Intradialytic Exercise on Changes in Blood Pressure in Chronic Kidney Failure Patients during Hemodialysis Therapy

BACKGROUND: Chronic renal failure (CRF) is a reduction in chronic renal function that leads to non-reversible and progressive kidney tissue damage. Blood pressure is a major risk factor that can increase the mortality rate by up to 20 times in patients with chronic renal failure who are undergoing hemodialysis therapy. Intradialytic exercise is an intervention that can be used to control systolic blood pressure. AIM: This study was to analyze the effect of intradialytic exercise on changes in blood pressure in chronic renal failure patients undergoing hemodialysis therapy at Indriati Solo Baru Hospital. METHODS: The research method is quasi-experimental design pre-post with control group design. The study population was 97 dialysis patients. The sampling technique used a purposive sampling of 30 people. Data analysis using Paired t-Test. RESULTS: The research results showed that the sex characteristics of most respondents were male as many as 17 people (56.7%), the average age of the respondents was 51.03 years, the pre-intervention in the control group obtained an average systolic blood pressure of 168.93 mmHg and 106 diastole, 120 mmHg, while the blood pressure in the control group post was 173.13 mmHg systole and 107 mmHg diastoles. In the treatment group, the average blood pressure in the pre-intradialytic exercise showed 162.20 mmHg systole and 104.27 mmHg diastole, while the post-intradialytic exercise system blood pressure was 153.13 mmHg and diastole 94.33 mmHg. CONCLUSION: There is an effect of intradialytic exercise on changes in blood pressure in chronic renal failure patients undergoing hemodialysis therapy at Indriati Solo Baru Hospital with a p-value of 0.025. Intradialytic exercise can be recommended as structured physical exercise therapy for hemodialysis therapy patients. KEYWORDS: intradialytic exercise, chronic renal failure, patients, changes in blood pressure, hemodialysis

The effect of intradialytic exercise on inflammatory markers in hemodialysis patients

Background Chronic low-grade inflammation is a feature of chronic kidney disease associated with increased risk of multiple morbidities and mortalities. Hemodialysis (HD) patients lead a sedentary life style which may aggravate their inflammatory state and practicing exercise may improve this condition. The aim of this work was to study the effect of intradialytic exercise (IDE) on inflammatory markers in HD patients. Results This prospective cohort study included 40 HD patients, divided into 2 groups: exercise group completed IDE for 3 months and non-exercise group matched in age and sex as controls. At baseline, there was no difference between both groups regarding physical performance assessed using short physical performance battery test (SPBT) or inflammatory markers C-reactive protein (CRP) and interleukin 6 (IL-6) P > 0.05. After 3 months, SPBT significantly improved in exercise group (P < 0.001). Also, both serum CRP and IL-6 levels showed significant decrease in exercise group compared to baseline (P < 0.001), while no similar change was noticed in non-exercise group. Conclusions Regular intradialytic aerobic exercise program can improve physical function and inflammation in hemodialysis patients. Further studies on larger number of patients are warranted.

Perbedaan Tekanan Darah Sebelum dan Sesudah Exercise Intradialysis Pada Pasien Hemodialisis di Unit Hemodialisis Rumah Sakit Panti Rahayu Gunung Kidul

ABSTRACT Background:Hemodialysis defines as a process of cleaning the blood from waste substances through a filtering process outside the body. Patients with chronic renal failure undergoing hemodialysis often experience complications including hypotension. Several references state an alternative intervention to prevent complications of hypotension in hemodialysis patients with an Intradialytic exercise. Intradialytic exercise is a planned and gradual form of exercise that includes various stages of flexibility exercise, strengthening exercise and cardiovascular exercise performed during hemodialysis. Intradialytic exercise is aimed to improve the work of the heart, respiration and improve hemodialysis regulation for the better. Objective:This study was aimed to determine the difference in blood pressure before and after intradialytic exercise in patients undergoing hemodialysis. Methods:This research design used a quasi-experimental design with pre-test and post-test with control design. The samples were 38 respondents who taken by total sampling at the Hemodialysis Unit of Panti Rahayu Hospital. The samples were divided into the intervention group who undertook intradialytic exercise for 4 weeks, each respondent experiences twice a week, while the control group who did routine hemodialysis and independent exercise. Results:The results showed that the distribution of the characteristics of the respondents was 51-54 years old (18.41%) the sex was mostly male (63.2%) Most of them (55.3%) underwent hemodialysis for less than 2 years. Statistically, it was known that there was no significant difference in blood pressure before and after intradialytic exercise inside patient’s body of the control and intervention groups. There was no significant difference in blood pressure between the intervention group compared to the control group, but there was a dynamic difference in blood pressure in patients who did intradialytic exercise. Conclusion:There was dynamics of differences in blood pressure in patients undergoing intradialytic exercise, it is recommended that hemodialysis nurses at Panti Rahayu Hospital take care patients during hemodialysis so that these interventions are routinely carried out.

Perbedaan Tekanan Darah Sebelum dan Sesudah Exercise Intradialysis Pada Pasien Hemodialisis di Unit Hemodialisis Rumah Sakit Panti Rahayu Gunung Kidul

ABSTRACT Background: Hemodialysis defines as a process of cleaning the blood from waste substances through a filtering process outside the body. Patients with chronic renal failure undergoing hemodialysis often experience complications including hypotension. Several references state an alternative intervention to prevent complications of hypotension in hemodialysis patients with an Intradialytic exercise. Intradialytic exercise is a planned and gradual form of exercise that includes various stages of flexibility exercise, strengthening exercise and cardiovascular exercise performed during hemodialysis. Intradialytic exercise is aimed to improve the work of the heart, respiration and improve hemodialysis regulation for the better. Objective: This study was aimed to determine the difference in blood pressure before and after intradialytic exercise in patients undergoing hemodialysis. Methods: This research design used a quasi-experimental design with pre-test and post-test with control design. The samples were 38 respondents who taken by total sampling at the Hemodialysis Unit of Panti Rahayu Hospital. The samples were divided into the intervention group who undertook intradialytic exercise for 4 weeks, each respondent experiences twice a week, while the control group who did routine hemodialysis and independent exercise. Results: The results showed that the distribution of the characteristics of the respondents was 51-54 years old (18.41%) the sex was mostly male (63.2%) Most of them (55.3%) underwent hemodialysis for less than 2 years. Statistically, it was known that there was no significant difference in blood pressure before and after intradialytic exercise inside patient’s body of the control and intervention groups. There was no significant difference in blood pressure between the intervention group compared to the control group, but there was a dynamic difference in blood pressure in patients who did intradialytic exercise. Conclusion: There was dynamics of differences in blood pressure in patients undergoing intradialytic exercise, it is recommended that hemodialysis nurses at Panti Rahayu Hospital take care patients during hemodialysis so that these interventions are routinely carried out.

Motivation, Barriers, and Suggestions for Intradialytic Exercise—A Qualitative Study among Patients and Nurses

Background: Intradialytic exercise is an effective intervention to reduce morbidity and mortality and increase quality of life among patients with chronic kidney disease undergoing dialysis. However, implementing and sustaining it in clinical practice has proved challenging. To identify how to best design an effective and sustainable intervention in clinical practice, we aimed to explore hemodialysis patients’ and nurses’ attitudes towards intradialytic exercise, including their motivation, anticipated barriers, and suggestions for the design of a proposed exercise program. Methods: Data were collected through qualitative semistructured interviews with patients and focus group interviews with nurses and analyzed inductively with content analysis. Results: Overall, patients’ and nurses’ attitudes towards intradialytic exercise were positive. Patients were motivated by their expectations about perceived benefits, such as improved quality of life and reduced musculoskeletal pain. Their main concern was triggering dialysis machine alarms and disturbing nurses. Nurses were more skeptical of intradialytic exercise and concerned about patient safety. Patients and nurses had several ideas on how to design a safe and motivating intradialytic exercise intervention. Conclusion: The analysis of patients’ and nurses’ experiences and attitudes generated recommendations for an intradialytic exercise program. Recommendations include individually tailored programs that are safe and that patients can do independently, continuous collaboration between patients, nurses, physicians, and physiotherapists, and educating nurses about the benefits and safety of intradialytic exercise.

Effect of intradialytic exercise on the inflammatory markers in prevalent hemodialysis patients

Background Chronic low-grade inflammation is a feature of chronic kidney disease associated with increased risk of multiple morbidities and mortalities. Dialysis patients lead a sedentary life style which could add to this risk. Aim assessment of the effect of intradialytic exercise IDE on inflammatory markers in prevalent hemodialysis HD patients. Patients and Methods This longitudinal prospective study included 40 adult patients on regular HD, divided equally into 2 groups; Exercise Group (n = 20); received IDE 3 times/week for 3 months and Non-exercise Group (n = 20) matched in age and sex acting as controls. Patients were subjected to full history taking and clinical examination. Physical performance assessment using Short Physical Performance Battery tests (SPBT), Laboratory investigations included; Complete blood picture, C-reactive protein (CRP) and interleukin 6 (IL6) assessed using Enzyme linked immunosorbent assay. All assessments were repeated 3 months after regular IDE. Results At baseline, there was no difference between both groups regarding physical performance or inflammatory markers. After 3 months, SPBT was significantly increased in Exercise group (P &lt; 0.001). Also, both serum CRP and IL-6 levels showed significant decrease in Exercise group compared to baseline (P &lt; 0.001), while no similar change was noticed in non-exercise group. Conclusion The significant decrease in serum CRP and IL-6 levels after 3 months of regular IDE and the improvement in physical performance in exercise group implements that regular IDE exercise training program can improve physical function and inflammation in hemodialysis patients. Further studies on larger number of patients is warranted.