Impact of an intradialysis virtual-reality-based exercise program on healthcare resources expenditure: a micro-costing analysis

[EN] Background Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program. Materials and methods Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program. Results The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests - 330 (95% CI:[- 533, - 126];p = 0.003), outpatient visits - 351 ([- 566, - 135];p = 0.003), and radiology tests - 111 ([- 209, - 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start. Conclusion The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.Funding was received from a research prize awarded by the nonprofit organization 'Fundacion Renal Tomas de Osma' as well as from a research grant (IDOC 17-19), a research project (FUSP-BS-PPC14/2017) grant from the Universidad Cardenal Herrera-CEU and a research project (PID2019-108814RA-100) from the Spanish Government 'Ministerio de Ciencia e Innovacion'.García-Testal, A.; Martínez-Olmos, FJ.; Gil-Gómez, J.; Villalón-Coca, J.; Ortiz-Ramón, R.; Cana-Poyatos, A.; García-Maset, R.... (2022). Impact of an intradialysis virtual-reality-based exercise program on healthcare resources expenditure: a micro-costing analysis. BMC Nephrology. 23(1). https://doi.org/10.1186/s12882-022-02859-823

Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session

[EN] Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.Funding included a research project (PID2019-108814RA-I00) supported by the Spanish Government 'Ministerio de Ciencia e Innovacion', a research prize awarded by the nonprofit organization Fundacion Renal Tomas de Osma, as well as from a research grant (IDOC 17-19 and PPC14/2017) awarded by the Universidad Cardenal Herrera CEU.García-Testal, A.; Martínez-Olmos, FJ.; Gil-Gómez, J.; López-Tercero, V.; Lahoz-Cano, L.; Hervás-Marín, D.; Cana-Poyatos, A.... (2023). Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session. Healthcare. 11(1). https://doi.org/10.3390/healthcare1101007911

Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session

Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability