Abstract
Background and Aims
Although physical activity has been documented to be effective in many categories of high-risk patients and more recently also in dialysis patients, there are no studies specifically focused on Peritoneal Dialysis (PD) patients. The peculiarity of this treatment modality for uremia is that it is carried out at the patient's home while the vast majority of physical exercise in dialysis patients is carried out during the hemodialysis (HD) session, then they are not applicable for PD patients. The Excite trial (JASN 2017; 28:1259-1268) is a home-based, individualized, low-intensity exercise program. In this multicenter, randomized clinical trial, the EXerCise Introduction To Enhance performance in dialysis patients trial (EXCITE), we aimed to investigate whether this home exercise program improves the degree of fitness and quality of life in patients with CKD-5D (Hemodialysis and Peritoneal Dialysis patients). The EXCITE home based clinical trial, is the first and may be the only one, involving peritoneal dialysis patients and this is of unique importance for the scientific community.
Method
We performed a secondary analysis of 35 peritoneal dialysis (PD) patients (age: 64±11 years; 74% males; 17% diabetics) who participated to the Exercise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a 6-month randomized, multicenter trial testing whether a simple, personalized walking exercise program at home, managed by dialysis staff, improves functional status in adult patients on dialysis. The main study outcomes included change in physical performance at 6 months, assessed by the 6-minute walking test (6MWD) and the five times sit-to-stand test (STS), and in quality of life, assessed by the Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire. Data are summarised as median and interquartile range (IQR).
Results
Out of 35 PD patients, 14 resulted to be allocated to the active arm and the remaining 21 to the control arm of the trial, and all completed the 6-month active phase of the trial. At baseline, the two groups did not differ as for age, gender, smoking, diabetes, and NYHA class (p ranging from 0.41 to 1.00) as well as for baseline values of 6MWD (active group, median 344 m, IQR: 307-440 m versus control group, median 302 m, IQR: 263-425m, P=0.12) and STS test (active group, median 18.2, IQR: 17.1-18.8 sec versus control group, median 20.2, IQR 16.2-27.1, P=0.25). During the 6 month period, there was a 34.0 m median increase of 6MWD (IQR: from 16.3 to 61.3 m) in the active group and only a modest increase of the same test in the control group (median: 14.0 m; IQR: from -39.5 to 38.5 m) and the between arms difference was statistically significant (P=0.034). No between arms difference was found in the STS test change (P=0.70). At 6 months, the quality of social interaction in the kidney disease component of the KDQOL-SF remained stable in patients of the active arm (median change from baseline: 0.0, IQR: from -5.0 to 17.5) whereas it decreased in patients in the control arm (median change from baseline: -5.8, IQR: from – 20.0 to -1.3) (between-arms difference, P=0.032).
Conclusion
The results of this multicentre trial involving PD patients show that a simple, personalized, home-based, low-intensity exercise program is feasible in PD patients and it may improve physical performance and quality of life in this high risk category of patients.
Effect of a home based, low intensity, physical exercise program in older adults dialysis patients: a secondary analysis of the EXCITE trial
