Feasibility of inspiratory muscle training as a rehabilitation program for chronic kidney disease patients in a developing country

OBJECTIVE: Hemodialysis (HD) twice a week is a Renal Replacement Therapy (RRT) option other than kidney transplantation in developing countries, such as Indonesia, due to its cost, limited facilities, and national social-health policy. The effectiveness of inspiratory muscle training ( IMT) as a rehabilitation program for chronic kidney disease (CKD) patients undergoing HD twice a week remains unclear. This study aims to evaluate the effect of IMT on kidney function, the immune system, and quality of life (QOL) of CKD patients undergoing HD twice a week. PATIENTS AND METHODS: A randomized controlled trial (RCT) study was conducted at Regional Province Hospital of West Java, involving thirty-two CKD patients receiving HD twice a week. All participants underwent 12 weeks of IMT, administered three days a week at a 50% Maximal Inspiratory Pressure (MIP) in the intervention group (n=16), and at a 10% MIP in the control group (n=16). Urea level, creatinine level, Interlukine-6 (IL-6) level, and QoL score were measured before and after intervention. RESULTS: The MIP increased after IMT rehabilitation in both groups (p= 0.0001). Urea, IL-6, and creatinine levels decreased after IMT rehabilitation in intervention groups, although the differences were not significant. Significant improvements were observed in the intervention group's QoL score after IMT rehabilitation ( p=0.001). CONCLUSIONS: IMT rehabilitation improved the MIP and QoL scores in CKD patients. Although not statistically significant, there were decreases in urea, creatinine, and IL- 6 levels after the IMT rehabilitation. This trial was registered at ClinicalTrial.gov with the identifier number: NCT05241652.