Invest Clin 65(3): 346 - 357, 2024 https://doi.org/10.54817/IC.v65n3a07

Corresponding author: Changdong Zhu. Department of Clinical Laboratory, Lujiang County People’s Hospital,

Hefei, China. E-mail: zhucd2023@163.com

The effect of regular exercise combined with

quantitative nutritional support on immune

function indicators such as CD3+, CD4+,

CD8+, and nutritional status in dialysis

patients.

Chunfeng Kong

and Changdong Zhu

Department of Hemodialysis, Lujiang County People’s Hospital, Hefei, China.

Department of Clinical Laboratory, Lujiang County People’s Hospital, Hefei, China.

Keywords: hemodialysis; immune function; nutritional status.

Abstract. To study the effect of regular exercise and quantitative nutri-

tional support on dialysis patients’ immune function indicators and nutritional

status, 100 uremic patients who underwent hemodialysis treatment in our hos-

pital from February 2021 to February 2023 were selected as the study subjects.

They were divided into a control group (n=50) that received regular exercise

and routine nutritional support, and a research group (n=50) that received

regular exercise and quantitative nutritional support. This study compared the

baseline levels of nutritional indicators such as prealbumin (PA), transferrin

(TF), serum albumin (SAB), and hemoglobin (HB); cellular immune indicators

such as CD3+, CD4+, and CD8+; as well as humoral immune indicators such

as immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin

M (IgM) at enrollment and after three months of intervention. At the time of

enrollment, there were no significant differences in nutritional indicators be-

tween the two groups of patients (

p>0.05), nor in the levels of cellular immune

indicators (

p>0.05) or humoral immune indicators (p>0.05). After three

months of intervention, nutritional indicators such as PA in all patients in the

experiment grew (

p<0.05), and those in the research group exceeded the con-

trol group (

p<0.05). Similarly, the levels of CD3+ and other cellular immune

indicators and the concentrations of IgA and other humoral immune indicators

increased in both groups after three months of intervention (

p<0.05). Howev-

er, these increases were higher in the research group than in the control group

(

p<0.05). Regular exercise combined with quantitative nutritional support can

effectively improve hemodialysis patients’ nutritional index levels, nutritional

status, immune index levels, and immune function.

Effect of regular exercise and quantitative nutritional support on dialysis patients 347

Vol. 65(3): 346 - 357, 2024

Efecto del ejercicio regular, combinado con soporte nutricional

cuantitativo, sobre indicadores de la función inmune tales

como CD3+, CD4+, CD8+, y el estado nutricional en pacientes

en diálisis.

Invest Clin 2024; 65 (3): 346 – 357

Palabras clave: hemodiálisis; función inmune; estado nutricional.

Resumen. Para estudiar el efecto del ejercicio regular y el apoyo nutri-

cional cuantitativo sobre los indicadores de función inmune y el estado nutri-

cional de los pacientes en diálisis, se seleccionaron como sujetos de estudio

100 pacientes urémicos que se sometieron a tratamiento de hemodiálisis en

nuestro hospital desde febrero de 2021 hasta febrero de 2023. Se dividieron en

un grupo control (n=50) que recibió ejercicio regular y apoyo nutricional de

rutina y un grupo de investigación (n=50) que recibió ejercicio regular y apoyo

nutricional cuantitativo. Este estudio comparó los niveles basales de indicado-

res nutricionales como prealbúmina (PA), transferrina (TF), albúmina sérica

(SAB) y hemoglobina (HB); indicadores inmunes celulares tales como CD3+,

CD4+ y CD8+; así como indicadores inmunes humorales como inmunoglobuli-

na A (IgA), inmunoglobulina G (IgG) e inmunoglobulina M (IgM) al momento

de la inscripción y después de tres meses de intervención. En el momento del

reclutamiento, no hubo diferencias significativas en los indicadores nutriciona-

les entre los dos grupos de pacientes (p>0,05), ni en los niveles de indicadores

inmunes celulares (p>0,05) o indicadores inmunes humorales (p>0,05). Des-

pués de tres meses de intervención, los indicadores nutricionales como la PA en

todos los pacientes del experimento aumentaron (p<0,05), y los del grupo de

investigación superaron al grupo control (p<0,05). De manera similar, los nive-

les de CD3+ y otros indicadores inmunes celulares y las concentraciones de IgA

y otros indicadores inmunes humorales aumentaron en ambos grupos después

de tres meses de intervención (p<0,05). Sin embargo, estos aumentos fueron

mayores en el grupo de investigación que en el grupo control (p<0,05). El ejer-

cicio regular combinado con apoyo nutricional cuantitativo puede mejorar efi-

cazmente los niveles de índices nutricionales, el estado nutricional, los niveles

de índices inmunológicos y la función inmune de los pacientes en hemodiálisis.

Received: 09-12-2023 Accepted: 02-03-2024

INTRODUCTION

Hemodialysis (HD) is a renal replace-

ment therapy commonly used in patients

with advanced or end-stage renal disease.

Diabetes nephropathy accounts for a high

proportion of HD, which is consistent with

the increasing trend of the number of dia-

betes patients

. When the kidneys lose nor-

mal function, HD draws the patient’s blood

out of the body, simulates kidney function

through a special filter to remove waste,

toxins, and excess water from the body, and

then reinfuses the purified blood back into

the patient’s body to maintain water-electro-

lyte and acid-base balance. This process can

348 Kong and Zhu

Investigación Clínica 65(3): 2024

help patients maintain and improve their

quality of life

. However, at the same time as

treatment, patients may experience compli-

cations such as malnutrition

During the HD process, waste and excess

water in the patient’s body are discharged

through a dialyzer, which may increase the

patient’s metabolic rate and energy con-

sumption. Dialysis patients must limit their

intake of substances such as sodium, potas-

sium, and phosphorus during and between

treatment periods while also controlling

their water intake, which may lead to loss

of appetite and reduced intake. When energy

intake is insufficient to meet the patient’s

metabolic needs, it can lead to energy expen-

diture exceeding the intake, leading to mal-

nutrition

. During dialysis, some nutrients

and proteins may be removed along with the

waste, leading to protein loss. The inflam-

matory response and chronic inflammatory

state during dialysis may lead to metabolic

disorders, promote protein breakdown, ac-

celerate protein loss, and lead to malnutri-

tion

. The causes of HD malnutrition include

both iatrogenic and non-iatrogenic factors.

Possible factors related to iatrogenic factors

include poor dialysis adequacy and excessive

loss of serum albumin during dialysis, while

non-iatrogenic factors include poor appetite

and insufficient nutrition supplementation.

These factors can be changed and incorpo-

rated into the nutritional assessment

When dialysis patients are in a state of

severe metabolic stress, a sharp decrease in

serum albumin and a significant decrease

in albumin and hemoglobin are usually ob-

served. These changes are usually accompa-

nied by a deterioration in the overall health

status of patients and are unlikely to respond

to adjustments in dialysis plans. In such cas-

es, targeted nutritional interventions and

protein supplementation must be used dur-

ing dialysis

. Protein-energy malnutrition

and deficiency of single nutrients can affect

immune responses

. When immune cells are

activated, they can meet nutritional needs

through anaerobic respiration. Signals from

adipose tissue limit the activity and quantity

of immune cells in nutrient-deficient situa-

tions

. Under malnutrition, the secretion

of adipokines is dysregulated, affecting the

activity of immune cells and leading to an

increased susceptibility of inflammatory au-

toimmune reactions to infectious diseases

Long-term protein deprivation correlates

the degree of malnutrition in body weight

with the antibody response in the humoral

immune response

. Nutritional metabolism

is related to the differentiation and func-

tion of various immune cells, and nutritional

intervention can manipulate immune cell

function. Nutritional intervention can en-

hance nutritional status, affecting immune

cell dynamics

. This study applies regular

exercise combined with quantitative nutri-

tional intervention to HD patients and ana-

lyzes its effectiveness.

PATIENTS AND METHODS

General Information: The research

subjects of this study consisted of 100 ure-

mic patients who received HD treatment in

our hospital from February 2021 to February

2023. The patients knew the purpose of the

research, agreed to participate, and signed

an informed consent form. Inclusion crite-

ria: (a) Dialysis time≥6 months. (b) Age≥18

years old. (c) Regular dialysis 2-3 times a

week. (d) Comply with the diagnostic criteria

for malnutrition in the GLIM Malnutrition

Diagnostic Standards - Global Consensus Re-

port in Clinical Nutrition receive nutritional

support. (e) Stable conditions, electrolyte

disorders, acidosis, and other uremic signs

have been effectively controlled. Exclusion

criteria: (a) Concomitant acute gastrointes-

tinal diseases. (b) Concomitant malignant

tumors and other malignant consumptive

diseases. (c) Presented diseases that affect

metabolism, such as hyperthyroidism and

adrenal diseases. (d) Significant edema

of pleural and abdominal effusion. (e) The

combination of severe depression and recent

poor appetite that led to a decrease in body

Effect of regular exercise and quantitative nutritional support on dialysis patients 349

Vol. 65(3): 346 - 357, 2024

mass index. Other exclusion criteria: (a) de-

terioration of the condition or death during

the study. (b) Missing visits. (c) Automatic

exit. This study included 100 patients, with

no excluded cases. Upon meeting the inclu-

sion criteria, participants were randomly as-

signed into two groups to ensure compara-

bility and to minimize selection bias. Data

were systematically collected at two distinct

time points: baseline data at the beginning

of the study and follow-up data upon inter-

vention completion. Eighty valid data were

collected, and the effective data recovery

rate was 100%. There were no significant

differences in general information such as

gender, age, body mass index, and primary

disease between the two groups of patients

(p>0.05), as shown in Table 1.

Method: A nutritional assessment was

conducted on the included patients, and

their nutritional status was evaluated based

on the Malnutrition Universal Screening

Tool (MUST). BMI ≥ 20.0 was scored as 0.

A BMI between 18.5 and 20.0 was 1 point.

BMI ≤ 18.5 was 2 points, or weight loss with-

in 5% in the past 3-6 months was 0 points.

Weight loss between 5% and 10% in the

past 3-6 months was 1 point. Weight loss of

more than 10% in the past 3-6 months was 2

points. Fasting or consuming food less than

five days due to acute illness was 2 points.

A score of 0 indicates a low nutritional risk

state, and regular nutritional screening is

sufficient. A score of 1 indicated a moder-

ate nutritional risk state, requiring record-

ing dietary intake status within three days

and repeated screening. A score of 2 or more

indicated a high-risk state and required nu-

tritional intervention. After evaluation, the

patient’s BMI was ≤ 18.5, indicating a high-

risk state and requiring nutritional interven-

tion.

Control Group (CG): Regular exercise

combined with routine nutritional support.

Regular exercise: When patients came to the

hospital for treatment, exercise education

was carried out, and patients were advised to

take moderate walks indoors and outdoors

and engage in mild aerobic exercises such

as jogging, cycling, and swimming. Exercise

should be carried out 2 hours after meals,

and loose and breathable clothes suitable for

the ambient temperature should be worn.

Before and after exercise, measuring the

pulse and keeping records was necessary. If

there was any discomfort during exercise, it

should have to be stopped immediately, and

excessive exercise should be avoided. The

frequency of exercise was 3-5 times a week,

and the heart rate of exercise needed to be

20 times/min higher than the resting rate.

Each walk took 2-3 minutes and required

2-3 minutes of rest, with an average of 60-

80 steps per minute, alternating. Nutritional

support: Based on the patient’s condition

and dietary habits, it was essential to know

Table 1

Comparison of general information between two groups of patients.

Group n

Gender

Age (years)

BMI

(kg/m

)

Primary disease

Male Female

Chronic

glomerulonephritis

Diabetic

nephropathy

Polycystic

kidney

Other

Control

Group

28 (56)

22 (44)

56.56±12.36

18.49±3.21

13 (26)

15 (30)

11 (22)

Research

Group

30 (60)

20 (40)

57.12±12.40

18.50±3.20

14 (28)

10 (20)

12 (24)

/t - 0.164 0.226 0.016 0.163

p - 0.685 0.822 0.988 0.983

Values are expressed as n (%) or X±SD.

350 Kong and Zhu

Investigación Clínica 65(3): 2024

how to correctly use scale tools such as salt

spoons and oil cups to help patients match

their daily meals and master nutritional sup-

port. Then, it was necessary to encourage pa-

tients to record and grasp their nutritional

intake. Weekly dietary surveys needed to be

conducted on patients, and timely guidance

and supplementation should be provided for

any unreasonable situation. It is also neces-

sary to correct unhealthy dietary habits and

adjust dietary plans.

Research group (RG): In the study, the

rRG received a comprehensive nutritional

intervention that included both a special-

ized nutrient formula and a tailored food

plan. The nutritional support was twofold:

(a) Specialized Nutrient Formula: The RG

was provided with a specially formulated oral

nutrient solution designed to meet the spe-

cific needs of hemodialysis (HD) patients.

The formula composition was based on indi-

vidual protein and energy requirements. Dai-

ly protein needs were calculated at 0.8 to 1.2

grams per kilogram of body weight. Energy

requirements for males and females were de-

termined using separate formulas: for males,

the formula used was 88.362 + (13.397 ×

weight in kg) + (4.799 × height in cm) -

(5.677 × age in years); for females, the for-

mula was 447.593 + (9.247 × weight in kg)

+ (3.098 × height in cm) - (4.330 × age in

years). The nutrient solution was composed

of a blend containing 1-9% protein, 1-20%

maltodextrin, 1-10% plant mixed oils, 0.1-

1% borage oil, 1-15% corn syrup solids, 1-5%

sugar, 1-2% cellulose, 0.1-1% essential min-

erals, 0.01-0.1% emulsifier, and 0.01-0.05%

L-carnitine and L-taurine. The RG members

were instructed to consume this nutrient

solution 200-250 mL per session, 6-7 times

daily, ensuring each feeding was completed

within 15-20 minutes and spaced at least two

hours apart. (b) Tailored Food Plan: In addi-

tion to the nutrient solution, patients in the

RG were provided with a food plan tailored

to their needs and dietary habits. This plan

was not solely based on the consumption of

the nutrient solution but was supplemented

by regular meals. The food plan aimed to en-

sure that patients received a balanced diet,

taking into account their daily total energy

and nutrient requirements. Fat intake was

targeted to provide 30% of the total daily

calorie intake, and carbohydrates were to

account for 50%. Patients were educated on

using tools like salt spoons and oil cups to

properly portion their meals and were en-

couraged to maintain a record of their nu-

tritional intake. Weekly dietary surveys were

conducted to offer personalized guidance

and to make any necessary adjustments to

their diet. (c) The combination of the nutri-

ent solution and the tailored food plan was

designed to ensure that patients in the RG

received adequate nutrition to address their

high-risk nutritional state, as identified by

the Malnutrition Universal Screening Tool

(MUST). Additionally, patients were advised

to consume fruit and vegetable juices be-

tween feedings, with a hydration goal of 500

mL of water plus the volume of the previous

day’s urine output. Weekly follow-ups via We-

Chat phone calls by nurses helped monitor

the patient’s adherence to the feeding regi-

men and provided an opportunity for ongo-

ing nursing guidance, including reminders

about the importance of nutrient tube main-

tenance and timely follow-up appointments.

Electronic records of follow-up data.

Outcome Measures

Nutritional status: At the time of en-

rollment, fasting peripheral venous blood

was collected from patients from 6:00 to

7:00 in the morning during the intervention

period of three months. After centrifuga-

tion, serum was collected for nutritional in-

dicators, including PA, TF, SAB, and HB. PA

standard reference range= 0.20-0.40 g/L.

TF’s typical reference range = 2.5-4.3 g/L.

SAB typical reference range = 35-55 g/L.

HB normal reference range=110~160 g/L.

Immunity

Cellular immune indicators: At the

time of enrollment, the patient’s fasting

Effect of regular exercise and quantitative nutritional support on dialysis patients 351

Vol. 65(3): 346 - 357, 2024

peripheral venous blood was collected from

6:00 to 7:00 in the morning for cellular im-

mune index testing during the intervention

period of three months. The detection in-

dicators include CD3+, CD4+, and CD8+.

The normal reference range for CD3+

was 955-2860/μL. CD4+normal reference

range= 450~1440/μL. CD8+ normal refer-

ence range= 320~1250/μL.

Humoral immune indicators: At en-

rollment, fasting venous blood was collected

from patients at 6:00 to 7:00 in the morn-

ing for humoral immune index testing dur-

ing the intervention period of three months.

The detection indicators include IgA, IgG,

and IgM, and the normal reference range of

IgA is 0.71-3.85 g/L. Normal reference range

of lgG =7.0-16.6 g/L. IgM typical reference

range = 0.4-3.45 g/L.

Statistical analysis: IBM SPSS 26.0®

was used for data processing, and the mea-

surement data was expressed as mean ± stan-

dard deviation (±SD). According to the Kol-

mogorov-Smirnov test, the measurement data

conformed to a normal distribution, with in-

dependent t-tests performed between groups

and paired t-tests performed within groups.

Graph Pad Prism 8 was used to draw a bar-

separated scatter plot of indicator horizontal

changes. The number of cases used in tech-

nical data, expressed as a percentage (n,%),

was subjected to the χ

test, and p<0.05 was

considered statistically significant.

RESULTS

Comparison of nutritional status between

the two groups of patients

At the time of enrollment, there was no

significant difference in the levels of PA, TF,

SAB, and HB nutritional indicators between

the two groups of patients (p>0.05). After

intervention for three months, the levels of

nutritional indicators such as PA in all pa-

tients in the experiment grew (p<0.05),

while the RG group exceeded the CG group

(p<0.05), as shown in Table 2.

Comparison of cellular immune indicators

between the two groups of patients

At the time of enrollment, there were

no significant differences in the levels of

cellular immune indicators such as CD3+,

CD4+, and CD8+ between the two groups of

patients (p>0.05). At the time of interven-

tion for three months, the levels of CD3+

and other cellular immune indicators in

both groups of patients increased (p<0.05),

while the RG exceeded the CG (p<0.05), as

shown in Table 3.

Table 2

Comparison of nutritional index levels between the two groups of patients.

Group n

PA (g/L) TF (g/L) SAB (g/L) HB (g/L)

Baseline

Parameters

At three

months of

intervention

Baseline

Parameters

At three

months of

intervention

Baseline

Parameters

At three

months of

intervention

Baseline

Parameters

At three

months of

intervention

Control

group

0.17±0.07

0.30±0.86

2.30±0.31

2.96±0.26

33.90±1.07

35.79±3.85

106.74±8.11

114.85±5.73

Research

group

0.16±0.07

0.34±0.57

2.30±0.33

3.15±0.40

33.74±1.06

37.11±2.17

104.82±6.27

117.44±5.16

t - 0.256 2.463 0.041 2.170 0.777 2.110 1.325 2.375

p - 0.799 0.016 0.968 0.032 0.439 0.037 0.188 0.020

PA: pre albumin. TF: transferrin. SAB: serum albumin. HB: hemoglobin.

Values are expressed as X±SD; *p<0.05 compared to levels at admission to the study.

352 Kong and Zhu

Investigación Clínica 65(3): 2024

Comparison of humoral immune indicators

between the two groups of patients

At the time of enrollment, a significant

difference did not exist in the concentration

of IgA, IgG, and IgM humoral immune indi-

cators between the two groups of patients

(p>0.05). At the time of intervention for

three months, the levels of IgA and other hu-

moral immune indicators in both groups of

patients increased (p<0.05), and the RG ex-

ceeded the CG (p<0.05), as shown in Table 4.

DISCUSSION

Prealbumin PA, also known as thyroid

binding protein, transports thyroid hor-

mones

. Its main synthetic organ is the liv-

er. In cases of malnutrition in the body, the

synthesis of PA is affected, and its blood level

decreases

. PA is often used as an essential

indicator to evaluate the nutritional status

of patients. During dialysis, HD patients ex-

crete a certain amount of protein through

dialysis, resulting in protein loss. The side

effects of medication, the disease itself, and

other factors in patients can lead to loss of

appetite and affect dietary intake. Patients

can also suffer malnutrition by limiting

phosphorus, sodium, and potassium intake

to control the fluid balance and avoid ma-

terial accumulation in the blood

. TF is a

protein responsible for iron transport, pres-

ent in plasma and involved in HB synthesis

and oxygen transport

. It absorbs iron from

Table 3

Comparison of cellular immune index levels between the two groups of patients.

Group n

CD3+(μL) CD4+(μL) CD8+(μL)

Baseline

Parameters

At three months

of intervention

Baseline

Parameters

At three months

of intervention

Baseline

Parameters

At three months

of intervention

Control

Group

944.74±21.05

974.04±24.64*

441.30±16.31

465.67±27.42*

313.38±14.93

364.68±20.60*

Research

Group

943.17±25.87

989.20±35.40*

442.11±18.57

479.95±27.49*

310.87±15.41

373.82±16.74*

t - 0.333 2.487 0.233 2.597 0.827 2.435

p - 0.740 0.015 0.816 0.011 0.410 0.017

Values are expressed as X±SD *p<0.05 Compared to the time of admission.

Table 4

Comparison of humoral immune index levels between the two groups of patients.

Group n

lgA (g/L) lgG (g/L) IgM (g/L)

Baseline

Parameters

At three

months of

intervention

Baseline

Parameters

At three

months of

intervention

Baseline

Parameters

At three

months of

intervention

Control

Group

0.70±0.06

1.26±0.09*

6.59±1.33

7.34±1.10*

0.39±0.05

1.57±0.08*

Research

Group

0.68±0.06

1.31±0.10*

6.44±1.21

7.94±1.22*

0.38±0.04

1.62±0.10*

t - 1.467 2.567 0.620 2.561 0.926 2.640

p - 0.146 0.012 0.537 0.012 0.357 0.010

IgA: Immunoglobulin A. LgG: Immunoglobulin G. IgM: Immunoglobulin M. Values are expressed as X±SD. *p<0.05

compared to Baseline Parameters.

Effect of regular exercise and quantitative nutritional support on dialysis patients 353

Vol. 65(3): 346 - 357, 2024

the intestines, spleen, and other tissues and

transports it to the RBC in the bone marrow,

synthesizing hemoglobin

. Iron metabolism

can be evaluated by monitoring the level of

TF in the blood. In cases of malnutrition, TF

can undergo a decrease

. SAB is a rich pro-

tein in the blood synthesized by the liver and

reaches the entire body through blood circu-

lation, maintaining a balance between plas-

ma and cells and avoiding the loss and reten-

tion of water and nutrients

. It participates

in the binding and transportation of various

substances, binds with free fatty acids, trans-

ports fatty acids to cells, participates in im-

mune regulation of the body, and maintains

acid-base balance

. Changes in SAB levels

can reflect the nutritional status of patients.

In HD patients with malnutrition, excessive

protein loss affects liver protein synthesis,

decreasing SAB levels

. HB is a Pro present

in RBC and an essential component in the

blood. It transports oxygen from the lungs to

various tissues for oxygen exchange

, and

HB levels are commonly used to assess the

degree of anemia in patients. Malnutrition

may cause anemia and decreased HB

. For

HD patients, long-term dialysis treatment

may lead to chronic inflammatory reactions

and iron loss, affecting RBC generation and

HB levels

Table 2 shows that regular exercise and

quantitative nutritional support can improve

patients’ nutritional indicators. Quantitative

nutritional intervention can develop person-

alized nutritional interventions based on the

specific nutritional needs of patients, ensur-

ing that patients consume sufficient Pro and

other nutrients. Pro is the primary raw mate-

rial for the synthesis of PA, and sufficient in-

take of Pro can promote the synthesis of PA.

Regular exercise can promote Pro synthesis

and increase muscle mass, which is the main

storage area for Pro. Increasing muscle mass

can increase Pro storage in the body. The

pro breakdown can lead to a decrease in PA

and transferrin levels. Regular exercise can

reduce Pro breakdown, and quantitative nu-

tritional interventions can increase Pro in-

take, thereby maintaining high Pro levels in

patients.

The effect of regular exercise and

quantitative nutritional intervention on

cellular immune indicators in HD mal-

nutrition patients. CD3+ is a cell surface

marker that refers to lymphocytes carrying

CD3 antigens. It mainly exists in the expres-

sion of T lymphocytes and is a part of T cell

receptor complexes. In immunology, cell

surface markers are identified and classified

to distinguish different types of immune

cells, and the number of T cells identified

by CD3 labelling can be monitored

. CD4+

cells, also known as helper T cells, are criti-

cal immune cells in the immune system and

influence the regulation and coordination

of immune responses in the body

. CD4+

are mainly present in the peripheral blood

and other parts of lymphatic tissue and par-

ticipate mainly in the immune response of

intracellular and extracellular pathogens,

as well as the immune regulation of T cells.

It suppresses the immune response through

inhibitory cytokines, avoiding excessive im-

mune response and autoimmune reactions

. CD8+ are cytotoxic T cells and essential

immune cells in the immune system. They

kill infected or mutated cells in the body

. When the body is invaded by pathogens

such as bacteria and viruses, CD8+ cells

can recognize and kill infected cells to pre-

vent pathogen transmission

. The activity

and function of CD8+ play a vital role in the

immune system, protecting the body from

pathogen infection and tumor invasion

The important subpopulations of lympho-

cytes play an essential role in the immune

response, and malnutrition may impact the

immune system, leading to impaired im-

mune function and affecting the level of

lymphocyte subpopulations. Thus, malnu-

trition can lead to a decrease in the num-

ber of T cells or impaired function, leading

to a decrease in the levels of CD3+, CD4+,

and CD8+, affecting the normal regulatory

function of the immune system

. Table 3

shows that regular exercise combined with

354 Kong and Zhu

Investigación Clínica 65(3): 2024

quantitative nutritional support can effec-

tively improve patients’ cellular and humor-

al immune indicator levels. Analyzing the

reasons, regular exercise combined with

quantitative nutritional intervention can

improve immune function and enhance the

number and activity of T cells, and regular

exercise can enhance the body’s immune

activity. Quantitative nutritional interven-

tion can provide T cells with the required

Pro and micronutrients, thereby increasing

cellular immune indicators such as CD3+

levels, helping to enhance T cell function

and immune response ability

The effect of regular exercise and

quantitative nutritional intervention on

humoral immune indicators in HD malnu-

trition patients. IgA is an immunoglobulin

mainly present on the surface of mucous

membranes and body fluids, mainly on the

surface of mucous membranes such as the

respiratory and digestive tracts. It is a barri-

er to protect the mucosa from pathogen in-

vasion and the first immune barrier. Abnor-

mal levels of IgA may be related to certain

immune diseases

. IgG is an immunoglob-

ulin in bodily fluids and blood, synthesized

by B lymphocytes and secreted during im-

mune activation during infection, mainly

involved in humoral immune responses. It

can bind to pathogens, neutralize toxins,

and activate the immune system, promot-

ing pathogen clearance and destruction

IgM is a crucial component of the humoral

immune system and is the immunoglobulin

first produced during early infection or ini-

tial exposure to antigens. It participates in

humoral immunity and can quickly initiate

immune responses, especially in early infec-

tions. It has a solid ability to agglutinate and

activate complement, quickly neutralizing

and clearing pathogens, thereby prevent-

ing the further spread of infection

. Pro

is the main component of immunoglobulin

. Due to an insufficient supply of Pro, mal-

nutrition patients limit immunoglobulin

synthesis, decreasing the levels of related

immunoglobulin indicators. Immunoglobu-

lin plays a crucial role in maintaining the

body’s immune function, and malnutrition,

leading to a decrease in immunoglobulin

synthesis, may increase the risk of infection

in patients. Therefore, providing reason-

able nutritional support for HD malnutri-

tion patients is crucial for improving their

immune indicators and preventing infec-

tion

37,38

. Regular exercise, combined with

quantitative nutritional intervention, could

markedly enhance the immune index levels

of patients, as shown in Table 4. Regular

exercise can stimulate immune cell activ-

ity and enhance the body’s ability to clear

pathogens. Quantitative nutritional sup-

port ensures patients receive sufficient Pro

supply through reasonable dietary adjust-

ments and nutritional supplementation, an

important immunoglobulin component. Re-

combinant Pro intake helps to increase the

synthesis of immunoglobulin.

In conclusion, this study observed a

significant effect of combining regular ex-

ercise with quantitative nutritional support

in improving the nutritional indicators of

HD malnutrition patients and also tested

the levels of humoral and cellular immune

indicators. The results show that regular

exercise combined with quantitative nutri-

tional support can also help improve im-

mune function and have an auxiliary thera-

peutic effect on the immune function of HD

malnourished patients. Its effect becomes

more pronounced with the extension of in-

tervention time. However, the sample size

of this study is relatively small, and the

specific efficacy needs to be confirmed by

expanding the sample size. Secondly, the

causes of malnutrition in dialysis patients

involve multiple factors and mechanisms.

This study only observed changes in nutri-

tional indicators and levels of humoral cel-

lular immune indicators, and its specific

mechanisms require further research in

animal experiments.

Effect of regular exercise and quantitative nutritional support on dialysis patients 355

Vol. 65(3): 346 - 357, 2024

ACKNOWLEDGMENT

We would like to acknowledge the in-

valuable contributions of all those who sup-

ported and assisted in this research.

Conflict of interest

No potential conflict of interest rele-

vant to this article was reported.

Funding

None

Authors’ ORCID number

• Chunfeng Kong:

0000-0002-0163-3569

• Changdong Zhu:

0000-0003-1350-5588

Contribution of authors

Both authors contributed equally to

this study, and their efforts were equally sig-

nificant in its completion.

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