The effect of acute intradialytic exercise on cardiovascular responses in hemodialysis patients


In patients with kidney failure requiring hemodialysis (HD) treatment, intradialytic exercise (IDEX, exercise during HD treatment) has been advocated for its feasibility and effectiveness for improving important health outcomes. However, IDEX as an adjunct therapeutic strategy is infrequently implemented, in part due to potential risks of IDEX. The purpose of this study was to evaluate the safety of IDEX by examining its effect on intradialytic cardiovascular (CV) hemodynamics. Intradialytic changes in brachial, aortic and cardiac hemodynamics and autonomic function were examined during a normal HD session without exercise, or when 30-minutes of cycling exercise was performed during the 1st- or 3rd-hour into HD in 12 HD patients. IDEX performed during either the 1st- or 3rd- hour does not appear to exacerbate hemodynamic instability during HD. While there were transient increases in stroke volume, cardiac output and heart rate during IDEX, the intradialytic changes in brachial and aortic blood pressure (BP) parameters, cardiac hemodynamics and autonomic function were similar on days with and without IDEX. This null effect of IDEX on hemodynamic parameters during HD was demonstrated regardless of the timing of exercise and patients’ underlying CV characteristics. Patient hydration status was correlated with the magnitude of BP drop and autonomic dysfunction, and increasing sympathetic activity was also correlated with drops in BP during HD. These results indicate that IDEX does not exacerbate hemodynamic instability during HD regardless of hydration status and the timing of the exercise. We also observed the potential roles of overhydration and autonomic dysfunction on hemodynamic regulation during HD. These results should help to improve our understanding regarding the CV safety of IDEX

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