SEX-DEPENDENCY OF THE EFFECT OF PHYSICAL EXERCISE ON PHYSICAL PERFORMANCE IN DIALYSIS PATIENTS

Objective: Physical inactivity in end-stage kidney disease (ESKD) patients is linked to poor quality of life and increased morbidity. This post-hoc analysis of the EXerCise Introduction to Enhance Performance in Dialysis (EXCITE) trial investigates the sex-dependent effects of a six-month exercise program on physical performance in dialysis patients. Design and method: In the EXCITE trial participants were randomized into an exercise group or a control group. This analysis focused on gender-dependent effects, including 227 dialysis patients (151 males, 76 females) who completed the six-minute walking distance test (6MWD) and the five times sit-to-stand test (5STS) at baseline and after six months. Changes in 6MWD and 5STS were analyzed using linear regression models to assess sex as an effect modifier. Results: Both male and female patients in the exercise group showed significant improvements in 6MWD compared to controls. In unadjusted (P=0.013) and fully adjusted (p=0.006) interaction analyses, the response to this test in females improved more than in males. In sex-stratified analyses, the between groups difference in the response to the 5STS was larger in females than in males (P=0.007), but this difference did not achieve statistical significance in interaction analysis (P=0.11). Conclusions: The exercise program improved physical performance in dialysis patients, with females showing more significant enhancements in 6MWD. These findings suggest sex-specific physiological differences may influence exercise outcomes in dialysis patients.