Impact of Intradialytic Exercise on Infection Rate and Calcium–phosphate Product in Pediatric Hemodialysis Patients: A Pilot Study Intradialytic Exercise in Pediatric
Journal of Pediatric Nephrology,
Vol. 13 (2025),
12 May 2026
https://doi.org/10.22037/jpn.v13i1.51236
Abstract
Background and Aim: Children with end-stage chronic kidney disease on maintenance
hemodialysis (HD) are highly susceptible to infections (catheter-related, urinary tract, and
upper respiratory) and disturbances in calcium–phosphate (Ca×P) metabolism. Intradialytic
exercise has been proposed as a safe non-pharmacologic strategy to improve physical function
and reduce inflammation; however, data in pediatric populations remain scarce. This pilot
study aimed to evaluate the feasibility of an 8-week combined intradialytic exercise program
and explore its effects on the infection rate and the Ca×P product.
Methods: This quasi-experimental single-group pre–post pilot study was conducted in five
children (aged 8–18 years) with maintenance HD ≥2 months and a stable central venous
catheter. The intervention comprised supervised upper-limb resistance and supine cycling
exercise three times per week during HD sessions for 8 weeks. Infection events were recorded
using standardized clinical and laboratory criteria. Serum calcium and phosphate were
measured pre- and post-intervention; Ca×P product was calculated. Prepost Ca×P changes
were analyzed with a paired t-test; infection rates during exercise versus non-exercise months
were compared using the Mann–Whitney U test (P<0.05).
Results: All five participants completed the program. The mean Ca×P increased nonsignificantly
from 52.7±17.71 to 59.43±8.43 mg²/dL² (P=0.36). Mean monthly infection rate
was 10% during exercise months versus 16% during non-exercise months (P=0.673). The
exercise protocol was feasible and well-tolerated.
Conclusion: An 8-week combined intradialytic exercise program was feasible and safe in
pediatric patients with HD. It did not significantly alter infection rates or Ca×P product in this
small, underpowered pilot study. Larger randomized controlled trials are needed.
- Chronic kidney disease (CKD)
- Intradialytic exercise
- Infection
- Calciumphosphate (Ca×P) product
- Pediatric
- Hemodialysis (HD)
How to Cite
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