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BMC Nephrology
Published in: BMC Nephrology 1/2023

Open Access 01-12-2023 | Chronic Kidney Disease | Research

The effect of intradialytic exercise on calcium, phosphorus and parathyroid hormone: a randomized controlled trial

Authors: Mohammad Ali Tabibi, Kenneth R. Wilund, Nasrin Salimian, Saghar Nikbakht, Mahsa Soleymany, Zahra Roshanaeian, Farzad Nazemi, Saghar Ahmadi

Published in: BMC Nephrology | Issue 1/2023

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Abstract

Background

Patients with kidney failure experience derangements of circulating markers of mineral metabolism and dysregulation of skeletal and cardiovascular physiology which results in high mortality rate in these patients. This study aimed to evaluate the effect of intradialytic exercise on regulation of these abnormalities in patients receiving chronic hemodialysis (HD).

Methods

In this randomized controlled trial conducted in an HD center in Iran, adult patients receiving chronic HD were randomized to intradialytic exercise (60 min) in the second hour of thrice weekly dialysis for 6 months (intervention) or no intradialytic exercise (control). The primary outcomes were serum calcium, serum phosphorous and parathyroid hormone levels. Secondary outcomes were serum alkaline phosphatase and calcium-phosphorous product.

Results

The study included 44 participants randomized to intervention (n = 22) or control (n = 22). During the 6-month intervention period, significant between-group changes were observed in all primary and secondary outcomes between the intervention and control groups. Statistical analyses reveal a significant increase in serum calcium (P < 0.05) as well as a significant decrease in serum phosphorous, parathyroid hormone, alkaline phosphatase and calcium-phosphorous product (P < 0.05).

Conclusion

Intradialytic exercise performed for at least 60 min during thrice weekly dialysis sessions improves bone mineral metabolism in adult patients receiving HD. Further studies should focus on observing and comparing the effect of different types of exercise on bone mineral disorders and all-cause mortality in HD patients.

Trial registration

ClinicalTrials.gov Identifier: NCT04916743, Registered on 08/06/2021. Registered trial name: The Effect of Intradialytic Exercise on Calcium, Phosphorous and Parathyroid Hormone: A Randomized Controlled Trial.
Appendix
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Literature
1.
Ortiz A, Covic A, Fliser D, Fouque D, Goldsmith D, Kanbay M, et al. Epidemiology, contributors to, and clinical trials of mortality risk in chronic kidney failure. Lancet. 2014;383(9931):1831–43.PubMed
2.
3.
Deligiannis A, D’Alessandro C, Cupisti A. Exercise training in dialysis patients: impact on cardiovascular and skeletal muscle health. Clin Kidney J. 2021;14(Suppl 2):ii25–33.PubMedPubMedCentral
4.
SONG Initiative. The SONG Handbook. Version 1.0 June 2017, Sydney,Australia Available at songinitiative.org/reports-and-publications/.
5.
Manera KE, Tong A, Craig JC, Shen J, Jesudason S, Cho Y, et al. An international Delphi survey helped develop consensus-based core outcome domains for trials in peritoneal dialysis. Kidney Int. 2019;96(3):699–710.PubMedPubMedCentral
6.
D. S. March, M. P. M. Graham-Brown, C. M. Stover, N. C. Bishop, and J. O. Burton, “Intestinal Barrier sturbances in Haemodialysis Patients: Mechanisms, Consequences, and Therapeutic Options,” BioMed Research International, vol. 2017, Article ID 5765417, 2017.
7.
Block GA, Hulbert-Shearon TE, Levin NW, et al. Association of serum phosphorus and calcium phosphate product with mortality risk inchronic hemodialysis patients: a national study. Am J Kidney Dis. 1998;31:607–17.PubMed
8.
Block GA, Klassen PS, Lazarus JM, et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15:2208–18.PubMed
9.
Ganesh SK, Stack AG, Levin NW, et al. Association of elevated serum PO(4), Ca PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001;12:2131–213.PubMed
10.
Stevens LADO, Cardew S, Cameron EC, Levin A. Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and utcomes. J Am Soc Nephrol. 2004;15:770.PubMed
11.
Slinin Y, Foley RN, Collins AJ. Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study. J Am Soc Nephrol. 2005;16:1788–93.PubMed
12.
Albuquerque RFC, Carbonara CEM, Martin RCT, Reis LM, Nascimento CP Jr, Arap SS, et al. Parathyroidectomy in patients with chronic kidney disease: Impacts of different techniques on the biochemical and clinical evolution of secondary hyperparathyroidism. Surgery. 2018;163(2):381–7.PubMed
13.
Campos SR, Gusmão MHL, Fortes A, Sampaio LR, Barreto JM. Estado nutricional e ingestão Estado nutricional e ingestão alimentar de pacientes em diálise peritoneal contínua com e sem hiperparatireoidismo secundário. J Bras Nefrol. 2012;34(2):170–7.PubMed
14.
Coelho DM, Castro ADM, Tavares HA, Abreu PBC, Glória RR, Duarte MH, et al. Efeitos de um Programa de Exercícios Físicos no Condicionamento de Pacientes em Hemodiálise. J Bras Nefrol. 2006;28(3):121–7.
15.
Duarte J, Medeiros RF, Di Pietro T, Lopes TM. Alterações de volumes e capacidades pulmonares pré e pós-hemodiálise em insuficiência renal crônica TT Changes in lung volume and capacity before and after hemodialysis in chronic renal failure. J Heal Sci Inst. 2011;29(1):70–2.
16.
Fassbinder TRC, Winkelmann ER, Schneider J, Wendland J, Oliveira OB. Functional Capacity and Quality of Life in Patients with Chronic Kidney Disease In Pre-Dialytic Treatment and on Hemodialysis - A Cross sectional study. J Bras Nefrol. 2015;37(1):47–54.PubMed
17.
Glastre C, Braillon P, David L, Cochat P, Meunier PJ, Delmas PD. Measurement of bone mineral content of the lumbar spine by dual energy x-ray absorptiometry in normal children: correlations with growth parameters. J Clin Endocrinol Metab. 1990;70:1330–3.PubMed
18.
Thorsen K, Kristoffersson A, Hultdin J, Lorentzon R. Effects of moderate endurance exercise on calcium, parathyroid hormone, and markers of bone metabolism in young women. Calcif Tissue Int. 1997;60:16–20.PubMed
19.
Brahm H, Piehl-Aulin K, Ljunghall S. Bone metabolism during exercise and recovery: the influence of plasma volume and physical fitness. Calcif Tissue Int. 1997;61:192–8.PubMed
20.
Ljunghall S, Joborn H, Roxin LE, Skarfors ET, Wide LE, Lithell HO. Increase in serum parathyroid hormone levels after prolonged physical exercise. Medicine and Science in Sports Exercise. 1988;20:122–5.
21.
Zerath E, Holy X, Douce P, Guezennec CY, Chatard JC. Effect of endurance training on postexercise parathyroid hormone levels in elderly men. Med Sci Sports Exerc. 1997;29:1139–4115.PubMed
22.
23.
Elshinnawy HA, Mohamed AMBB, Farrag DAB, et al. Effect of intradialytic exercise on bone profile in hemodialysis patients. Egypt Rheumatol Rehabil. 2021;48:24.
24.
Bouassida A, Latiri I, Bouassida S, Zalleg D, Zaouali M, Feki Y, Gharbi N, Zbidi A, Tabka Z. Parathyroid hormone and physical exercise: a brief review. J Sports Sci Med. 2006;5(3):367–74.PubMedPubMedCentral
25.
Lombardi G, Ziemann E, Banfi G, Corbetta S. Physical activity- dependent regulation of parathyroid hormone and calcium-phosphorous metabolism. Int J Mol Sci. 2020;21(15):5388.PubMedPubMedCentral
26.
Makhlough A, Ilali E, Mohseni R, Shahmohammadi S. Effect of intradialytic aerobic exercise on serum electrolytes levels in he- modialysis patients. Iran J Kidney Dis. 2012;6(2):119–23.PubMed
27.
Vaithilingam I, Polkinghorne KR, Atkins RC, Kerr PG. Time and exercise improve phosphate removal in hemodialysis patients. Am J Kidney Dis. 2004;43(1):85–9.PubMed
28.
Spalding EM, Chamney PW, Farrington K. Phosphate kinetics during hemodialysis: evidence for biphasic regulation. Kidney Int. 2002;61(2):655–67.PubMed
29.
Sorlie D, Myhre K, Saugstad OD, Giercksky KE. Release of hypoxanthine and phosphate from exercising human legs with and without arterial insufficiency. Acta Med Scan. 1982;211(4):281–6.
30.
Kirkman DL, Roberts LD, Kelm M, Wagner J, Jibani MM, Macdonald JH. Interaction between intradialytic exercise and hemodialysis ade- quacy. Am J Nephrol. 2013;38(6):475–82.PubMed
31.
Asadi Noghabi A, Bassampour SH, Zolfaghari M. Critical care nursing ICU, CCU, dialysis. Salemi publication; 2th ed. 2007; p. 448–53.
32.
Cappy CS, Jablonka J, Schroeder ET. The effects of exercise during hemodialysis on physical performance and nutrition assessment. J Ren Nutr. 1999;9:63–70.PubMed
33.
Salhab N, Alrukhaimi M, Kooman J, Fiaccadori E, Aljubori H, Rizk R, Karavetian M. Effect of intradialytic exercise on hyperphosphatemia and malnutrition. Nutrients. 2019;11(10):2464.PubMedPubMedCentral
34.
35.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group (2017) KDIGO 2017 Clinical practice guideline update for the diagnosis,evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 7:1–59. 2009;76(Suppl 113):S1-S130.
36.
Tentori F, Wang M, Bieber BA, et al. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clin J Am Soc Nephrol. 2015;10(1):98–109.PubMed
37.
Nickolas TL, Leonard MB, Shane E. Chronic kidney disease and bone fracture: a growing concern. Kidney Int. 2008;74(6):721–31.PubMedPubMedCentral
38.
Hruska KA, Choi ET, Memon I, Davis TK, Mathew S. Cardiovascular risk in chronic kidney disease (CKD): the CKD-mineral bone disorder (CKD-MBD). Pediatr Nephrol. 2010;25(4):769–78.PubMed
39.
Faul C, Amaral AP, Oskouei B, et al. FGF23 induces left ventricular hypertrophy. J Clin Invest. 2011;121(11):4393–408.PubMedPubMedCentral
40.
Moe SM, Chertow GM, Coburn JW, et al. Achieving NKF-K/DOQI bone metabolism and disease treatment goals with cinacalcet HCl. Kidney Int. 2005;67(2):760–71.PubMed
41.
Chertow GM, Block GA, Correa-Rotter R, et al. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med. 2012;367(26):2482–94.PubMed
42.
Cardoso DF, Marques EA, Leal DV, et al. Impact of physical activity and exercise on bone health in patients with chronic kidney disease: a systematic review of observational and experimental studies. BMC Nephrol. 2020;21:334.PubMedPubMedCentral
43.
Huang G-S, Chu T-S, Lou M-F, Hwang S-L, Yang R-S. Factors associated with low bone mass in the hemodialysis patients - a cross-sectional correlation study. BMC Musculoskelet Disord. 2009;10:60.PubMedPubMedCentral
44.
Ota S, Takahashi K, Taniai K, Makino H. Bone metabolism and daily physical activity in women undergoing hemodialysis. Nihon Jinzo Gakkai Shi. 1997;39(4):441–6.PubMed
45.
Gomes TS, Aioke DT, Baria FG, Graciolli FG, Moyses RMA, Cuppari L. Effect of aerobic exercise on markers of bone metabolism of overweight and obese patients with chronic kidney disease. J Ren Nutr. 2017;27(5):364–71.PubMed
46.
Magnusson P, Sharp CA, Magnusson M, Risteli J, Davie MW, Larsson L. Effect of chronic renal failure on bone turnover and bone alkaline phosphatase isoforms. Kidney Int. 2001;60:257–65.PubMed
47.
Torres PU. Bone alkaline phosphatase isoforms in chronic renal failure. Kidney Int. 2002;61:1178–9.PubMed
48.
Regidor DL, Kovesdy CP, Mehrotra R, et al. Serum alkaline phosphatase predicts mortality among maintenance hemodialysis patients. J Am Soc Nephrol. 2008;19:2193–203.PubMedPubMedCentral
49.
Lomashvili KA, Garg P, Narisawa S, Millan JL, O’Neill WC. Upregulation of alkaline phosphatase and pyrophosphate hydrolysis: potential mechanism for uremic vascular calcification. Kidney Int. 2008;73:1024–30.PubMedPubMedCentral
50.
O’Neill WC. Pyrophosphate, alkaline phosphatase, and vascular calcification. Circ Res. 2006;99: e2.PubMed
51.
Schoppet M, Shanahan CM. Role for alkaline phosphatase as an inducer of vascular calcification in renal failure. Kidney Int. 2008;73:989–91.PubMed
52.
Tonelli M, Curhan G, Pfeffer M, et al. Relation between alkaline phosphatase, serum phosphate, and all-cause or cardiovascular mortality. Circulation. 2009;120:1784–92.PubMed
53.
54.
Frost HM. The mechanostat: a proposed pathogenic mechanism of osteoporoses and the bone mass effects of mechanical and nonmechanical agents. Bone Miner. 1987;2(2):73–85.PubMed
55.
Frost HM. Bone’s mechanostat: a 2003 update. Anat Rec A Discov Mol Cell Evol Biol. 2003;275(2):1081–101.PubMed
56.
Liao M-T, Liu W-C, Lin F-H, Huang C-F, Chen S-Y, Liu C-C, et al. Intradialytic aerobic cycling exercise alleviates inflammation and improves endothelial progenitor cell count and bone density in hemodialysis patients. Medicine. 2016;95(27):e4134.PubMedPubMedCentral
57.
Metadata
Title
The effect of intradialytic exercise on calcium, phosphorus and parathyroid hormone: a randomized controlled trial
Authors
Mohammad Ali Tabibi
Kenneth R. Wilund
Nasrin Salimian
Saghar Nikbakht
Mahsa Soleymany
Zahra Roshanaeian
Farzad Nazemi
Saghar Ahmadi
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2023
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-023-03327-7

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