Background: The specific training of respiratory muscles may be a useful alternative for patients with chronic kidney disease because the conditioning and strengthening of respiratory muscles can delay the complications of loss of muscle mass.
The aim of the work: The study aim was to examine the effect of intra dialytic respiratory muscle training on cardiopulmonary efficiency in hemodialysis patients.  
Patients and Methods: From both sexes, sixty patients with chronic kidney disease participated in this study. They were aged 48 to 60 years old. Patients were randomly assigned to two groups; Study and control groups. The study group (n=30) received a daily morning and evening 20-minute diaphragmatic breathing exercise and intra dialytic 10- minute respiratory muscle training (RMT) by Sonmol respiratory trainer device three times per week for 12 weeks. The control group (n=30) received a daily morning and evening 20-minute diaphragmatic breathing exercise alone. The patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), two-minute walk test (2MWT), peak expiratory pressure (PEP), and left ventricular ejection fraction (LVEF) were assessed in both groups twice pre-study and after 12 weeks at the end of the study.
Results: A significant improvement in SBP, DBP, 2MWT, PEP, LVEF was documented within both groups, but the improvements of group A were higher than group B. Between-group analysis of post-values of outcomes showed a significant improvement in all outcomes at toward group A: PEP(cmH₂O) improved by 29.59 %, LVEF (%) improved by 8.5 %, 2MWT(meter) improved by 19.32 %, SBP (mmHg) improved by 4.79 %, DBP(mmHg) improved by 5.10 %.
Conclusion: This trial suggests that adding 12-week RMT to diaphragmatic breathing exercise maximizes the significant improvement of outcomes (PEP, LVEF, 2MWT, SBP, and DBP) gained from diaphragmatic breathing exercise.