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Abstract: SA-OR064

The Effects of a 6-Month Structured Programme of Intradialytic Cycling on Cardiovascular Remodelling, Myocardial Fibrosis, and Aortic Stiffness: Results from the CYCLE-HD Study

Session Information

  • Hemodialysis Potpourri
    November 09, 2019 | Location: 144, Walter E. Washington Convention Center
    Abstract Time: 05:42 PM - 05:54 PM

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Graham-Brown, Matthew P.M., University of Leicester, Leicester, United Kingdom
  • March, Daniel Scott, University of Leicester, Leicester, United Kingdom
  • Hull, Katherine Leigh, University Hospitals of Leicester NHS Trust, Coventry, United Kingdom
  • Wormleighton, Joanne V., University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
  • Young, Robin, University of Glasgow, Glasgow, United Kingdom
  • Mccann, Gerry Patrick, University of Leicester, Leicester, United Kingdom
  • Burton, James, University of Leicester, Leicester, United Kingdom
Background

Cardiovascular disease (CVD) is the leading cause of death in patients on haemodialysis (HD). Traditional and non-traditional risk factors drive pathological changes in cardiovascular structure that relate directly to outcomes, including elevated LV mass (LVM), adverse LV remodelling (LVM/LVEDV), myocardial fibrosis (MF) and aortic stiffness. Exercise improves many of the risk factors that drive these processes. In this study we assessed the effects of a 6-month programme of intra-dialytic cycling (IDC) compared to usual care on prognostically significant measures of CVD in HD patients using cardiac MRI (CMR).

Methods

In an open-label, blinded end-point, cluster randomised controlled trial, adults undergoing maintenance HD were assigned to either a 6-month structured programme of IDC or usual care. Subjects underwent CMR scanning with assessment of LVM, LVM/LVEDV, native T1 mapping and aortic pulse wave velocity (aPWV) at baseline and study completion. Outcomes were analysed as intention-to-treat, using linear mixed-effects models, adjusted for baseline value.

Results

130 subjects completed baseline assessments (65 per group) with 101 completing the study protocol (control group n=50, IDC group n=51). Patient demographics were well matched between groups. There was a significant between group reduction in LVM of -11.1g (95% CI -15.8,-6.4, p<0.001) with reverse LV remodelling (LVM/LVEDV) -0.07g/ml (95% CI -0.12,-0.07, p<0.01) favouring the IDC group. There was a significant reduction in native T1 between groups over the study period of -32.2ms [95% CI -46.1,-18.3, p<0.001), with significant reductions in septal native T1 (-23.8ms [95% CI -37.2,-10.3]) and non-septal native T1 (-37.5ms [95% CI -54.3,-20.7]) favouring the IDC group (both p<0.001). There was a significant improvement in aPWV between groups over the study period of -2.07ms-1 (95% CI -3.16,-0.99, p<0.01) favouring the IDC group.

Conclusion

A 6-month programme of IDC associated with significant reductions in LVM and reverse LV remodelling, as well as reductions in native T1 and aPWV. These data suggest IDC is associated with beneficial LV remodelling, improvements in extent of MF and severity of aortic stiffness compared to usual care HD.

Funding

  • Other NIH Support