Cardiac stunning during haemodialysis: the therapeutic effect of intra-dialytic exercise

Scott McGuire, Elizabeth J Horton, Derek Renshaw, Klaris Chan, Alfonso Jimenez, Helen Maddock, Nithya Krishnan, Gordon McGregor

Research output: Contribution to journalArticle

3 Downloads (Pure)

Abstract

Background. Cardiovascular risk is elevated in end-stage renal disease. Left ventricular (LV) dysfunction is linked to repetitive transient ischaemia occurring during haemodialysis (HD). Cardiomyocyte ischaemia results in ‘cardiac stunning’, evidenced by regional wall motion abnormalities (RWMAs). Ischaemic RWMA have been documented during HD resulting in maladaptive cardiac remodelling and increased risk of heart failure. Intra-dialytic exercise is well tolerated and can improve quality of life and functional capacity. It may also attenuate HD-induced cardiac stunning.
Methods. This exploratory study aimed to assess the effect of intra-dialytic cycle ergometry on cardiac stunning. Twenty
exercise-naı¨ve participants on maintenance HD (mean 6 SD, 59 6 11 years) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain-derived RWMAs at four time points during (i) standard HD and (ii) HD with 30 min of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90% oxygen uptake at the anaerobic threshold (VO2AT). Central haemodynamics and cardiac troponin I were also assessed.
Results. Compared with HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5 h of HD (total 110 6 4, mean 7 6 4 segments versus total 77 6 3, mean 5 6 3, respectively; P ¼ 0.008). Global cardiac function, intra-dialytic
haemodynamics and LV volumetric parameters were not significantly altered with exercise.
Conclusions. Intra-dialytic exercise reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90% VO2AT was
sufficient to elicit acute cardio-protection. These data potentially demonstrate a novel therapeutic effect of intra-dialytic
exercise.
Original languageEnglish
Article numbersfz159
Number of pages10
JournalCKJ: Clinical Kidney Journal
Volume(In-Press)
DOIs
Publication statusPublished - 17 Dec 2019

Fingerprint

Therapeutic Uses
Renal Dialysis
Ergometry
Ischemia
Anaerobic Threshold
Troponin I
Left Ventricular Dysfunction
Workload
Cardiac Myocytes
Chronic Kidney Failure
Echocardiography
Heart Failure
Hemodynamics
Maintenance
Quality of Life
Oxygen

Bibliographical note

The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords

  • end-stage renal disease
  • global longitudinal strain
  • regional wall motion abnormality

Cite this

Cardiac stunning during haemodialysis: the therapeutic effect of intra-dialytic exercise. / McGuire, Scott; Horton, Elizabeth J; Renshaw, Derek; Chan, Klaris; Jimenez, Alfonso; Maddock, Helen; Krishnan, Nithya; McGregor, Gordon.

In: CKJ: Clinical Kidney Journal, Vol. (In-Press), sfz159, 17.12.2019.

Research output: Contribution to journalArticle

@article{35773c5eb2844814a5a7c4eb1e469fee,
title = "Cardiac stunning during haemodialysis: the therapeutic effect of intra-dialytic exercise",
abstract = "Background. Cardiovascular risk is elevated in end-stage renal disease. Left ventricular (LV) dysfunction is linked to repetitive transient ischaemia occurring during haemodialysis (HD). Cardiomyocyte ischaemia results in ‘cardiac stunning’, evidenced by regional wall motion abnormalities (RWMAs). Ischaemic RWMA have been documented during HD resulting in maladaptive cardiac remodelling and increased risk of heart failure. Intra-dialytic exercise is well tolerated and can improve quality of life and functional capacity. It may also attenuate HD-induced cardiac stunning.Methods. This exploratory study aimed to assess the effect of intra-dialytic cycle ergometry on cardiac stunning. Twentyexercise-naı¨ve participants on maintenance HD (mean 6 SD, 59 6 11 years) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain-derived RWMAs at four time points during (i) standard HD and (ii) HD with 30 min of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90{\%} oxygen uptake at the anaerobic threshold (VO2AT). Central haemodynamics and cardiac troponin I were also assessed.Results. Compared with HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5 h of HD (total 110 6 4, mean 7 6 4 segments versus total 77 6 3, mean 5 6 3, respectively; P ¼ 0.008). Global cardiac function, intra-dialytichaemodynamics and LV volumetric parameters were not significantly altered with exercise.Conclusions. Intra-dialytic exercise reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90{\%} VO2AT wassufficient to elicit acute cardio-protection. These data potentially demonstrate a novel therapeutic effect of intra-dialyticexercise.",
keywords = "end-stage renal disease, global longitudinal strain, regional wall motion abnormality",
author = "Scott McGuire and Horton, {Elizabeth J} and Derek Renshaw and Klaris Chan and Alfonso Jimenez and Helen Maddock and Nithya Krishnan and Gordon McGregor",
note = "The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.",
year = "2019",
month = "12",
day = "17",
doi = "10.1093/ckj/sfz159",
language = "English",
volume = "(In-Press)",
journal = "CKJ: Clinical Kidney Journal",
issn = "2048-8505",
publisher = "Oxford University Press",

}

TY - JOUR

T1 - Cardiac stunning during haemodialysis: the therapeutic effect of intra-dialytic exercise

AU - McGuire, Scott

AU - Horton, Elizabeth J

AU - Renshaw, Derek

AU - Chan, Klaris

AU - Jimenez, Alfonso

AU - Maddock, Helen

AU - Krishnan, Nithya

AU - McGregor, Gordon

N1 - The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

PY - 2019/12/17

Y1 - 2019/12/17

N2 - Background. Cardiovascular risk is elevated in end-stage renal disease. Left ventricular (LV) dysfunction is linked to repetitive transient ischaemia occurring during haemodialysis (HD). Cardiomyocyte ischaemia results in ‘cardiac stunning’, evidenced by regional wall motion abnormalities (RWMAs). Ischaemic RWMA have been documented during HD resulting in maladaptive cardiac remodelling and increased risk of heart failure. Intra-dialytic exercise is well tolerated and can improve quality of life and functional capacity. It may also attenuate HD-induced cardiac stunning.Methods. This exploratory study aimed to assess the effect of intra-dialytic cycle ergometry on cardiac stunning. Twentyexercise-naı¨ve participants on maintenance HD (mean 6 SD, 59 6 11 years) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain-derived RWMAs at four time points during (i) standard HD and (ii) HD with 30 min of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90% oxygen uptake at the anaerobic threshold (VO2AT). Central haemodynamics and cardiac troponin I were also assessed.Results. Compared with HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5 h of HD (total 110 6 4, mean 7 6 4 segments versus total 77 6 3, mean 5 6 3, respectively; P ¼ 0.008). Global cardiac function, intra-dialytichaemodynamics and LV volumetric parameters were not significantly altered with exercise.Conclusions. Intra-dialytic exercise reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90% VO2AT wassufficient to elicit acute cardio-protection. These data potentially demonstrate a novel therapeutic effect of intra-dialyticexercise.

AB - Background. Cardiovascular risk is elevated in end-stage renal disease. Left ventricular (LV) dysfunction is linked to repetitive transient ischaemia occurring during haemodialysis (HD). Cardiomyocyte ischaemia results in ‘cardiac stunning’, evidenced by regional wall motion abnormalities (RWMAs). Ischaemic RWMA have been documented during HD resulting in maladaptive cardiac remodelling and increased risk of heart failure. Intra-dialytic exercise is well tolerated and can improve quality of life and functional capacity. It may also attenuate HD-induced cardiac stunning.Methods. This exploratory study aimed to assess the effect of intra-dialytic cycle ergometry on cardiac stunning. Twentyexercise-naı¨ve participants on maintenance HD (mean 6 SD, 59 6 11 years) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain-derived RWMAs at four time points during (i) standard HD and (ii) HD with 30 min of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90% oxygen uptake at the anaerobic threshold (VO2AT). Central haemodynamics and cardiac troponin I were also assessed.Results. Compared with HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5 h of HD (total 110 6 4, mean 7 6 4 segments versus total 77 6 3, mean 5 6 3, respectively; P ¼ 0.008). Global cardiac function, intra-dialytichaemodynamics and LV volumetric parameters were not significantly altered with exercise.Conclusions. Intra-dialytic exercise reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90% VO2AT wassufficient to elicit acute cardio-protection. These data potentially demonstrate a novel therapeutic effect of intra-dialyticexercise.

KW - end-stage renal disease

KW - global longitudinal strain

KW - regional wall motion abnormality

UR - https://doi.org/10.1093/ckj/sfz159

U2 - 10.1093/ckj/sfz159

DO - 10.1093/ckj/sfz159

M3 - Article

VL - (In-Press)

JO - CKJ: Clinical Kidney Journal

JF - CKJ: Clinical Kidney Journal

SN - 2048-8505

M1 - sfz159

ER -