Feasibility and effectiveness of pre-emptive rehabilitation in persons approaching dialysis (PREHAB).

Abstract

INTRODUCTION: End-stage kidney disease (ESKD) is characterised by several complications, leading to reduced functional ability and quality of life during transition to dialysis. This study aimed to establish the feasibility and effectiveness of a patient-centred programme of exercise, nutritional intervention and multidisciplinary education for persons approaching dialysis. METHODS: Patients with eGFR <15 ml/min/1.73 m2 and anticipated to start dialysis within 6-12 months were invited to participate. The 10-week pre-dialysis intervention included a weekly 1-hour gym-based exercise circuit and an education programme. Feasibility and acceptability were assessed through recruitment and retention rates, adherence to the intervention, and from patient feedback following the intervention. Physical function, nutritional status, and anxiety and depression, were assessed at baseline, after intervention, and as dialysis commenced. RESULTS: Thirty patients agreed to participate, with 22 completing the pre-dialysis intervention. Thirteen (59%) participants achieved 100% attendance at the exercise and education sessions, with only two participants attending less than 8/10 sessions. The intervention also led to improved physical function, demonstrated by significant increase in both incremental shuttle walk distance (330 vs. 385 m, p = 0.006) and quadriceps one repetition maximum (p = 0.007), and a trend towards increased sit-to-stand repetitions (20-23, p = 0.11). There was a trend for improved patient perception of activity (Duke Activity Status Index score 31.55 vs. 33.75, p = 0.09). Hand grip strength (29.1 vs. 29.8 kg), body mass index (30.4 vs. 30.5 kg/m2 ) and nutritional status assessed by subjective global assessment (73% well-nourished) were maintained. CONCLUSION: This study demonstrated the feasibility and effectiveness of a patient-centred exercise and education programme in those approaching dialysis. Further research is therefore required to evaluate the impact of this programme on clinical outcomes.