Intradialytic exercise in haemodialysis patients: applicability and effects on muscle function

Chronic kidney disease (CKD) negatively impacts quality of life and increases mortality risks, while the financial costs of nephrology care and dialysis therapy strain the healthcare system and patients. Haemodialysis is one of the renal replacement therapy options for CKD patients with established kidney failure. Dialysis therapy- and disease-related complications contribute to patients' sedentary behaviour and poor muscle functions (MF), which increases their frailty. This is associated with increased risks of hospitalisation, complications and mortality. Promotion of physical activity has a strong potential to suppress the deterioration in patients' MF. In this thesis, we explored the effects of intradialytic exercise (IDE) on patients' MF, and the roles of age, sex and gene expression profile on these effects. We further surveyed healthcare providers' perceptions on the benefits, risks and barriers of IDE. We found that IDE prevented loss of MF, particularly in middle-aged and female patients, and in patients with higher expression of a specific microribonucleic acid (miRNA-206). Healthcare providers' perceptions were that benefits mostly related to patients' physical and psychosocial functioning, and that risks predominantly regarded exercise-related damage to the vascular access points. Limitations in financial and personal resources for IDE were frequently reported as barriers. Our findings show that IDE might be effective in preventing MF deterioration, especially if IDE prescriptions are personalised regarding the patient's socio-demographic and genetic factors. Safe and sustainable implementation of IDE requires adjustments to minimise the risk of injury, alignment of planned physical activities with the patient's clinical profile, and adequate availability of resources.