Network meta-analysis of exercise modalities for their effects on micro-inflammation in patients undergoing hemodialysis.

AIMS: Exercise can effectively ameliorate the micro-inflammatory state in patients undergoing maintenance hemodialysis (MHD), but the optimal intervention modality remains unclear. This study systematically compared the anti-inflammatory efficacy of different exercise modalities by focusing on evaluating the levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). METHODS: A systematic search was conducted across the CNKI, VIP, Wanfang, China Biology Medicine disc (CBMdisc), PubMed, Web of Science, Embase, and Cochrane Library databases to identify randomized controlled trials investigating exercise interventions for micro-inflammatory state in MHD patients, from database inception to November 16, 2024. The Cochrane Risk of Bias Tool was employed to assess the methodological quality of the included studies. Data were analyzed using Stata 16.0 and Review Manager 5.3 software. RESULTS: A total of 41 RCTs involving 12 intervention modalities and 2939 patients were ultimately included. The network meta-analysis results demonstrated that, compared with usual care (UC), intradialytic resistance exercise combined with non-dialytic aerobic exercise (IRE + NAE) [SMD = - 1.78, 95% CI (- 3.06, - 0.5)] showed the most promising effect in improving CRP levels (SUCRA = 89.1%). Intradialytic aerobic exercise combined with non-dialytic aerobic exercise (IAE + NAE) [SMD = - 1.43, 95% CI (- 2.71, - 0.14)] exhibited the most promising efficacy in reducing IL-6 levels (SUCRA = 85.9%). Non-dialytic aerobic exercise (NAE) [SMD = - 2.77, 95% CI (- 4.37, - 1.16)] was most promising in lowering TNF-α levels (SUCRA = 95.8%). CONCLUSIONS: Different exercise interventions showed varying effects on ameliorating the micro-inflammatory state in MHD patients. Based on comprehensive evaluation of three biomarkers (CRP, IL-6, and TNF-α), intradialytic aerobic exercise combined with non-dialytic aerobic exercise (IAE + NAE) demonstrated the most promising anti-inflammatory effects, with non-dialytic exercise modalities generally superior to intradialytic interventions. These findings require further validation through higher-quality studies. This network meta-analysis has been registered on PROSPERO (Registration ID: CRD420250653330).