Intradialytic cognitive and physical exercise for enhancing cognitive function in haemodialysis patients: a systematic review and meta-analysis

Abstract Background Cognitive impairment negatively impacts patients on maintenance haemodialysis. This review evaluates the effects of combined cognitive and physical training on cognitive outcomes in this population. Methods This review protocol was registered with PROSPERO (CRD420251076992). Cochrane Library, PubMed and LIVIVO databases were searched for randomised controlled trials and quasi-experimental studies evaluating the combined interventions among adult patients on haemodialysis for ≥ 3 months. Studies done on patients with prior malignancy or infections, acute kidney injury, active psychosis or delirium, severe arthritis or any other physical disability contraindicating exercise, undergoing peritoneal dialysis, or having had a kidney transplant were excluded. Meta-analyses using random effects models compared the intervention with standard care. The Cochrane Risk of Bias 2 tool assessed potential bias. Results Five records (three randomised controlled trials and two additional records) with 195 patients were included. Two studies consistently showed a significant improvement in Trail Making Test B with intervention compared with control (mean difference 21.11 s; 95% confidence interval 11.93, 30.29; p < 0.01). Two additional studies evaluating the difference between Trail Making Test B and Trail Making Test A favoured the intervention (mean difference = 10.82; 95% confidence interval 1.1, 20.53; p = 0.03). Another meta-analysis of two studies showed an improvement in Montreal Cognitive Assessment scores with the intervention (mean difference 1.98; 95% confidence interval 0.43, 3.53; p = 0.01). Conclusions Integrated intradialytic cognitive and physical therapy appears to improve cognitive function in patients with end-stage kidney disease.