Effect of intradialytic exercise training on hemodialysis-induced myocardial stunning: a pilot-controlled trial

Hemodialysis (HD) can lead to left ventricular (LV) transient regional wall motion abnormalities (RWMAs), due to segmental hypoperfusion, better known as myocardial stunning. Repeated episodes of HD-induced ischemia contribute directly to the development of heart failure and increased mortality in p...

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Published in:Clinical kidney journal Vol. 18; no. 1; p. sfae352
Main Authors: Josse, Matthieu, Patrier, Laure, Cristol, Jean-Paul, Isnard, Myriam, Grandperrin, Antoine, Turc-Baron, Cécile, Nottin, Stéphane, Mandigout, Stéphane, Maufrais, Claire, Obert, Philippe
Format: Journal Article
Language:English
Published: England Oxford University Press 01.01.2025
Subjects:
Cardiology and cardiovascular system
France
Hemodialysis
Human health and pathology
Ischemia
Life Sciences
Medical research
Medicine, Experimental
Mortality
Original
Tissues and Organs
Urology and Nephrology
Weight training
France
hemodialysis
cardiovascular disease
echocardiography
ISSN:2048-8505, 2048-8513
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Summary:Hemodialysis (HD) can lead to left ventricular (LV) transient regional wall motion abnormalities (RWMAs), due to segmental hypoperfusion, better known as myocardial stunning. Repeated episodes of HD-induced ischemia contribute directly to the development of heart failure and increased mortality in patients receiving HD. Intradialytic exercise (IDE) training is capable of exerting favorable effects on the cardiovascular system. However, its impact on HD-induced myocardial stunning remains currently unknown. In this prospective controlled study, 31 patients participating in an intradialytic aerobic and resistance training program (3/week for 16 weeks) were compared with 30 patients receiving usual care. Two-dimensional echocardiography was performed at baseline and follow-up both just before HD onset (T ) and at peak stress of HD (T ). LV longitudinal strain from an 18-segment model were used to assess the presence of RWMAs. Training resulted in a significant reduction of RWMAs at T between groups [-2.22 segments; 95% confidence interval (CI) -0.49/-3.96;  = .01]. Compared with usual care, trained patients demonstrated also a greater reduction in the decline of global longitudinal strain during HD (-1.45%; 95% CI -0.24/-2.66;  = .01). There were significant reductions in LV mass (-23.3 g; 95% CI -8.7/-37.9;  = .002) and improvements in LV ejection fraction (4%; 95% CI 1.5/6.6;  = .002) between groups favoring IDE. Correlations were found between change in RWMAs with change in LV mass and ejection fraction over the study period. IDE training is cardioprotective, improving LV remodeling and reducing HD-induced myocardial stunning.
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ISSN:2048-8505
2048-8513
DOI:10.1093/ckj/sfae352