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

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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
Pages (from-to)1-10
Number of pages10
JournalCKJ: Clinical Kidney Journal
Volume(In-Press)
DOIs
Publication statusPublished - 17 Dec 2019

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

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