The impact of acute intradialytic exercise on cardioprotection

People with end-stage kidney disease (ESKD) have a greatly increased incidence of cardiovascular events and mortality. While the pathogenesis of heart disease in ESKD is multifactorial, haemodialysis (HD) is recognised as an independent risk factor. It is associated with intradialytic hypotension (IDH) and acute left-ventricular myocardial wall motion abnormalities, known as myocardial stunning. 

This prospective, open-label, two-centre randomised crossover trial explored the effects of acute intradialytic exercise (IDE) on individuals with ESRD receiving HD. Participants (n=60; mean age 63±14 years; 72% male) were assigned to take part in two sessions – standard HD and HD incorporating 30 minutes of aerobic exercise (HDEX). Using speckle-tracking echocardiography analysis, global longitudinal strain (GLS) was measured at baseline (T0), after 90 minutes of HD (T1) and 30 minutes before ending HD (T2). Circumferential strain and peak twist were measured at T0 and T2.

A decline in GLS was observed from T0 to T2 during standard HD, but was significantly attenuated in the HDEX sessions (estimated difference, –1.16%; P=0.008]. This attenuation offers preliminary evidence that IDE provides cardiac protection, as a reduction in GLS is associated with worse outcomes in this population. 

Compared to HD, HDEX also demonstrated greater improvements from T0 to T2 in circumferential strain and in twist, an important component in left-ventricular myocardial function. 

Left-ventricular transient dysfunction from repetitive HD may result in long-term overt cardiac dysfunction and increased risk of cardiac events and mortality. The cardioprotection conferred by IDE in this study warrants consideration, therefore, as a therapeutic approach for people with stable ESKD.

The full study can be read here.