Cold Dialysis Combined with Intradialytic Exercise Improves Insulin Sensitivity in Hemodialysis Patients: A Pilot Randomized Clinical Trial.

Background and Objectives: Hemodialysis patients are characterized by insulin resistance. Cold dialysis (CD), with or without intradialytic exercise training (IET), can be beneficial for overall health in this population. The present study aimed to examine the long-term effect of the combined effect of cold dialysis and intradialytic exercise training on glucose disposal and various health and quality-of-life parameters in hemodialysis patients. Materials and Methods: Fourteen stable hemodialysis patients were randomly allocated in one of the two groups: the Cold Dialysis (35 °C) + Exercise Group (N = 7) (CD) and the Standard dialysis (37 °C) + Exercise Group (N = 7) (SD). Glucose disposal and insulin sensitivity, body composition, functional capacity, and quality of life were assessed before and after a 7-month intervention period. Results: Insulin sensitivity was improved by 16.7% in the CD group compared to the SD group. The area under the curve (AUC) for glucose and insulin disposal rate was also improved in the CD group compared to the SD group. Functional capacity and quality-of-life indices improved significantly in both groups (all p ≤ 0.05) independent of dialysate temperature. Conclusions: Seven months of cold dialysis combined with intradialytic exercise training was associated with improvements in insulin sensitivity and glucose metabolism in stable hemodialysis patients. Long-term exercise training has proven benefits for hemodialysis patients' health that can be further enhanced by cold dialysis. Trial Registration: The study is registered at ClinicalTrials.gov (NCT03905551).