الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2, persisting for 3 months or more, irrespective of the cause. Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with end-stage renal disease (ESRD) on haemodialysis (HD).
Arterial stiffness is a term employed to define the arteries’ capacity to expand and contract during the cardiac cycle. Arterial stiffening is another major contributor to the heightened cardiovascular risk in ESRD, causing hemodynamic alterations via multiple pathways. Arterial stiffness augments systolic pressure and pulse pressure (PP) in the ascending aorta, increases left ventricular (LV) afterload and promotes the adverse myocardial remodeling towards hypertrophy and fibrosis.
Aortic pulse wave velocity (PWV), a direct marker of aortic stiffness is repeatedly shown to be an independent risk factor for cardiovascular events and mortality in hemodialysis patients. Similarly, indexes of wave reflections, such as augmentation index (AIx) and central pulse pressure (central PP) have been associated with increased mortality in hemodialysis patients.
A specific form of muscle wasting in patients with ESRD is defined as the so called protein- energy wasting (PEW). PEW is also related to metabolic derangements, hormonal abnormalities, and consequent abnormalities in muscle structure in dialysis patients. In addition, muscle wasting is a strong risk factor for mortality in ESRD patients. Therefore, prevention or treatment of PEW is important for the management of ESRD patients.
Exercise is one of the possible preventive maneuvers to reduce muscle protein loss and maintain muscle function. Both intradialytic aerobic exercise and resistance exercise have many advantages. Mostly, cycling is used as the aerobic exercise and a free-weight dumbbell is used as the resistance exercise. Resistance exercise is usually taken earlier than aerobic exercise.
The aim of this study was to compare the effect of intradialytic aerobic exercise alone versus combined aerobic and resistance exercise on arterial stiffness and the echocardiographic findings among hemodialysis patients.
This study was conducted on 45 chronic kidney disease stage 5(CKD-5) patients. All patients receiving regular maintenance hemodialysis 4 hourly sessions thrice weekly through a well-functioning arteriovenous fistula (AVF) at Medical Research Institute Dialysis Unit. Patients greater than 60 years, with dysrhythmia or severe cardiac disease, with left ventricular ejection fraction (LVEF) less than 40% on echocardiography and patients with any physical or psychological disability that would impact study participation were excluded from the study.
Arterial stiffness and echocardiography assessment were done at the beginning of the study and 3 months later for both exercise groups (group A and group B) and control group (group C). This study showed a non-significant decrease of the post exercise AI in group A (mean 1.91 ± 4.40) and a significant decrease in group B (mean 6.74 ± 9.88).In the control group there was a significant increase of the post exercise AI (mean 21.12 ± 36.71).
Our study also showed a significant increase of the post exercise EF% in both group A with increase of 4.14 ± 3.97% and in group B with increase of 2.96 ± 2.09%.In the control group there was a significant decrease of the post exercise EF% with decrease of 2.26 ± 2.51%).
It also showed a significant decrease in both group A with decrease of 10.47 ± 11.38% and in group B with decrease of 6.54 ± 4.32%.In the control group there was a significant increase of the post exercise LVMI with increase of 9.61 ± 13.87%.