Inspiratory Muscle Training for Chronic Kidney Disease Patients on Hemodialysis
Condition: Chronic Kidney Disease Stage 5 on Dialysis
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic
Study type: Interventional

Summary: 
      Chronic Kidney Disease (CKD) is a global public health problem with an increasing prevalence
      and incidence, poor prognosis, and high costs. It is characterized by changes in the kidney
      structure and functions for more than three months. It is grouped into several stages,
      including end-stage kidney disease requiring renal replacement therapy (RRT). Hemodialysis
      (HD) is one of the RRT options other than kidney transplantation. Regular moderate-intensity
      exercise may improve certain elements of the immune system and have anti-inflammatory
      benefits. Aerobic exercise, extremity muscle strength exercises, and inspiratory muscle
      training have been reported to improve kidney function and quality of life in CKD patients
      receiving hemodialysis three times a week. However, the effect of inspiratory muscle training
      on kidney and immune function, and quality of life in CKD patients receiving HD twice a week
      remains unclear.
    

Detailed description: 
      Exercise causes a variety of immunological responses, including the production of
      interleukins. There is some evidence that exercise is correlated with a reduction in systemic
      inflammation. Prolonged exercise and regular exercise decrease baseline IL-6 levels as a
      pro-inflammatory cytokine. Inspiratory Muscle Training (IMT) exercise program can improve
      endothelial function and oxidative stress, both of which affect the progression of kidney
      disease. The IMT exercise program can induce a decrease in sympathoadrenal activation, as
      well as a decrease in adrenaline and noradrenaline circulation, thereby preventing
      endothelial and glycocalyx injury. So, the IMT can improve kidney function. Previous study
      showed IMT reducing urea and creatinine levels in CKD patients receiving HD thrice a week.
      The IMT also can improve quality of life of CKD patients receiving HD thrice a week.

      Hemodialysis remains the primary RRT modality in Indonesia, and practice is strongly
      influenced by the socioeconomics of the region due to lack of third-party payers. Stretching
      resources to maximize outcome benefit is critical, and twice-weekly HD sessions are an
      improved and cost-effective clinical practice. Observational studies of twice-weekly HD in
      Taiwan and China have shown a possible benefit of the slower decline of renal function and
      acceptable nutritional status in recent years. However, there are limited data from
      performing IMT can improve kidney and immune function, and quality of life of CKD patients
      receiving HD twice a week.

      As result of limited data, the investigators is looked forward to answer about the effect of
      the IMT exercise program on improving inflammatory cytokine IL-6, kidney function, and
      quality of life in end-stage CKD patients receiving HD twice a week.
    

Intervention name(s): Inspiratory Muscle Training with an intensity of 50% MIP; Inspiratory Muscle Training with an intensity of 10% MIP
Intervention type(s): Other; Other
Intervention description(s): Patients received IMT exercise program at a 50% MIP intensity for 12 weeks; Patients received IMT exercise program at a 10% MIP intensity for 12 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care