Effectiveness of intradialytic exercise to reduce interdialytic weight gain in patients on hemodialysis at Private Hospital Yogyakarta

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Positos, Allana Louisse A. Abellanosa, Christine Alaiza L. Galgo, Christine Myca B. Tecson, Geraldine S. Ridad, Marjorie M. Tabigue" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Jude D." "apellidos" => "Positos" ] 1 => array:2 [ "nombre" => "Allana Louisse A." "apellidos" => "Abellanosa" ] 2 => array:2 [ "nombre" => "Christine Alaiza L." "apellidos" => "Galgo" ] 3 => array:2 [ "nombre" => "Christine Myca B." "apellidos" => "Tecson" ] 4 => array:2 [ "nombre" => "Geraldine S." "apellidos" => "Ridad" ] 5 => array:2 [ "nombre" => "Marjorie M." "apellidos" => "Tabigue" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862120300449?idApp=UINPBA00004N" "url" => "/11308621/00000030000000S5/v1_202007240748/S1130862120300449/v1_202007240748/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "titulo" => "Effectiveness of intradialytic exercise to reduce interdialytic weight gain in patients on hemodialysis at Private Hospital Yogyakarta" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "17" "paginaFinal" => "20" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Theresia Tatik Pujiastuti, Havidz Aima, Suganthi Lokonathan, Lisa Chiew" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Theresia Tatik" "apellidos" => "Pujiastuti" "email" => array:1 [ 0 => "theresiatatikpujiastuti@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Havidz" "apellidos" => "Aima" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Suganthi" "apellidos" => "Lokonathan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Lisa" "apellidos" => "Chiew" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "STIKes Panti Rapih, Yogyakarta, Indonesia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universitas Mercu Buana, Jakarta, Indonesia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Faculty of Nursing, Lincoln University College, Malaysia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 839 "Ancho" => 1545 "Tamanyo" => 72277 ] ] "descripcion" => array:1 [ "en" => "Average of IDWG by observations every week." ] ] ] "textoCompleto" => "IntroductionHemodialysis is a live saving treatment to replace of kidney function, especially excretion function in patients with end stage renal disease (ESRD). The aims of hemodialysis to remove nitrogenous substances from the blood and remove excess volume of body fluids.<a class="elsevierStyleCrossRef" href="#bib0075">1</a> The number of patients on hemodialysis is increasing, therefore special intervention is needed to anticipate various problems.The incidence of new case patients undergoing hemodialysis has increased year by year. The data from<a class="elsevierStyleCrossRef" href="#bib0080">2</a> in 2017 showed the incidence of new case patients on hemodialysis increased from 21,050 to 24,460 (20.8%) in 2016 and increased from 24,460 to 30,831 or 21.1% in 2017. Based on the data, there are 70% of hemodialysis patients who stop hemodialysis die due to cardiovascular disorders 37%.One of the main problems in patients on hemodialysis is increasing of interdialytic weight gain (IDWG). IDWG is weight among dialysis calculated based on pre-dialysis weight minus post-dialysis body weight in the previous dialysis session from the prior treatment. IDWG is one of indicator of the success on hemodialysis.<a class="elsevierStyleCrossRef" href="#bib0085">3</a> Interdialytic weight control is an important intervention for patients undergoing hemodialysis.<a class="elsevierStyleCrossRef" href="#bib0090">4</a> Increasing of IDWG can cause cardiovascular disorders. High level of IDWG can cause negative effects on the body including hypotension, muscle cramps, shortness of breath and vomiting.<a class="elsevierStyleCrossRef" href="#bib0095">5</a> Absolute IDWG>3kg was associated with outcomes other than myocardial infarction: point estimates ranged from 1.11 to 1.20 (heart failure).<a class="elsevierStyleCrossRef" href="#bib0100">6</a> High level of IDWG is an indication of inadequate hemodialysis. Therefore, patients on hemodialysis need intervention to achieve hemodialysis adequacy and normal IDWG levels.Intradialytic exercise is one alternative intervention to manage IDWG. Intradialytic exercise is all active and passive movements, especially in the upper and lower extremities performed during hemodialysis.<a class="elsevierStyleCrossRef" href="#bib0105">7</a> Intradialytic exercise improves muscle pump function, peripheral vasodilation and increase venous return, thereby increasing the process of diffusion, osmosis and ultrafiltration during dialysis.<a class="elsevierStyleCrossRef" href="#bib0110">8</a> The effect of intradialytic session is IDWG level more controlled during the interdialysis session.Based on a preliminary study in the Hemodialysis Unit in Yogyakarta, the incidence of ESRD increased by 17.08% and hemodialysis visits increased by 48.86% in 2017. Almost all patients undergoing hemodialysis have increased of IDWG. Based on interviews with hemodialysis nurses that hemodialysis is just a routine procedure. Nurses have not developed nursing intervention yet to reduce IDWG during hemodialysis. This phenomenon is a new issue to be studied. Therefore, it is important to know the effectiveness of intradialytic exercise to reduce IDWG in patients on hemodialysis.MethodsThe purpose of this study was to determine the effectiveness of intradialytic exercise intervention to reduce intradialytic weight gain in patients on hemodialysis. A quantitative descriptive analytic study was conducted. Sixty-four patients on hemodialysis were randomly selected in hemodialysis unit. Patients performed intradialytic exercise consisting of stretching and strengthening exercise twice a week for 8 weeks. Each patient given an example of the movement in the IDWG exercise and leaflet about the movement in the IDWG exercise. The research instruments used include weight scales hat have been standardized by hospitals and observation sheets to write body weight before hemodialysis and after hemodialysis in the previous period.ResultsBased on <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, it is known that the largest number of respondents were male, 43 people (61.2%). It showed that male has a greater risk to ESRD and undergoing hemodialysis. It is also known that the majority of respondents 41–65 years old (70.3%). It showed that people in advanced adulthood and early elderly have a risk to ESRD and undergoing hemodialysis.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Based on <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, it is known that the mean IDWG in the intervention group was greater than the control group before the intradialytic exercise intervention. The mean of IDWG in the intervention group was 3.04±1.21kg. This IDWG is still in normal tolerance, which is less than 5% body weight after dialysis.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Based on <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, there is a significant difference in average body weight before and after intradialytic exercise with p=0.000, <0.05. It showed that intradialytic exercise intervention can reduce the IDWG in patients on hemodialysis.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> depicts significant differences in weight variables occurred from the first week after the intervention. This study found that intradialytic exercise interventions were very effective to reduce IDWG.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows significant difference of IDWG between the intervention group and the control group with p=0.000; <0.05. It showed that intradialytic exercise interventions were effective to reduce IDWG in patients on hemodialysis.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> reveals statistically intradialytic exercise has significant effect on the IDWG. The effect was starting the third week. That effect was stable after the fourth week compared before intradialytic exercise.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> depicts the average IDWG decreased significantly from 0.281kg in the first week to 1.438kg in the eighth week compared before intradialytic exercise intervention.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionStatistically, there is a significant difference on IDWG before and after intradialytic exercise with p=0.000, <0.005. The mean difference of IDWG from 3.04±1.21 before the intradialytic exercise intervention to 1.60±0.90 after the intradialytic exercise intervention. It indicates that intradialytic exercise has an influence on control IDWG in patients on hemodialysis. The difference of IDWG after exercise occurred because intradialytic exercise improves the pumping system in all of body tissue compartment. The accumulation of fluid in the tissue compartment will be pumped into the vascular system, the process of diffusion and ultrafiltration becomes more effective as a result weight loss after dialysis becomes more optimal and decreases of edema.<a class="elsevierStyleCrossRef" href="#bib0115">9</a> The results of this study are consistent with research by<a class="elsevierStyleCrossRef" href="#bib0120">10</a> about exercise training in hemodialysis patients: a systematic review and meta-analysis, the study states that exercise include knee extension, abduction and pelvic flexion are performed within six months during dialysis significantly reduced body weight after hemodialysis with p<0.0001.Statistically, there was also significant differences of IDWG in the intervention group compared with control group p=0.00, <0.05. It indicates that intradialytic exercise is effective in controlling the IDWG of hemodialysis patients. The mean difference of IDWG in the intervention group was 1.60±0.98kg compared with control group 2.98±0.95kg. There was a very adaptive IDWG response. This also means that exercise is very effective in creating pump mechanisms, increasing the mobilization of body fluids and facilitating the process of ultrafiltation.Statistically, it is also known that the intradialytic exercise interventions have a significant effect on IDWG with a p value of 0.000, <0.05 after 8 weeks. When analyzed based on data in every week, it known that statistically intradialytic exercise was a significant effect in the third week. The effect was stable after the fourth week. Based on the average decrease of IDWG, it known that the longer of the exercise duration, the better of IDWG. It is supported by the average IDWG reduce 0.281kg in the first week to 1.438 in the eighth week compared before intradialytic exercise. This shows that exercise effective to reduce IDWG.Intradialytic exercise has an effective effect on IDWG because intradialytic exercise as a vascular pumping which increases the mobilization of tissue fluid into the vascular system. Furthermore, the vascular fluid will be withdrawn during the ultrafiltation process. This condition led decreasing the degree of edema and body weight until interdialysis. This vascular pumping system also strongly influenced by the physiological adaptability of blood vessels. Intradialytic exercise will improve body compensation by optimizing venous development and improving mobilization of body fluids through activation of muscle pumps, especially in the lower limb muscles thereby increasing fluid mobility from lower extremities and reducing the severity of edema during ultrafiltation in the intrahemodialysis phase. The results of this study support the research by<a class="elsevierStyleCrossRef" href="#bib0115">9</a> that the movement of muscles in the lower limb during the dialysis process will optimize the function of ultrafiltration. This condition causes the remove of fluid out of the body up to 78–96% of the target.Exercise in hemodialysis patients is an adjuvant therapy, which recommended to improve the effectiveness of the hemodialysis intervention.<a class="elsevierStyleCrossRef" href="#bib0125">11</a> Intradialytic exercise during hemodialysis has been shown to increase muscle mass. It prevents the occurrence of protein catabolism. Increased muscle mass causes weight gain but not due to water retention in free space which causes edema. Furthermore, interdialysis exercise increases fluid mobilization and makes balance of body compartment. Patients on hemodialysis are suggested to do aerobic exercise for 30min 5 days a week and resistance exercise for 10min 2 times a week.<a class="elsevierStyleCrossRef" href="#bib0130">12</a>However, to control IDWG, hemodialysis exercise, and excessive fluid intake should be monitored. Patients on hemodialysis are recommended to restrict fluid intake by calculating the amount of urine output in a day 300–600cc/day.<a class="elsevierStyleCrossRef" href="#bib0135">13</a> The decrease on IDWG is one of the important indicators because it indicates the hemodialysis adequacy and improve healthy status in patients on hemodialysis.<a class="elsevierStyleCrossRef" href="#bib0140">14</a> Minimal three weeks Intradialytic exercise was effective to reduced intradialytic weight gain in patients on hemodialysis. Based on the results of the study, it has been suggested for nurses to educate patient on hemodialysis about intradialytic exercise.The researcher would like to thank for all the patients in the hemodialysis unit who are willing to be respondents, hospital management, the hemodialysis unit and all nurses who helped during the research process. The researcher would also like to thank the management of the STIKes Panti Rapih Yogyakarta, which provides funding and spiritual support.Conflict of interestsThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1366015" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1255761" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-09-25" "fechaAceptado" => "2019-11-11" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1255761" "palabras" => array:3 [ 0 => "Hemodialysis" 1 => "Intradialytic exercise" 2 => "Interdialytic weight gain" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Hemodialysis is a treatment for patients with kidney failure. One of the main problems in patients on hemodialysis is increasing of interdialytic weight gain (IDWG) due to decreased kidney excretion function. Increasing of interdialytic weight gain cause dangerous conditions and reduce the function of whole-body systems, especially cardiovascular and respiratory systems. These conditions require appropriate intervention. Various references reported intradialysis exercise can be an alternative intervention to reduce interdialytic weight gain. The purpose of this study was to determine the effectiveness of intradialytic exercise intervention to reduce interdialytic weight gain in patients on hemodialysis. A quantitative descriptive analytic study was conducted. Sixty-four patients on hemodialysis were randomly selected in hemodialysis unit. Patients performed intradialytic exercise twice a week for 8 weeks. Statistical analysis with general linear model repeated measure showed there was decrease in the interdialytic weight gain mean in patients on hemodialysis after 3–8 weeks intervention intradialytic exercise with p value of 0.000; <0.05. The interdialytic weight gain mean decrease between 0.281 and 1.438kg. Performed minimal four weeks intradialytic exercise was effective to reduced interdialytic weight gain in patients on hemodialysis. Based on the results of the study, it is suggested for nurses to educate patient on hemodialysis about intradialytic exercise. Intradialytic exercise can be an alternative independent nursing intervention to reduce interdialytic weight gain in patients on hemodialysis." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Peer-review under responsibility of the scientific committee of the 3rd International Conference on Healthcare and Allied Sciences (2019). Full-text and the content of it is under responsibility of authors of the article." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 839 "Ancho" => 1545 "Tamanyo" => 72277 ] ] "descripcion" => array:1 [ "en" => "Average of IDWG by observations every week." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 822 "Ancho" => 1573 "Tamanyo" => 79407 ] ] "descripcion" => array:1 [ "en" => "Effect of intradialytic exercise on IDWG." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 902 "Ancho" => 1577 "Tamanyo" => 73687 ] ] "descripcion" => array:1 [ "en" => "Average decrease on IDWG in observations every week." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Source: Primary data." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20–40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41–65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2346214.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of respondents (N=64)." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Source: Primary data." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention groupn=48</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control groupn=16</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IDWG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2346215.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of respondents based on IDWG (N=64)." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Source: Primary data.Unit: Kilogram (kg)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Before intradialytic exercise</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">After intradialytic exercise</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IDWG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2346216.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Difference of IDWG before and after intradialytic exercise in intervention group." ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Source: Primary data.Unit: Kilogram (kg)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention groupn=48</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control groupn=16</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IDWG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2346213.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Average of IDWG in the intervention and control groups." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brunner & Suddarth's textbook of medical surgical nursing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Hinkle" 1 => "CheeverF K.H." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "14th ed." "fecha" => "2018" "editorial" => "Wolters Kluwer" "editorialLocalizacion" => "Philadelphia" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0080" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Indonesian Renal Registry (IRR). 10th Report of Indonesian Renal Registry; 2017. Available at: <a target="_blank" href="http://www.um.es/eglobal/5/05b01.html">http://www.um.es/eglobal/5/05b01.html</a> [accessed 18.11.19]." ] ] ] 2 => array:3 [ "identificador" => "bib0085" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Essential orthopaedics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Maheswari" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2012" "editorial" => "Jaypee Brothers Medical Pub" "editorialLocalizacion" => "London" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0090" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical-surgical nursing: concepts for interprofessional collaborative care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.D. Ignatavicius" 1 => "M.L. Workman" 2 => "C. Rebar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "edicion" => "9th ed." "fecha" => "2018" "paginaInicial" => "2018" "editorial" => "Elsevier" "editorialLocalizacion" => "USA" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0095" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bioimpedance-guided fluid management in hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "U. Moisll" 1 => "M.A. Guillen" 2 => "P. Wabel" 3 => "N. Fonsere" 4 => "M. Carrera" 5 => "J.M. Campistol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.12411212" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "1575" "paginaFinal" => "1582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23949235" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0100" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intradialytic hypotension and risk of cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.V. Stefánsson" 1 => "S.M. Brunelli" 2 => "C. Cabrera" 3 => "D. Rosenbaum" 4 => "E. Anum" 5 => "K. 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Svagrova" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5772/53058" "Libro" => array:2 [ "fecha" => "2013" "editorial" => "INTECH" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0110" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intradialytic exercise program for hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.D. Jung" 1 => "H.S. 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McLeod" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000167010" "Revista" => array:6 [ "tituloSerie" => "Blood Purif" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "58" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19169019" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0120" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise training in haemodialysis patients: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Smart" 1 => "M. Steele" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1797.2011.01471.x" "Revista" => array:6 [ "tituloSerie" => "Nephrology" "fecha" => "2011" "volumen" => "16" "paginaInicial" => "626" "paginaFinal" => "632" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21557787" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0125" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interaction between intradialytic exercise and hemodialysis adequacy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.L. Kirkman" 1 => "L.D. Roberts" 2 => "M. Kelm" 3 => "J. Wagner" 4 => "M.M. Jibani" 5 => "J.H. Macdonald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000356340" "Revista" => array:6 [ "tituloSerie" => "Am J Nephrol" "fecha" => "2013" "volumen" => "38" "paginaInicial" => "475" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24296748" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0130" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physical exercise in patients with severe kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.C. Kosmadakis" 1 => "A. Bevington" 2 => "A.C. Smith" 3 => "E.L. Clapp" 4 => "J.L. Viana" 5 => "N.C. 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Theresia Tatik Pujiastutia,

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theresiatatikpujiastuti@yahoo.com

Corresponding author.

, Havidz Aimab, Suganthi Lokonathanc, Lisa Chiewc

a STIKes Panti Rapih, Yogyakarta, Indonesia

b Universitas Mercu Buana, Jakarta, Indonesia

c Faculty of Nursing, Lincoln University College, Malaysia

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in 2016 and increased from 24&#44;460 to 30&#44;831 or 21&#46;1&#37; in 2017&#46; Based on the data&#44; there are 70&#37; of hemodialysis patients who stop hemodialysis die due to cardiovascular disorders 37&#37;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the main problems in patients on hemodialysis is increasing of interdialytic weight gain &#40;IDWG&#41;&#46; IDWG is weight among dialysis calculated based on pre-dialysis weight minus post-dialysis body weight in the previous dialysis session from the prior treatment&#46; IDWG is one of indicator of the success on hemodialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> Interdialytic weight control is an important intervention for patients undergoing hemodialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> Increasing of IDWG can cause cardiovascular disorders&#46; High level of IDWG can cause negative effects on the body including hypotension&#44; muscle cramps&#44; shortness of breath and vomiting&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> Absolute IDWG<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>kg was associated with outcomes other than myocardial infarction&#58; point estimates ranged from 1&#46;11 to 1&#46;20 &#40;heart failure&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> High level of IDWG is an indication of inadequate hemodialysis&#46; Therefore&#44; patients on hemodialysis need intervention to achieve hemodialysis adequacy and normal IDWG levels&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Intradialytic exercise is one alternative intervention to manage IDWG&#46; Intradialytic exercise is all active and passive movements&#44; especially in the upper and lower extremities performed during hemodialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> Intradialytic exercise improves muscle pump function&#44; peripheral vasodilation and increase venous return&#44; thereby increasing the process of diffusion&#44; osmosis and ultrafiltration during dialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> The effect of intradialytic session is IDWG level more controlled during the interdialysis session&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Based on a preliminary study in the Hemodialysis Unit in Yogyakarta&#44; the incidence of ESRD increased by 17&#46;08&#37; and hemodialysis visits increased by 48&#46;86&#37; in 2017&#46; Almost all patients undergoing hemodialysis have increased of IDWG&#46; Based on interviews with hemodialysis nurses that hemodialysis is just a routine procedure&#46; Nurses have not developed nursing intervention yet to reduce IDWG during hemodialysis&#46; This phenomenon is a new issue to be studied&#46; Therefore&#44; it is important to know the effectiveness of intradialytic exercise to reduce IDWG in patients on hemodialysis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The purpose of this study was to determine the effectiveness of intradialytic exercise intervention to reduce intradialytic weight gain in patients on hemodialysis&#46; A quantitative descriptive analytic study was conducted&#46; Sixty-four patients on hemodialysis were randomly selected in hemodialysis unit&#46; Patients performed intradialytic exercise consisting of <span class="elsevierStyleItalic">stretching</span> and <span class="elsevierStyleItalic">strengthening</span> exercise twice a week for 8 weeks&#46; Each patient given an example of the movement in the IDWG exercise and leaflet about the movement in the IDWG exercise&#46; The research instruments used include weight scales hat have been standardized by hospitals and observation sheets to write body weight before hemodialysis and after hemodialysis in the previous period&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">Based on <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; it is known that the largest number of respondents were male&#44; 43 people &#40;61&#46;2&#37;&#41;&#46; It showed that male has a greater risk to ESRD and undergoing hemodialysis&#46; It is also known that the majority of respondents 41&#8211;65 years old &#40;70&#46;3&#37;&#41;&#46; It showed that people in advanced adulthood and early elderly have a risk to ESRD and undergoing hemodialysis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Based on <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; it is known that the mean IDWG in the intervention group was greater than the control group before the intradialytic exercise intervention&#46; The mean of IDWG in the intervention group was 3&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;21<span class="elsevierStyleHsp" style=""></span>kg&#46; This IDWG is still in normal tolerance&#44; which is less than 5&#37; body weight after dialysis&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Based on <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; there is a significant difference in average body weight before and after intradialytic exercise with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#44; &#60;0&#46;05&#46; It showed that intradialytic exercise intervention can reduce the IDWG in patients on hemodialysis&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> depicts significant differences in weight variables occurred from the first week after the intervention&#46; This study found that intradialytic exercise interventions were very effective to reduce IDWG&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows significant difference of IDWG between the intervention group and the control group with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#59; &#60;0&#46;05&#46; It showed that intradialytic exercise interventions were effective to reduce IDWG in patients on hemodialysis&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> reveals statistically intradialytic exercise has significant effect on the IDWG&#46; The effect was starting the third week&#46; That effect was stable after the fourth week compared before intradialytic exercise&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> depicts the average IDWG decreased significantly from 0&#46;281<span class="elsevierStyleHsp" style=""></span>kg in the first week to 1&#46;438<span class="elsevierStyleHsp" style=""></span>kg in the eighth week compared before intradialytic exercise intervention&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Statistically&#44; there is a significant difference on IDWG before and after intradialytic exercise with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#44; &#60;0&#46;005&#46; The mean difference of IDWG from 3&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;21 before the intradialytic exercise intervention to 1&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;90 after the intradialytic exercise intervention&#46; It indicates that intradialytic exercise has an influence on control IDWG in patients on hemodialysis&#46; The difference of IDWG after exercise occurred because intradialytic exercise improves the pumping system in all of body tissue compartment&#46; The accumulation of fluid in the tissue compartment will be pumped into the vascular system&#44; the process of diffusion and ultrafiltration becomes more effective as a result weight loss after dialysis becomes more optimal and decreases of edema&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> The results of this study are consistent with research by<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> about exercise training in hemodialysis patients&#58; a systematic review and meta-analysis&#44; the study states that exercise include knee extension&#44; abduction and pelvic flexion are performed within six months during dialysis significantly reduced body weight after hemodialysis with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Statistically&#44; there was also significant differences of IDWG in the intervention group compared with control group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00&#44; &#60;0&#46;05&#46; It indicates that intradialytic exercise is effective in controlling the IDWG of hemodialysis patients&#46; The mean difference of IDWG in the intervention group was 1&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;98<span class="elsevierStyleHsp" style=""></span>kg compared with control group 2&#46;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;95<span class="elsevierStyleHsp" style=""></span>kg&#46; There was a very adaptive IDWG response&#46; This also means that exercise is very effective in creating pump mechanisms&#44; increasing the mobilization of body fluids and facilitating the process of ultrafiltation&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Statistically&#44; it is also known that the intradialytic exercise interventions have a significant effect on IDWG with a <span class="elsevierStyleItalic">p</span> value of 0&#46;000&#44; &#60;0&#46;05 after 8 weeks&#46; When analyzed based on data in every week&#44; it known that statistically intradialytic exercise was a significant effect in the third week&#46; The effect was stable after the fourth week&#46; Based on the average decrease of IDWG&#44; it known that the longer of the exercise duration&#44; the better of IDWG&#46; It is supported by the average IDWG reduce 0&#46;281<span class="elsevierStyleHsp" style=""></span>kg in the first week to 1&#46;438 in the eighth week compared before intradialytic exercise&#46; This shows that exercise effective to reduce IDWG&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Intradialytic exercise has an effective effect on IDWG because intradialytic exercise as a vascular pumping which increases the mobilization of tissue fluid into the vascular system&#46; Furthermore&#44; the vascular fluid will be withdrawn during the ultrafiltation process&#46; This condition led decreasing the degree of edema and body weight until interdialysis&#46; This vascular pumping system also strongly influenced by the physiological adaptability of blood vessels&#46; Intradialytic exercise will improve body compensation by optimizing venous development and improving mobilization of body fluids through activation of muscle pumps&#44; especially in the lower limb muscles thereby increasing fluid mobility from lower extremities and reducing the severity of edema during ultrafiltation in the intrahemodialysis phase&#46; The results of this study support the research by<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> that the movement of muscles in the lower limb during the dialysis process will optimize the function of ultrafiltration&#46; This condition causes the remove of fluid out of the body up to 78&#8211;96&#37; of the target&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Exercise in hemodialysis patients is an adjuvant therapy&#44; which recommended to improve the effectiveness of the hemodialysis intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> Intradialytic exercise during hemodialysis has been shown to increase muscle mass&#46; It prevents the occurrence of protein catabolism&#46; Increased muscle mass causes weight gain but not due to water retention in free space which causes edema&#46; Furthermore&#44; interdialysis exercise increases fluid mobilization and makes balance of body compartment&#46; Patients on hemodialysis are suggested to do aerobic exercise for 30<span class="elsevierStyleHsp" style=""></span>min 5 days a week and resistance exercise for 10<span class="elsevierStyleHsp" style=""></span>min 2 times a week&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">However&#44; to control IDWG&#44; hemodialysis exercise&#44; and excessive fluid intake should be monitored&#46; Patients on hemodialysis are recommended to restrict fluid intake by calculating the amount of urine output in a day 300&#8211;600<span class="elsevierStyleHsp" style=""></span>cc&#47;day&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> The decrease on IDWG is one of the important indicators because it indicates the hemodialysis adequacy and improve healthy status in patients on hemodialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> Minimal three weeks Intradialytic exercise was effective to reduced intradialytic weight gain in patients on hemodialysis&#46; Based on the results of the study&#44; it has been suggested for nurses to educate patient on hemodialysis about intradialytic exercise&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The researcher would like to thank for all the patients in the hemodialysis unit who are willing to be respondents&#44; hospital management&#44; the hemodialysis unit and all nurses who helped during the research process&#46; The researcher would also like to thank the management of the STIKes Panti Rapih Yogyakarta&#44; which provides funding and spiritual support&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        1 => array:2 [
          "identificador" => "xpalclavsec1255761"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
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        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
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        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflict of interests"
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        7 => array:1 [
          "titulo" => "References"
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    ]
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    "fechaRecibido" => "2019-09-25"
    "fechaAceptado" => "2019-11-11"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Hemodialysis"
            1 => "Intradialytic exercise"
            2 => "Interdialytic weight gain"
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    "resumen" => array:1 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hemodialysis is a treatment for patients with kidney failure&#46; One of the main problems in patients on hemodialysis is increasing of interdialytic weight gain &#40;IDWG&#41; due to decreased kidney excretion function&#46; Increasing of interdialytic weight gain cause dangerous conditions and reduce the function of whole-body systems&#44; especially cardiovascular and respiratory systems&#46; These conditions require appropriate intervention&#46; Various references reported intradialysis exercise can be an alternative intervention to reduce interdialytic weight gain&#46; The purpose of this study was to determine the effectiveness of intradialytic exercise intervention to reduce interdialytic weight gain in patients on hemodialysis&#46; A quantitative descriptive analytic study was conducted&#46; Sixty-four patients on hemodialysis were randomly selected in hemodialysis unit&#46; Patients performed intradialytic exercise twice a week for 8 weeks&#46; Statistical analysis with general linear model repeated measure showed there was decrease in the interdialytic weight gain mean in patients on hemodialysis after 3&#8211;8 weeks intervention intradialytic exercise with <span class="elsevierStyleItalic">p</span> value of 0&#46;000&#59; &#60;0&#46;05&#46; The interdialytic weight gain mean decrease between 0&#46;281 and 1&#46;438<span class="elsevierStyleHsp" style=""></span>kg&#46; Performed minimal four weeks intradialytic exercise was effective to reduced interdialytic weight gain in patients on hemodialysis&#46; Based on the results of the study&#44; it is suggested for nurses to educate patient on hemodialysis about intradialytic exercise&#46; Intradialytic exercise can be an alternative independent nursing intervention to reduce interdialytic weight gain in patients on hemodialysis&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 3rd International Conference on Healthcare and Allied Sciences &#40;2019&#41;&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Brunner &#38; Suddarth&#39;s textbook of medical surgical nursing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;L&#46; Hinkle"
                            1 => "CheeverF K&#46;H&#46;"
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                    0 => array:1 [
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                        "edicion" => "14th ed&#46;"
                        "fecha" => "2018"
                        "editorial" => "Wolters Kluwer"
                        "editorialLocalizacion" => "Philadelphia"
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              "identificador" => "bib0080"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Indonesian Renal Registry &#40;IRR&#41;&#46; 10th Report of Indonesian Renal Registry&#59; 2017&#46; Available at&#58; <a target="_blank" href="http://www.um.es/eglobal/5/05b01.html">http&#58;&#47;&#47;www&#46;um&#46;es&#47;eglobal&#47;5&#47;05b01&#46;html</a> &#91;accessed 18&#46;11&#46;19&#93;&#46;"
                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Essential orthopaedics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Maheswari"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2012"
                        "editorial" => "Jaypee Brothers Medical Pub"
                        "editorialLocalizacion" => "London"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medical-surgical nursing&#58; concepts for interprofessional collaborative care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;D&#46; Ignatavicius"
                            1 => "M&#46;L&#46; Workman"
                            2 => "C&#46; Rebar"
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                    ]
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                    0 => array:1 [
                      "Libro" => array:5 [
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                        "editorial" => "Elsevier"
                        "editorialLocalizacion" => "USA"
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              "identificador" => "bib0095"
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                  "contribucion" => array:1 [
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                      "titulo" => "Bioimpedance-guided fluid management in hemodialysis patients"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "U&#46; Moisll"
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                            2 => "P&#46; Wabel"
                            3 => "N&#46; Fonsere"
                            4 => "M&#46; Carrera"
                            5 => "J&#46;M&#46; Campistol"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.2215/CJN.12411212"
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                        "tituloSerie" => "Clin J Am Soc Nephrol"
                        "fecha" => "2013"
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                        "paginaInicial" => "1575"
                        "paginaFinal" => "1582"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23949235"
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                  "contribucion" => array:1 [
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                      "titulo" => "Intradialytic hypotension and risk of cardiovascular disease"
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                            0 => "B&#46;V&#46; Stef&#225;nsson"
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                            2 => "C&#46; Cabrera"
                            3 => "D&#46; Rosenbaum"
                            4 => "E&#46; Anum"
                            5 => "K&#46; Ramakrishnan"
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.2215/CJN.02680314"
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Article information

ISSN: 11308621
Original language: English

DOI:10.1016/j.enfcli.2020.01.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	28	4	32
2024 October	135	32	167
2024 September	113	31	144
2024 August	145	27	172
2024 July	131	28	159
2024 June	75	10	85
2024 May	83	17	100
2024 April	97	8	105
2024 March	127	33	160
2024 February	143	18	161
2024 January	159	30	189
2023 December	125	32	157
2023 November	142	28	170
2023 October	123	24	147
2023 September	106	29	135
2023 August	74	11	85
2023 July	111	26	137
2023 June	87	36	123
2023 May	104	8	112
2023 April	67	9	76
2023 March	85	6	91
2023 February	43	6	49
2023 January	43	7	50
2022 December	46	13	59
2022 November	50	8	58
2022 October	35	10	45
2022 September	101	18	119
2022 August	67	16	83
2022 July	54	15	69
2022 June	48	9	57
2022 May	65	9	74
2022 April	62	15	77
2022 March	114	16	130
2022 February	125	12	137
2022 January	110	12	122
2021 December	76	12	88
2021 November	89	12	101
2021 October	45	22	67
2021 September	47	18	65
2021 August	62	19	81
2021 July	62	23	85
2021 June	48	9	57
2021 May	47	1	48
2021 April	67	5	72
2021 March	42	19	61
2021 February	17	14	31
2021 January	19	4	23
2020 December	11	9	20
2020 November	17	4	21
2020 October	4	4	8

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