89 (0.56-1.42; P = 0.64) in prevalent patients. The LOS decreased from 7.8 (95% confidence interval (CI): 7.3-8.4) to 3.1 (95% CI: 2.8-3.4) days and LOS IRR was 0.39 (0.35-0.45; P < 0.001). The main predictors of hospitalization were lower albumin levels (P = 0.007) and lack of intradialytic exercise program participation (P < 0.001). In conclusion, 6 months of intradialytic exercise was associated with decreased LOS in both incident and prevalent HD patients.
authors.affiliation: Southern Alberta Renal Program, South Calgary Hemodialysis, 31 Sunpark Plaza SE, Calgary, AB T2X 3W5, Canada.
authors.forename: Kristen
authors.initials: K
authors.lastname: Parker
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Adriane
authors.initials: A
authors.lastname: Lewin
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: MacRae
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D001642:Bicycling; D015444:Exercise; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: durée du séjour; end-stage kidney disease; hospitalisation; hospitalization; length of stay; maladie rénale au stade terminal