#3319 GOODRENAL: A FEASIBILITY STUDY OF AN INTRADIALYTIC HOLISTIC VIRTUAL-REALITY PLATFORM
Authors: Segura-Ortí Eva , Avesani Carla Maria , Clyne Naomi , Garcia-Testal Alicia , Kouidi Evangelia , Lozano-Quilis José Antonio , Mesa-Gresa Patricia , Van Craenenbroeck Amaryllis , Cana-Poyatos Alicia , Lauer Andreas , Lindholm Bengt , Marín Alexandra E , Michou Vasiliki , Juhlin Anna-Karin 
Published: June 2023

Abstract

Background and Aims
People with advanced stages of chronic kidney disease (CKD) undergoing hemodialysis often suffer from comorbidities that together with malnutrition and frailty contribute to a sedentary lifestyle, and cognitive and emotional impairments. Intradialytic non-immersive virtual reality exercise programs may improve the health-related quality of life and physical function of people undertaking hemodialysis. The aim of the GoodRENal project was to test the feasibility of an intradialytic holistic virtual-reality platform designed to combine exercise with efforts to improve nutrition and psychological well-being as well as cognitive functioning and to assess the impact on physical, nutritional and psychological variables.

Method
People undergoing hemodialysis for at least 3 months who were medically stable, from Spain (Hospital de Manises), Sweden (Skane University Hospital and Karolinska Institutet), and Greece (Aristotle University of Thessaloniki) were selected and randomized into the GoodRENal intradialysis intervention group and a control group (usual care). The GoodRENal group was exposed to a platform that consisted of several Virtual Scenarios (games) for each one of the targeted treatment areas: Physical Activity, Nutritional Information, Psychological Well-being and Cognitive Functionality. Specifically, these scenarios (“games”) are aimed to make participants move (Physical Activity), learn aspects related to nutrition that they must follow (Nutritional Information), improve their psychological state (Psychological Well-being), and practice their cognitive abilities (Cognitive Functionality). The interaction with the Virtual Scenarios was designed to minimize “invasive” and “annoying” features by using a depth camera (AZURE Kinect), so that the patient, through the movement of their lower extremities (legs) was able to carry out the interaction. The control group carried out the usual care in the unit.
The test battery included physical variables (lower-limb muscle strength, Sit-to-stand to sit test 10 repetitions, 4-meters gait speed, and 6-minute walking test), nutritional variables (short-form food question, 7-point subjective global assessment, body weight, and handgrip strength), psychological variables (depression and anxiety), and cognitive variables. Differences between groups (GoodRENal vs usual care) will be analyzed with a mixed ANOVA model for repeated measures.

Results
The study so far includes 55 participants (mean age 65.4 ± 13 years), 17 females, median time on hemodialysis 48 months). The program, which starts in 2023, will last 12 weeks, until the middle of May 2023.

Conclusion
The evaluation of the GoodRENal platform will show if this is a feasible holistic treatment for improving the physical, nutritional, psychological and cognitive condition of people undertaking hemodialysis.