Pre-hemodialysis exercise training improves systemic aerobic capacity and platelet bioenergetic efficiency in patients with end-stage renal disease.

INTRODUCTION

Platelet mitochondrial bioenergetics contribute to vascular thrombosis in patients with end-stage renal disease (ESRD). This study aimed to elucidate the effect of pre-hemodialysis exercise training (preHD-ET) on platelet mitochondrial bioenergetic efficiency in ESRD patients.

METHODS

Ninety ESRD patients were enrolled, and eighteen eligible ESRD candidates participated in the preHD-ET program. The ESRD patients underwent 24 weeks of hospital-supervised and 12 weeks of home-based preHD-ET on cycling exercise at 50-60% Wpeak for 30 min/day, 3 days/week. Moreover, this study also analyzed 18 age- and gender matched healthy sedentary participants as a healthy sedentary (HS) group. Peak oxygen consumption (VO2peak) and capacities of oxidative phosphorylation (OXPHOS) and electron transport system (ETC), and bioenergetic health index (BHI) in platelets were measured using an automatic gas analyzer and a high-resolution respirometer, respectively.

RESULTS

The ESRD group exhibited (i) lower Wpeak and VO2peak, (ii) inferior capacities of Complex I and II-dependent OXPHOS and ETC in platelets, and (iii) less platelet BHI, compared to the HS group. However, the preHD-ET significantly (i) elevated Wpeak and VO2peak, (ii) enhanced capacities of OXPHOS and ETC by facilitating Complex I and II-linked pathways in platelets, and (iii) raised platelet BHI in the ESRD patients. Moreover, the changes of VO2peak were positively correlated to the changes of OXPHOS, ETC and BHI in platelets following the preHD-ET.

CONCLUSIONS

The preHD-ET for 36 weeks improves systemic aerobic capacity in ESRD patients. Moreover, this exercise regimen enhances mitochondrial bioenergetics efficiency in platelets, whose responses are associated with increased VO2peak in ESRD patients. Clinical trials registration No. NCT06417307.