Resistance exercise interventions for sarcopenia and nutritional status of maintenance hemodialysis patients: a meta-analysis

Background

A previous meta-analysis showed that exercise training improves patients' physical function and health status. However, the efficacy of resistance exercise (RE) in improving patients' physical function and nutritional status is uncertain.

Objective

To evaluate the effect of RE on sarcopenia and nutritional indicators in maintenance hemodialysis (MHD) patients.

Design

A meta-analysis.

Methods

Randomized controlled trials up to March 28, 2023 were searched from eight databases, including PubMed, Web of Science, Embase, Cochrane, China National Knowledge Infrastructure, Wan Fang, China Science and Technology Journal Database, and CBM. The risk of bias of the literature eligible for inclusion was assessed using the Cochrane risk-of-bias tool. When a high heterogeneity was detected, a random-effects model was used. Egger's tests were used to assess publication bias. This review was conducted in accordance with the PRISMA guidelines. The reliability of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation method, and a meta-analysis of the collected data was performed using Review Manager 5.4.1 software.

Results

Nine studies that met the criteria were identified, and 541 patients were included in these research.

Subjects

The results of this review showed that RE improved patients' grip strength levels (mean difference (MD) = 4.39, 95% confidence interval (CI) [3.14-5.64]; P < 0.00001), 6 min walking distance (MD = 40.71, 95% CI [8.92-72.49]; P = 0.01), muscle mass (MD = 4.50, 95% CI [2.01-6.99]; P = 0.0004), and serum albumin level (MD = 3.16, 95% CI [1.13-5.19]; P = 0.002) compared with the controls. However, the improvement caused by RE on hemoglobin (MD = 1.69, 95% CI [-1.49 to 4.87], P = 0.30) and cholesterol (MD = 2.33, 95% CI [-5.00 to 9.65], P = 0.53) levels was not statistically significant.

Conclusion

RE showed a significant effect on muscle function and strength of MHD patients. This meta-analysis provides new ideas on the efficacy of RE in muscle function and strength of MHD patients. The use of consistent RE patterns and nutritional interventions should be considered in future studies for further assessment of its effects. In the future, more high-quality studies will be required to verify these results.

Implications for practice

This meta-analysis identified the effect of RE on muscle strength, muscle function, and walking ability of HD patients, and provided a basis for clinical formulation of the optimal timing of intervention and the optimal frequency, intensity, modality, and content of intervention.

Patient or public contribution

No patient or public contribution because it does not apply to my work. This review has been registered at the International Platform of Registered Systematic Review and Meta-analysis (INPLASY) (registration number: INPLASY202340078).

The Effect of Non-Pharmacological and Pharmacological Interventions on Measures Associated with Sarcopenia in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis provides a synthesis of the available evidence for the effects of interventions on outcome measures associated with sarcopenia in end-stage kidney disease (ESKD). Thirteen databases were searched, supplemented with internet and hand searching. Randomised controlled trials of non-pharmacological or pharmacological interventions in adults with ESKD were eligible. Trials were restricted to those which had reported measures of sarcopenia. Primary outcome measures were hand grip strength and sit-to-stand tests. Sixty-four trials were eligible (with nineteen being included in meta-analyses). Synthesised data indicated that intradialytic exercise increased hand grip strength (standardised mean difference, 0.58; 0.24 to 0.91; p = 0.0007; I2 = 40%), and sit-to-stand (STS) 60 score (mean difference, 3.74 repetitions; 2.35 to 5.14; p < 0.001; I2 = 0%). Intradialytic exercise alone, and protein supplementation alone, resulted in no statistically significant change in STS5 (−0.78 s; −1.86 to 0.30; p = 0.16; I2 = 0%), and STS30 (MD, 0.97 repetitions; −0.16 to 2.10; p = 0.09; I2 = 0%) performance, respectively. For secondary outcomes, L-carnitine and nandrolone-decanoate resulted in significant increases in muscle quantity in the dialysis population. Intradialytic exercise modifies measures of sarcopenia in the haemodialysis population; however, the majority of trials were low in quality. There is limited evidence for efficacious interventions in the peritoneal dialysis and transplant recipient populations.