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Abstract: SA-PO373

Intradialytic Exercise on Cardiac Response to Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Hur, Lisa, Western University, London, Ontario, Canada
  • Penny, Jarrin D., London Health Sciences Centre London Kidney Clinical Research Unit, London, Ontario, Canada
  • Dorie, Justin R., London Health Sciences Centre London Kidney Clinical Research Unit, London, Ontario, Canada
  • McIntyre, Christopher W., London Health Sciences Centre London Kidney Clinical Research Unit, London, Ontario, Canada

Hemodialysis (HD) is associated with high rates of cardiovascular mortality due to recurrent cardiac ischemia-reperfusion injury during each HD session. Intradialytic exercise (IDE) can improve intradialytic hemodynamic tolerability, although its mechanisms remain elusive. The objective of the present study was to use intradialytic CT perfusion imaging and echocardiography to evaluate cardiac injury during HD with and without exercise.


10 participants underwent two intradialytic imaging sessions: (1) the control visit (no IDE) and (2) the IDE visit, cycling on a stationary ergometer during the first 30 mins of HD treatment. In both visits, dynamic contrast-enhanced CT scans (Revolution CT, GE) were conducted at baseline, peak HD stress, and 30 mins post HD. Following each dynamic CT scan, apical 4-chamber and 2-chamber views of the heart were acquired with 2D echocardiography (Vivid Q, GE). The dynamic CT images were analyzed using the Johnson-Wilson-Lee tracer kinetic model to quantify global myocardial perfusion (MP) of the left ventricle. Using echocardiography, systolic function was evaluated by measuring segmental longitudinal strain (LS) using commercially available software (EchoPAC, GE). Myocardial segments demonstrating >20% reduction in LS compared to baseline were defined as regional wall motion abnormalities (RWMA).


During the control visit, MP significantly dropped from baseline to peak HD stress (1.0 ± 0.4 to 0.8 ± 0.2 ml/min/g, p=0.02, Fig 1A), followed by partial recovery post HD (0.9 ± 0.2 ml/min/g, p=0.5, Fig 1A). Similar results were found during the exercise visit (baseline: 0.9 ± 0.3 ml/min/g, peak HD: 0.7 ± 0.1 ml/min/g, post HD: 0.8 ± 0.2 ml/min/g, p=0.05, Fig 1B). MP of control and exercise visits were not significantly different. The number of myocardial segments experiencing RWMA at peak stress were comparable between the two visits (5 segments, Fig 2). However, fewer RWMAs post HD were observed with intradialytic exercise compared to no exercise (p=0.2).


Preliminary results indicate that MP response to HD remain unaffected by the IDE. A decrease in the number of RWMAs post-HD with exercise suggests potential exercise-associated cardiac resilience to HD-induced cardiac injury.