Skip to main content
Top
Published in: Pediatric Nephrology 3/2014

01-03-2014 | Original Article

Intradialytic cycling in children and young adults on chronic hemodialysis

Authors: Fabio Paglialonga, Amalia Lopopolo, Rosalia Viviana Scarfia, Silvia Consolo, Maria Albina Galli, Simona Salera, Maria Rosa Grassi, Anna Brivio, Alberto Edefonti

Published in: Pediatric Nephrology | Issue 3/2014

Login to get access

Abstract

Background

Intradialytic exercise has been poorly investigated in pediatric patients on chronic hemodialysis (HD). The aim of this study was to assess the acceptability, safety and efficacy of intradialytic exercise in children and young adults on HD.

Methods

The intradialytic exercise program consisted of 30-min sessions of intra-HD exercise using a cycloergometer two to three times a week for 3 months. Study endpoints were the 6-min walking test (6MWT) distances, lung function, number of stands in the chair test, lower extremity strength (LES), anthropometry, dietary intake, dialysis adequacy, incidence of symptomatic sessions, biochemistry and left ventricular mass index.

Results

Ten pediatric patients with a median age of 15.3 (range 9.1–24.2) years were enrolled. Two of these underwent kidney transplantation; the remaining eight completed the study and adapted well to the exercise program. At the end of the 3-month study period, all patients had significantly improved results for the 6MWT (+4.9 %; p < 0.05), chair test (+19 %; p < 0.05) and LES (+29.3 %; p < 0.05). Pre-HD albumin, creatinine and total protein levels and post-HD creatinine levels had also significantly improved. The incidence of symptomatic sessions did not increase during the study period. No adverse events occurred.

Conclusions

Based on our results, we conclude that a 30-min exercise program of intradialytic cycling is feasible for the majority of pediatric patients on chronic HD and will be well accepted. Such an exercise program can lead to a significant improvement in the exercise capacity of this patient population.
Literature
1.
go back to reference Schaar B, Feldkötter M, Nonn JM, Hoppe B (2011) Cardiorespiratory capacity in children and adolescents on maintenance haemodialysis. Nephrol Dial Transplant 26(11):3701–3708PubMedCrossRef Schaar B, Feldkötter M, Nonn JM, Hoppe B (2011) Cardiorespiratory capacity in children and adolescents on maintenance haemodialysis. Nephrol Dial Transplant 26(11):3701–3708PubMedCrossRef
2.
go back to reference Zanconato S, Baraldi E, Montini G, Zacchello G, Zacchello F (1990) Exercise tolerance in end-stage renal disease. Child Nephrol Urol 10(1):26–31PubMed Zanconato S, Baraldi E, Montini G, Zacchello G, Zacchello F (1990) Exercise tolerance in end-stage renal disease. Child Nephrol Urol 10(1):26–31PubMed
3.
go back to reference Baraldi E, Montini G, Zanconato S, Zacchello G, Zacchello F (1990) Exercise tolerance after anaemia correction with recombinant human erythropoietin in end-stage renal disease. Pediatr Nephrol 4(6):623–626PubMedCrossRef Baraldi E, Montini G, Zanconato S, Zacchello G, Zacchello F (1990) Exercise tolerance after anaemia correction with recombinant human erythropoietin in end-stage renal disease. Pediatr Nephrol 4(6):623–626PubMedCrossRef
4.
go back to reference Pattaragarn A, Warady BA, Sabath RJ (2004) Exercise capacity in pediatric patients with end-stage renal disease. Perit Dial Int 24(3):274–280PubMed Pattaragarn A, Warady BA, Sabath RJ (2004) Exercise capacity in pediatric patients with end-stage renal disease. Perit Dial Int 24(3):274–280PubMed
5.
go back to reference Bonzel KE, Wildi B, Weiss M, Scharer K (1991) Spiroergometric performance of children and adolescents with chronic renal failure. Pediatr Nephrol 5(1):22–28PubMedCrossRef Bonzel KE, Wildi B, Weiss M, Scharer K (1991) Spiroergometric performance of children and adolescents with chronic renal failure. Pediatr Nephrol 5(1):22–28PubMedCrossRef
6.
go back to reference Painter P, Krasnoff J, Mathias R (2007) Exercise capacity and physical fitness in pediatric dialysis and kidney transplant patients. Pediatr Nephrol 22(7):1030–1039PubMedCrossRef Painter P, Krasnoff J, Mathias R (2007) Exercise capacity and physical fitness in pediatric dialysis and kidney transplant patients. Pediatr Nephrol 22(7):1030–1039PubMedCrossRef
7.
go back to reference Alayli G, Ozkaya O, Bek K, Calmasur A, Diren B, Bek Y, Canturk F (2008) Physical function, muscle strength and muscle mass in children on peritoneal dialysis. Pediatr Nephrol 23(4):639–644PubMedCrossRef Alayli G, Ozkaya O, Bek K, Calmasur A, Diren B, Bek Y, Canturk F (2008) Physical function, muscle strength and muscle mass in children on peritoneal dialysis. Pediatr Nephrol 23(4):639–644PubMedCrossRef
8.
go back to reference Weaver DJ Jr, Kimball TR, Knilans T, Mays W, Knecht SK, Gerdes YM, Witt S, Glascock BJ, Kartal J, Khoury P, Mitsnefes MM (2008) Decreased maximal aerobic capacity in pediatric chronic kidney disease. J Am Soc Nephrol 19(3):624–630PubMedCrossRef Weaver DJ Jr, Kimball TR, Knilans T, Mays W, Knecht SK, Gerdes YM, Witt S, Glascock BJ, Kartal J, Khoury P, Mitsnefes MM (2008) Decreased maximal aerobic capacity in pediatric chronic kidney disease. J Am Soc Nephrol 19(3):624–630PubMedCrossRef
9.
go back to reference Takken T, Engelbert E, van Bergen M, Groothoff J, Nauta J, van Hoeck K, Lilien M, Helders P (2009) Six-minute walking test in children with ESRD: discrimination validity and construct validity. Pediatr Nephrol 24:2217–2223PubMedCentralPubMedCrossRef Takken T, Engelbert E, van Bergen M, Groothoff J, Nauta J, van Hoeck K, Lilien M, Helders P (2009) Six-minute walking test in children with ESRD: discrimination validity and construct validity. Pediatr Nephrol 24:2217–2223PubMedCentralPubMedCrossRef
10.
go back to reference Eijsermans RM, Creemers DG, Helders PJ, Schröder CH (2004) Motor performance, exercise tolerance, and health-related quality of life in children on dialysis. Pediatr Nephrol 19(11):1262–1266PubMedCrossRef Eijsermans RM, Creemers DG, Helders PJ, Schröder CH (2004) Motor performance, exercise tolerance, and health-related quality of life in children on dialysis. Pediatr Nephrol 19(11):1262–1266PubMedCrossRef
11.
go back to reference Goldstein SL (2009) Physical functioning in children with end-stage renal disease: small steps first. Pediatr Transplant 13(7):802–804PubMedCrossRef Goldstein SL (2009) Physical functioning in children with end-stage renal disease: small steps first. Pediatr Transplant 13(7):802–804PubMedCrossRef
12.
go back to reference Clapp EL, Bevington A, Smith AC (2012) Exercise for children with chronic kidney disease and end-stage renal disease. Pediatr Nephrol 27(2):165–172PubMedCrossRef Clapp EL, Bevington A, Smith AC (2012) Exercise for children with chronic kidney disease and end-stage renal disease. Pediatr Nephrol 27(2):165–172PubMedCrossRef
13.
go back to reference Goldstein SL (2009) Physical fitness in children with end-stage renal disease. Adv Chron Kidney Dis 16(6):430–436CrossRef Goldstein SL (2009) Physical fitness in children with end-stage renal disease. Adv Chron Kidney Dis 16(6):430–436CrossRef
14.
go back to reference Konstantinidou E, Koukouvou G, Kouidi E, Deligiannis A, Tourkantonis A (2002) Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. Clin Nephrol 61[Suppl 1]:S31–S38 Konstantinidou E, Koukouvou G, Kouidi E, Deligiannis A, Tourkantonis A (2002) Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. Clin Nephrol 61[Suppl 1]:S31–S38
15.
go back to reference Storer TW, Casaburi R, Sawelson S, Kopple JD (2005) Endurance exercise training during haemodialysis improves strength, power, fatigability and physical performance in maintenance haemodialysis patients. Nephrol Dial Transplant 20(7):1429–1437PubMedCrossRef Storer TW, Casaburi R, Sawelson S, Kopple JD (2005) Endurance exercise training during haemodialysis improves strength, power, fatigability and physical performance in maintenance haemodialysis patients. Nephrol Dial Transplant 20(7):1429–1437PubMedCrossRef
16.
go back to reference Petersen AC, Leikis MJ, McMahon LP, Kent AB, McKenna MJ (2009) Effects of endurance training on extrarenal potassium regulation and exercise performance in patients on haemodialysis. Nephrol Dial Transplant 24(9):2882–2888PubMedCrossRef Petersen AC, Leikis MJ, McMahon LP, Kent AB, McKenna MJ (2009) Effects of endurance training on extrarenal potassium regulation and exercise performance in patients on haemodialysis. Nephrol Dial Transplant 24(9):2882–2888PubMedCrossRef
17.
go back to reference Heiwe S, Jacobson SH (2011) Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev 5: CD003236 Heiwe S, Jacobson SH (2011) Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev 5: CD003236
18.
go back to reference Kosmadakis GC, Bevington A, Smith AC, Clapp EL, Viana JL, Bishop NC, Feehally J (2010) Physical exercise in patients with severe kidney disease. Nephron Clin Pract 115(1):c7–c16PubMedCrossRef Kosmadakis GC, Bevington A, Smith AC, Clapp EL, Viana JL, Bishop NC, Feehally J (2010) Physical exercise in patients with severe kidney disease. Nephron Clin Pract 115(1):c7–c16PubMedCrossRef
19.
go back to reference Giannaki CD, Stefanidis I, Karatzaferi C, Liakos N, Roka V, Ntente I, Sakkas GK (2011) The effect of prolonged intradialytic exercise in hemodialysis efficiency indices. ASAIO J 57(3):213–218PubMedCrossRef Giannaki CD, Stefanidis I, Karatzaferi C, Liakos N, Roka V, Ntente I, Sakkas GK (2011) The effect of prolonged intradialytic exercise in hemodialysis efficiency indices. ASAIO J 57(3):213–218PubMedCrossRef
20.
go back to reference Smart N, Steele M (2011) Exercise training in haemodialysis patients: a systematic review and meta-analysis. Nephrology (Carlton) 16(7):626–632 Smart N, Steele M (2011) Exercise training in haemodialysis patients: a systematic review and meta-analysis. Nephrology (Carlton) 16(7):626–632
21.
go back to reference Cheema B, Abas H, Smith B, O'Sullivan A, Chan M, Patwardhan A, Kelly J, Gillin A, Pang G, Lloyd B, Singh MF (2007) Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. J Am Soc Nephrol 18(5):1594–1601PubMedCrossRef Cheema B, Abas H, Smith B, O'Sullivan A, Chan M, Patwardhan A, Kelly J, Gillin A, Pang G, Lloyd B, Singh MF (2007) Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. J Am Soc Nephrol 18(5):1594–1601PubMedCrossRef
22.
go back to reference Wilund KR, Tomayko EJ, Wu PT, Ryong Chung H, Vallurupalli S, Lakshminarayanan B, Fernhall B (2010) Intradialytic exercise training reduces oxidative stress and epicardial fat: a pilot study. Nephrol Dial Transplant 25(8):2695–2701PubMedCrossRef Wilund KR, Tomayko EJ, Wu PT, Ryong Chung H, Vallurupalli S, Lakshminarayanan B, Fernhall B (2010) Intradialytic exercise training reduces oxidative stress and epicardial fat: a pilot study. Nephrol Dial Transplant 25(8):2695–2701PubMedCrossRef
23.
go back to reference Ouzouni S, Kouidi E, Sioulis A, Grekas D, Deligiannis A (2009) Effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients. Clin Rehabil 23(1):53–63PubMedCrossRef Ouzouni S, Kouidi E, Sioulis A, Grekas D, Deligiannis A (2009) Effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients. Clin Rehabil 23(1):53–63PubMedCrossRef
24.
go back to reference Parsons TL, Toffelmire EB, King-VanVlack CE (2004) The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure and quality of life in end-stage renal disease (ESRD) patients. Clin Nephrol 61(4):261–274PubMedCrossRef Parsons TL, Toffelmire EB, King-VanVlack CE (2004) The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure and quality of life in end-stage renal disease (ESRD) patients. Clin Nephrol 61(4):261–274PubMedCrossRef
25.
go back to reference Anderson JE, Boivin MR Jr, Hatchett L (2004) Effect of exercise training on interdialytic ambulatory and treatment-related blood pressure in hemodialysis patients. Ren Fail 26(5):539–544PubMedCrossRef Anderson JE, Boivin MR Jr, Hatchett L (2004) Effect of exercise training on interdialytic ambulatory and treatment-related blood pressure in hemodialysis patients. Ren Fail 26(5):539–544PubMedCrossRef
26.
go back to reference Majchrzak KM, Pupim LB, Flakoll PJ, Ikizler TA (2008) Resistance exercise augments the acute anabolic effects of intradialytic oral nutritional supplementation. Nephrol Dial Transplant 23(4):1362–1369PubMedCrossRef Majchrzak KM, Pupim LB, Flakoll PJ, Ikizler TA (2008) Resistance exercise augments the acute anabolic effects of intradialytic oral nutritional supplementation. Nephrol Dial Transplant 23(4):1362–1369PubMedCrossRef
27.
go back to reference Mustata S, Chan C, Lai V, Miller JA (2004) Impact of an exercise program on arterial stiffness and insulin resistance in hemodialysis patients. J Am Soc Nephrol 15(10):2713–2718PubMedCrossRef Mustata S, Chan C, Lai V, Miller JA (2004) Impact of an exercise program on arterial stiffness and insulin resistance in hemodialysis patients. J Am Soc Nephrol 15(10):2713–2718PubMedCrossRef
28.
go back to reference Kouidi EJ, Grekas DM, Deligiannis AP (2009) Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a randomized controlled trial. Am J Kidney Dis 54(3):511–521PubMedCrossRef Kouidi EJ, Grekas DM, Deligiannis AP (2009) Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a randomized controlled trial. Am J Kidney Dis 54(3):511–521PubMedCrossRef
29.
go back to reference Segura-Ortí E, Kouidi E, Lisón JF (2009) Effect of resistance exercise during hemodialysis on physical function and quality of life: randomized controlled trial. Clin Nephrol 71(5):527–537PubMedCrossRef Segura-Ortí E, Kouidi E, Lisón JF (2009) Effect of resistance exercise during hemodialysis on physical function and quality of life: randomized controlled trial. Clin Nephrol 71(5):527–537PubMedCrossRef
30.
go back to reference Kopple JD, Wang H, Casaburi R, Fournier M, Lewis MI, Taylor W, Storer TW (2007) Exercise in maintenance hemodialysis patients induces transcriptional changes in genes favoring anabolic muscle. J Am Soc Nephrol 18(11):2975–2986PubMedCrossRef Kopple JD, Wang H, Casaburi R, Fournier M, Lewis MI, Taylor W, Storer TW (2007) Exercise in maintenance hemodialysis patients induces transcriptional changes in genes favoring anabolic muscle. J Am Soc Nephrol 18(11):2975–2986PubMedCrossRef
31.
go back to reference Pupim LB, Flakoll PJ, Ikizler TA (2007) Exercise improves albumin fractional synthetic rate in chronic hemodialysis patients. Eur J Clin Nutr 61(5):686–689PubMed Pupim LB, Flakoll PJ, Ikizler TA (2007) Exercise improves albumin fractional synthetic rate in chronic hemodialysis patients. Eur J Clin Nutr 61(5):686–689PubMed
32.
go back to reference Vaithilingam I, Polkinghorne KR, Atkins RC, Kerr PG (2004) Time and exercise improve phosphate removal in hemodialysis patients. Am J Kidney Dis 43(1):85–89PubMedCrossRef Vaithilingam I, Polkinghorne KR, Atkins RC, Kerr PG (2004) Time and exercise improve phosphate removal in hemodialysis patients. Am J Kidney Dis 43(1):85–89PubMedCrossRef
33.
go back to reference Kong CH, Tattersall JE, Greenwood RN, Farrington K (1999) The effect of exercise during haemodialysis on solute removal. Nephrol Dial Transplant 14(12):2927–2931PubMedCrossRef Kong CH, Tattersall JE, Greenwood RN, Farrington K (1999) The effect of exercise during haemodialysis on solute removal. Nephrol Dial Transplant 14(12):2927–2931PubMedCrossRef
34.
go back to reference van Bergen M, Takken T, Engelbert R, Groothoff J, Nauta J, van Hoeck K, Helders P, Lilien M (2009) Exercise training in pediatric patients with end-stage renal disease. Pediatr Nephrol 24:619–622PubMedCrossRef van Bergen M, Takken T, Engelbert R, Groothoff J, Nauta J, van Hoeck K, Helders P, Lilien M (2009) Exercise training in pediatric patients with end-stage renal disease. Pediatr Nephrol 24:619–622PubMedCrossRef
35.
go back to reference Goldstein SL, Montgomery LR (2009) A pilot study of twice-weekly exercise during hemodialysis in children. Pediatr Nephrol 24:833–839PubMedCrossRef Goldstein SL, Montgomery LR (2009) A pilot study of twice-weekly exercise during hemodialysis in children. Pediatr Nephrol 24:833–839PubMedCrossRef
36.
go back to reference Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J, ATS/ERS Task Force (2005) General considerations for lung function testing. Eur Respir J 26(1):153–161PubMedCrossRef Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J, ATS/ERS Task Force (2005) General considerations for lung function testing. Eur Respir J 26(1):153–161PubMedCrossRef
37.
go back to reference ATS/ERS Task Force (2005) Standardisation of spirometry. Eur Respir J 26(2):319–338CrossRef ATS/ERS Task Force (2005) Standardisation of spirometry. Eur Respir J 26(2):319–338CrossRef
38.
go back to reference Frisancho AR (1981) New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 34:2540–2545PubMed Frisancho AR (1981) New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 34:2540–2545PubMed
39.
go back to reference Daniels SR, Kimball TR, Morrison JA, Khoury P, Meyers RA (1995) Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am J Cardiol 76:699–701PubMedCrossRef Daniels SR, Kimball TR, Morrison JA, Khoury P, Meyers RA (1995) Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am J Cardiol 76:699–701PubMedCrossRef
40.
go back to reference Paglialonga F, Lopopolo A, Scarfia RV, Galli MA, Brivio A, Grassi MR, Salera S, Edefonti A (2013) Correlates of exercise capacity in pediatric patients on chronic hemodialysis. J Ren Nutr 23(5):380–386PubMedCrossRef Paglialonga F, Lopopolo A, Scarfia RV, Galli MA, Brivio A, Grassi MR, Salera S, Edefonti A (2013) Correlates of exercise capacity in pediatric patients on chronic hemodialysis. J Ren Nutr 23(5):380–386PubMedCrossRef
41.
go back to reference Sietsema KE, Hiatt WR, Esler A, Adler S, Amato A, Brass EP (2002) Clinical and demographic predictors of exercise capacity in end-stage renal disease. Am J Kidney Dis 39(1):76–85PubMedCrossRef Sietsema KE, Hiatt WR, Esler A, Adler S, Amato A, Brass EP (2002) Clinical and demographic predictors of exercise capacity in end-stage renal disease. Am J Kidney Dis 39(1):76–85PubMedCrossRef
Metadata
Title
Intradialytic cycling in children and young adults on chronic hemodialysis
Authors
Fabio Paglialonga
Amalia Lopopolo
Rosalia Viviana Scarfia
Silvia Consolo
Maria Albina Galli
Simona Salera
Maria Rosa Grassi
Anna Brivio
Alberto Edefonti
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 3/2014
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-013-2675-5

Other articles of this Issue 3/2014

Pediatric Nephrology 3/2014 Go to the issue