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Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis.

ABSTRACT: OBJECTIVE:To assess the efficacy and safety of intradialytic exercise for haemodialysis patients. DESIGN:Systematic review and meta-analysis. DATA SOURCES:Databases, including PubMed, Embase, the Cochrane Library, China Biology Medicine and China National Knowledge Infrastructure, were screened from inception to March 2017. ELIGIBILITY CRITERIA:Randomised controlled trials (RCTs) aimed at comparing the efficacy and safety of intradialytic exercise versus no exercise in adult patients on haemodialysis for at least 3?months. A minimum exercise programme period of 8?weeks. DATA EXTRACTION:Study characteristics and study quality domains were reviewed. Studies were selected, and data extracted by two reviewers. DATA ANALYSIS:The pooled risk ratios and mean differences (MDs) with 95% CIs for dichotomous data and continuous data were calculated, respectively. RESULTS:A total of 27 RCTs involving 1215 subjects were analysed. Compared with no exercise, intradialytic exercise increased dialysis adequacy (Kt/V) (MD 0.07, 95%?CI 0.01 to 0.12, p=0.02) and maximum volume of oxygen that the body can use during physical exertion peak oxygen consumption (MD 4.11, 95%?CI 2.94 to 5.27, p<0.0001), alleviated depression standardised mean difference (-1.16, 95%?CI -1.86 to -0.45, p=0.001) and improved physical component summary-short form-36 (SF-36) level (MD 7.72, 95%?CI 1.93 to 13.51, p=0.009). Also, intradialytic exercise could significantly reduce systolic blood pressure (MD -4.87, 95%?CI -9.20 to -0.55, p=0.03) as well as diastolic blood pressure (MD -4.11, 95%?CI -6.50 to -1.72, p=0.0007). However, intradialytic exercise could not improve mental component summary-SF-36 level (MD 3.05, 95%?CI -1.47 to 7.57, p=0.19). There was no difference in the incidence of adverse events between the intradialytic exercise and control groups. CONCLUSIONS:Intradialytic exercise resulted in benefits in terms of improving haemodialysis adequacy, exercise capacity, depression and quality of life for haemodialysis.

SUBMITTER: Pu J

PROVIDER: S-EPMC6347951 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis.

Pu Jiang J Jiang Zheng Z Wu Weihua W Li Li L Zhang Liling L Li Ying Y Liu Qi Q Ou Santao S

BMJ open 20190121 1

<h4>Objective</h4>To assess the efficacy and safety of intradialytic exercise for haemodialysis patients.<h4>Design</h4>Systematic review and meta-analysis.<h4>Data sources</h4>Databases, including PubMed, Embase, the Cochrane Library, China Biology Medicine and China National Knowledge Infrastructure, were screened from inception to March 2017.<h4>Eligibility criteria</h4>Randomised controlled trials (RCTs) aimed at comparing the efficacy and safety of intradialytic exercise versus no exercise ...[more]

PMID: 30670499

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Project description:Background: Many heart failure (HF) patients admitted to cardiac rehabilitation (CR) centers have a cardiac resynchronization therapy (CRT) device. However, information about the efficacy and safety of exercise rehabilitation in HF patients with a CRT device is scant. We assessed the effects of exercise rehabilitation in HF patients with a CRT device. Methods and Results: The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycInfo, China Biology Medicine, Wanfang, and China National Knowledge Infrastructure databases were searched comprehensively to identify randomized controlled trials (RCTs) published between January 1, 1990 and July 1, 2019 on exercise rehabilitation in HF patients with CRT devices. We identified seven studies published from 2006 to 2019, including 661 patients with an intervention duration of 8 to 24 weeks. Three studies reported all-cause mortality and serious adverse events, and no significant difference was found between exercise rehabilitation patients and controls at the longest available follow-up (both P > 0.05; both I 2 = 0%). Exercise rehabilitation patients exhibited a higher exercise capacity (peak oxygen uptake: random-effect WMD = 2.02 ml/kg/min, 95% CI 0.62 to 3.41, P = 0.005, I 2 = 67.4%; exercise duration: fixed-effect WMD = 102.34s, 95% CI 67.06 to 137.62, P < 0.001, I 2 = 25%) after intervention, despite the significant heterogeneity of studies. Left ventricular ejection fraction (LVEF) was significantly improved in exercise rehabilitation patients compared to that in controls (fixed-effect WMD = 3.89%, 95% CI 1.50 to 6.28; P = 0.001; I 2 = 48.0%). Due to differences in health-related quality of life (HRQOL) assessment methods, we only pooled data that reported Minnesota Living with Heart Failure Questionnaire scores. Exercise rehabilitation patients exhibited a better HRQOL than controls (fixed-effect WMD = -5.34, 95% CI -10.12 to -0.56; P = 0.028; I 2 = 0%). Conclusions: Exercise rehabilitation may restore exercise capacity and cardiac function in HF patients with a CRT device. Furthermore, exercise training was associated with better HRQOL on follow-up.

Project description:Vancomycin and teicoplanin are the glycopeptides currently in use for the treatment of infections caused by invasive beta-lactam-resistant gram-positive organisms. We conducted a systematic review and meta-analysis of randomized controlled trials that have compared vancomycin and teicoplanin administered systemically for the treatment of suspected or proven infections. A comprehensive search of trials without year, language, or publication status restrictions was performed. The primary outcome was all-cause mortality. Two reviewers independently extracted the data. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled by using the fixed-effect model (RRs of >1 favor vancomycin). Twenty-four trials were included. All-cause mortality was similar overall (RR, 0.95; 95% CI, 0.74 to 1.21), and there was no significant heterogeneity. In trials that used adequate allocation concealment, the results favored teicoplanin (RR, 0.82; 95% CI, 0.63 to 1.06), while in trials with unknown methods or inadequate concealment, the results favored vancomycin (RR, 3.61; 95% CI, 1.27 to 10.30). The latter trials might have recruited more severely ill patients. No other variable affected the RRs for mortality, including the assessment of glycopeptides administered empirically or for proven infections, neutropenia, the participant's age, and drug dosing. There were no significant differences between teicoplanin and vancomycin with regard to clinical failure (RR, 0.92; 95% CI, 0.81 to 1.05), microbiological failure (RR, 1.24; 95% CI, 0.93 to 1.65), and other efficacy outcomes. Lower RRs (in favor of teicoplanin) for clinical failure were observed with a lower risk of bias and when treatment was initiated for infections caused by gram-positive organisms rather than empirically. Total adverse events (RR, 0.61; 95% CI, 0.50 to 0.74), nephrotoxicity (RR, 0.44; 95% CI, 0.32 to 0.61), and red man syndrome were significantly less frequent with teicoplanin. Teicoplanin is not inferior to vancomycin with regard to efficacy and is associated with a lower adverse event rate than vancomycin.

Dataset Information

Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis.

Publications

Efficacy and safety of intradialytic exercise in haemodialysis patients: a systematic review and meta-analysis.

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