Kidney Week

Abstract: FR-PO447

Cardiac Stunning During Haemodialysis: The Therapeutic Effect of Intradialytic Cycling

Session Information

• Hemodialysis and Frequent Dialysis - III
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Mcguire, Scott, Coventry University, Coventry, United Kingdom

Scott Mcguire,

• Mcgregor, Gordon, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom

Gordon Mcgregor,

• Krishnan, Nithya, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom

Nithya Krishnan,

• Renshaw, Derek, Coventry University, Coventry, United Kingdom

Derek Renshaw,

• Horton, Elizabeth, Coventry University, Coventry, United Kingdom

Elizabeth Horton,

Background

Cardiovascular risk is elevated in end stage renal disease (ESRD). Left ventricular dysfunction is linked to repetitive transient ischemia occurring during maintenance haemodialysis (HD); cardiac stunning can subsequently occur defined as myocardial regional wall motion abnormalities (RWMA). Ischemic 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 physical function. It may also attenuate HD induced cardiac stunning. The aim of this exploratory study was to assess the effect of intra-dialytic cycle ergometry on cardiac stunning.

Methods

Twenty exercise naïve participants on maintenance HD (59 ± 11 yrs) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain derived RWMAs at four time-points during 1) standard HD, and 2) HD with 30 mins of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90% of oxygen uptake at the anaerobic threshold (VO₂AT).

Results

Compared to HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5hrs of HD had elapsed (Total 110 ± 4, mean 7 ± 4 segments vs. total 77 ± 3, mean 5 ± 3 respectively; p = 0.008). Global cardiac function, intra-dialytic haemodynamics and left ventricular volumetric parameters were not significantly altered with exercise.

Conclusion

Intra-dialytic exercise, completed after one hour of maintenance HD, significantly reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90% VO₂AT was sufficient to elicit this acute cardio-protective response.

Regional wall motion abnormalities during haemodialysis. At 2.5h-HD, the number of regional wall motion abnormalities was significantly reduced with intradialytic exercise (HD+CLE).

Funding

• Commercial Support –