Exercise during hemodialysis decreases the use of antihypertensive medications☆☆☆★

Abstract 

Most hemodialysis patients require antihypertensive therapy. Aerobic exercise has been suggested as a nonpharmacologic treatment for hypertension in many patient populations, including those with chronic renal failure. To test the effectiveness of this therapy in an outpatient long-term hemodialysis clinic, the hemodialysis staff instituted a stationary cycling program during dialysis and offered the program to all patients (n = 107). Forty patients agreed to participate, and 35 nonexercising patients served as controls. Patients performed stationary cycling during each hemodialysis treatment. Predialysis blood pressures, postdialysis blood pressures, and antihypertensive medication use were recorded during a 6-month period. Costs of the medication were analyzed at the end of the study. Of participants, 24 (60%) completed 6 months of exercise with a mean increase in total cycling time from 16.9 min/session to 45.5 min/session. No serious adverse events were reported. Predialysis and postdialysis blood pressures were not statistically different between the two groups at month 0 or month 6, but 13 (54%) in the exercise group had a reduction in antihypertensive medication versus 4 (12.5%) in the control group (P = 0.008). The average relative benefit of exercise was a 36% reduction in antihypertensive medications (P = 0.018) with an average annual cost savings of $885/patient-year (P = 0.005) in the exercise group. Stationary cycling is safe during hemodialysis and can lead to significant reductions in blood pressure medication use and cost savings, justifying the initial capital cost of equipment and small incremental increase in staff time. © 2002 by the National Kidney Foundation, Inc.

Keywords:  Hypertension, chronic renal failure (CRF), hemodialysis (HD), exercise physiology, pharmacoeconomics