Abstract
Introduction: Mortality rates are high in end-stage renal disease due to cardiovascular complications. Perfusion of the myocardium declines during and after hemodialysis sessions with the potential for aerobic exercise to mitigate these during hemodialysis. Objectives: The purpose of this study was to investigate acute changes in hemodynamics in subjects with end-stage renal disease (ESRD) during exercise. Patients and Methods: Subjects (n = 10) were monitored for 1.5 hours during hemodialysis treatment during a control (CON) and an exercise (EX) session. Subjects cycled using an ergometer strapped to the reclining dialysis chair at an RPE of 11-13 for 30 minutes during the EX session beginning at 30 min into dialysis and ending at 60 minutes. Data for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were collected using an automated blood pressure cuff attached to the hemodialysis machine. Data for cardiac output (Q̇ ), cardiac power index (CPI), stroke volume (SV), systemic vascular resistance (SVR), and heart rate (HR) were collected using the NICaS bioelectrical impedance device. Results: During the EX session, CPI, Q̇ , SV, and HR were significantly greater (P<0.05) than the CON session. Additionally, Q̇ was significantly (P< 0.05) greater at 45 minutes and 60 minutes compared to 15 minutes. HR was significantly (P<0.05) greater at 45 minutes compared to 90 minutes. No significant interactions were found for MAP, CPI, Q̇ , HR, SV, SBP, DBP, or SVR. Conclusion: In conclusion, exercise during dialysis may decrease the likelihood of experiencing ischemic or hypotensive events by enhancing myocardial perfusion through increasing CPI and Q̇ .
Highlights
Mortality rates are high in end-stage renal disease due to cardiovascular complications
End-stage renal disease (ESRD) is present in 15 per 10 000 people in first world countries and these individuals are more prone to developing cardiovascular disease (CVD) (1)
Patients and Methods A repeated measures study design was used to determine the effect of an acute bout of intradialytic exercise on hemodynamics in end-stage renal disease (ESRD) subjects using the NICaS bioelectrical impedance device (NICaS, NI Medical, Peta Tikva, Israel) and an automated blood pressure device attached to the dialysis machine (2008T Hemodialysis Machine, Fresenius, USA)
Summary
Mortality rates are high in end-stage renal disease due to cardiovascular complications. Objectives: The purpose of this study was to investigate acute changes in hemodynamics in subjects with end-stage renal disease (ESRD) during exercise. Patients and Methods: Subjects (n = 10) were monitored for 1.5 hours during hemodialysis treatment during a control (CON) and an exercise (EX) session. End-stage renal disease (ESRD) is present in 15 per 10 000 people in first world countries and these individuals are more prone to developing cardiovascular disease (CVD) (1). Low exercise capacities in ESRD patients contributes to abnormally high mortality rates (4). Patients with impaired renal function display lower glomerular filtration rates (GFR) and present with elevated serum creatinine and blood urea nitrogen levels from damage to nephrons (1). ESRD patients must undergo renal replacement therapy through hemodialysis, peritoneal dialysis, or kidney transplantation (1).
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