The PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease trial: study design and baseline data for a multicentre randomized controlled trial

Greenwood, Sharlene A.; Koufaki, Pelagia; Macdonald, Jamie; Bhandari, Sunil; Burton, James; Dasgupta, Indranil; Farrington, Kenneth; Ford, Ian; Kalra, Philip A.; Kean, Sharon; Kumwenda, Mick; Macdougall, Iain C.; Messow, Claudia-Martina; Mitra, Sandip; Reid, Chante; Smith, Alice C.; Taal, Maarten W.; Thomson, Peter C.; Wheeler, David C.; White, Claire; Yaqoob, Magdi; Mercer, Thomas H.

Abstract

Background
Exercise interventions designed to improve physical function and reduce sedentary behaviour in haemodialysis (HD) patients might improve exercise capacity, reduce fatigue and lead to improved quality of life (QOL). The PrEscription of intraDialytic exercise to improve quAlity of Life study aimed to evaluate the effectiveness of a 6-month intradialytic exercise programme on QOL and physical function, compared with usual care for patients on HD in the UK.

Methods
We conducted a prospective, pragmatic multicentre randomized controlled trial in 335 HD patients and randomly (1:1) assigned them to either (i) intradialytic exercise training plus usual care maintenance HD or (ii) usual care maintenance HD. The primary outcome of the study was the change in Kidney Disease Quality of Life Short Form (KDQOL-SF 1.3) Physical Component Score between baseline and 6 months. Additional secondary outcomes included changes in peak aerobic capacity, physical fitness, habitual physical activity levels and falls (International Physical Activity Questionnaire, Duke’s Activity Status Index and Tinetti Falls Efficacy Scale), QOL and symptom burden assessments (EQ5D), arterial stiffness (pulse wave velocity), anthropometric measures, resting blood pressure, clinical chemistry, safety and harms associated with the intervention, hospitalizations and cost-effectiveness. A nested qualitative study investigated the experience and acceptability of the intervention for both participants and members of the renal health care team.

Results
At baseline assessment, 62.4% of the randomized cohort were male, the median age was 59.3 years and 50.4% were white. Prior cerebrovascular events and myocardial infarction were present in 8 and 12% of the cohort, respectively, 77.9% of patients had hypertension and 39.4% had diabetes. Baseline clinical characteristics and laboratory data for the randomized cohort were generally concordant with data from the UK Renal Registry.

Conclusion
The results from this study will address a significant knowledge gap in the prescription of exercise interventions for patients receiving maintenance HD therapy and inform the development of intradialytic exercise programmes both nationally and internationally.

• Journal Article Type: Article
• Acceptance Date: May 12, 2020
• Online Publication Date: Sep 10, 2020
• Publication Date: 2021-05
• Deposit Date: Sep 14, 2020
• Publicly Available Date: Sep 14, 2020
• Journal: Clinical Kidney Journal
• Print ISSN: 2048-8505
• Electronic ISSN: 2048-8513
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 5
• Pages: 1345–1355
• DOI: https://doi.org/10.1093/ckj/sfaa107
• Keywords: Nephrology; Transplantation
• Public URL: https://nottingham-repository.worktribe.com/output/4903062
• Publisher URL: https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfaa107/5903831