Randomized Controlled Trial of Walking Training with and without Blood Flow Restriction in Patients Treated with Maintenance Hemodialysis

Abstract

Key Points:

1. We compared the effectiveness of walking training with and without blood flow restriction on walking capacity in hemodialysis patients.

2. Blood flow restriction walking resulted in greater improvements in walking capacity than usual care in hemodialysis patients.

3. The low-intensity, simple walking-based intervention may be an effective complementary intervention for patients treated with hemodialysis.

Background: The decline in walking capacity among patients undergoing maintenance hemodialysis can worsen physical function, leading to impaired health-related quality of life (HRQOL). This randomized controlled trial compared the effectiveness of walking training with blood flow restriction (WT-BFR) and walking training (WT) versus usual care controls on walking capacity among hemodialysis patients.

Methods: Patients treated with maintenance hemodialysis were recruited from two dialysis units in Suzhou, China, between February and June 2024 and were randomly allocated into three groups using block randomization. The control group (CG) received usual care. The WT group received 8 weeks of low-to-moderate intensity walking intervention. The WT-BFR group received the same intervention as the WT group, with the addition of 40%–50% limb occlusion pressure applied during walking sessions. Walking capacity (primary outcome), physical function, HRQOL, anxiety, and depression were assessed at baseline, 8, and 16 weeks.

Results: Fifty-seven eligible patients with a mean age of 54 years (SD=10) were recruited. They were randomly allocated equally into the CG (n=19), WT-BFR group (n=19), and WT group (n=19). From baseline to 8 weeks, the improvements in walking capacity were greater in the WT-BFR (mean differences and 95% confidence interval, 48.48, 28.81 to 68.16 m) and WT (31.70, 9.29 to 54.11 m) groups compared with the CG. At 16 weeks, the WT-BFR group also demonstrated a greater improvement in walking capacity than the WT group (34.63, 8.90 to 60.36 m). Similarly, the WT-BFR and WT groups showed greater improvements in physical function and disease-specific domains of HRQOL, compared with the CG.

Conclusions: After an 8-week intervention, both WT-BFR and WT improved walking capacity, physical function, and HRQOL in maintenance hemodialysis patients. However, the prolonged benefits of WT-BFR in the hemodialysis population require further investigation.

Clinical Trial registry name and registration number:: Chinese Clinical Trial Register registration number: ChiCTR2400080779.

Keywords: CKD; clinical trial; dialysis; hemodialysis.