Effect of Exercise on Parathyroid Hormone Levels in Dialysis Patients: A Systematic Review and Meta-Analysis

IF 1.4 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2026-07-09 Epub Date: 2026-03-13 DOI:10.1111/hdi.70071

Zhong Li, Yaxin Li, Qiaoling Jin, Menglin Chen, Nujia You, Linshen Xie

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引用次数: 0

Abstract

Introduction

Exercise has been increasingly recognized as a safe and effective adjunct therapy for improving physiological and biochemical outcomes in dialysis patients. However, its specific impact on parathyroid hormone (PTH) regulation remains uncertain. This systematic review and meta-analysis aimed to determine the effect of exercise interventions on PTH levels in adults undergoing dialysis.

Methods

A systematic search of PubMed, Scopus, Embase, Web of Science, and Google Scholar databases was conducted up to October 31, 2025, without language or date restrictions. Eligible interventional studies compared exercise-based programs with standard dialysis care and reported quantitative PTH outcomes. Methodological quality was assessed using RoB 2.0 for randomized controlled trials and ROBINS-I for non-randomized trials. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random-effects model, with subgroup, sensitivity, and publication bias analyses performed to assess the robustness of results.

Results

Nine eligible studies involving 438 dialysis patients were analyzed. Pooled results showed a significant reduction in PTH levels in the exercise groups compared with controls (SMD = −0.70; 95% CI: −1.00 to −0.40; p < 0.001). This effect remained consistent across study designs, randomized controlled trials (SMD = −0.68) and non-randomized trials (SMD = −0.72), and across both short-term (≤ 12 weeks; SMD = −0.71; 95% CI: −0.99 to −0.42) and long-term (> 12 weeks; SMD = −0.81; 95% CI: −1.37 to −0.25) interventions, with no significant subgroup difference. Sensitivity analysis confirmed that no single study significantly altered the pooled effect size, and funnel plot assessment with Egger's test indicated no publication bias (p = 0.181). Several individual trials also reported concurrent improvements in serum calcium and phosphate balance following exercise.

Conclusion

Exercise interventions significantly lower PTH levels in dialysis patients and may be integrated as a non-pharmacological adjunct to conventional secondary hyperparathyroidism management. Implementing structured physical activity during dialysis sessions can help improve mineral balance and endocrine stability. Further large-scale, multicenter randomized controlled trials with standardized protocols and longer follow-up periods are warranted to establish optimal exercise regimens for this population.

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运动对透析患者甲状旁腺激素水平的影响：系统回顾和荟萃分析。

导读：运动作为一种安全有效的辅助治疗已被越来越多的人认识到，它可以改善透析患者的生理生化结果。然而，其对甲状旁腺激素（PTH）调节的具体影响仍不确定。本系统综述和荟萃分析旨在确定运动干预对透析成人甲状旁腺激素水平的影响。方法：系统检索PubMed、Scopus、Embase、Web of Science和谷歌Scholar数据库，检索截止日期为2025年10月31日，无语言和日期限制。合格的介入研究比较了以运动为基础的方案与标准透析护理，并报告了定量的甲状旁腺激素结果。随机对照试验采用rob2.0，非随机对照试验采用ROBINS-I评价方法学质量。使用随机效应模型计算合并标准化平均差（SMD）和95%置信区间（CI），并进行亚组、敏感性和发表偏倚分析以评估结果的稳健性。结果：9项符合条件的研究纳入了438例透析患者。综合结果显示，与对照组相比，运动组的甲状旁腺激素水平显著降低（SMD = -0.70; 95% CI: -1.00至-0.40；p 12周；SMD = -0.81; 95% CI: -1.37至-0.25），无显著亚组差异。敏感性分析证实，没有单个研究显著改变合并效应大小，采用Egger检验的漏斗图评估显示无发表偏倚（p = 0.181）。几个单独的试验也报告了运动后血清钙和磷酸盐平衡的同时改善。结论：运动干预可显著降低透析患者的甲状旁腺激素水平，可作为传统继发性甲状旁腺功能亢进治疗的非药物辅助手段。在透析期间进行有组织的体育活动可以帮助改善矿物质平衡和内分泌稳定性。进一步的大规模、多中心随机对照试验需要标准化的方案和更长的随访期，以建立适合这一人群的最佳运动方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.