Nutritional and exercise interventions for muscle status in hemodialysis patients: A systematic review and network meta-analysis.

BACKGROUND

Muscle mass depletion and functional decline in hemodialysis (HD) patients are associated with an increased risk of mortality. This study systematically assessed the effectiveness of nutritional and exercise interventions on muscle status in HD patients.

METHODS

We conducted a network meta-analysis of 89 randomized controlled trials retrieved from four databases, including 6,128 HD patients across 26 intervention arms. Data on muscle mass, strength, function, and quality of life were extracted from primary studies. Results were presented as mean difference (MD) with 95 % credible interval (CrI).

RESULTS

Combined aerobic exercise (AE) and resistance exercise (RE) significantly improved 6-min walk test (6MWT) (MD = 52.2 m; 95 % CrI, 31.7-73.0). Multi-modality exercise (MME) performed best in enhancing the handgrip strength (MD = 9.1 kg; 95%CrI, 1.8-16.4), also showed potential superiority over AE + RE in improving 6MWT and 30STS performance. Protein oral nutritional supplements positively affected lean body mass (MD = 0.3 kg; 95%CrI, 0.1-0.45).

CONCLUSION

Our research validates the role of AE + RE in improving muscle function and reveals the potential of MME to surpass AE + RE in enhancing muscle strength and function. Protein supplementation may improve muscle mass. These findings support clinical decisions regarding effective exercise and nutritional interventions for HD patients and provide a foundation for exploring optimal combination strategies. Larger-scale, high-quality studies are needed in the future to expand and strengthen our conclusions.