A randomized controlled trial to investigate the effects of intra-dialytic cycling on left ventricular mass

Graham-Brown, Matthew P M; March, Daniel S.; Young, Robin; Highton, Patrick J; Young, Hannah; Churchward, Darren R; Dungey, Maurice; Stensel, David J.; Bishop, Nicolette C.; Brunskill, Nigel J.; Smith, Alice C.; McCann, Gerry P; McConnachie, Alex; Burton, James O.

doi:10.1016/j.kint.2021.02.027

Cited by 47 publications

(62 citation statements)

References 45 publications

(43 reference statements)

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“…[ 33 , 44 ] In this context, native T 1 effectively served as surrogate endpoint in a randomised trial exploring the effect of a program of intradialytic cycling, which was associated with reductions in LV mass, native T 1 values and pulse wave velocity. [ 45 ]…”

Section: T 1 and T 2 Mappingmentioning

confidence: 99%

T1 and T2 Mapping in Uremic Cardiomyopathy: An Update

Arcari¹,

Camastra²,

Ciolina³

et al. 2022

Card Fail Rev

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Uremic cardiomyopathy (UC) is the cardiac remodelling that occurs in patients with chronic kidney disease (CKD). It is characterised by a left ventricular (LV) hypertrophy phenotype, diastolic dysfunction and generally preserved LV ejection fraction. UC has a major role mediating the increased rate of cardiovascular events, especially heart failure related, observed in patients with CKD. Recently, the use of T1 and T2 mapping techniques on cardiac MRI has expanded the ability to characterise cardiac involvement in CKD. Native T1 mapping effectively tracks the progression of interstitial fibrosis in UC, whereas T2 mapping analysis suggests the contribution of myocardial oedema, at least in a subgroup of patients. Both T1 and T2 increased values were related to worsening clinical status, myocardial injury and B-type natriuretic peptide release. Studies investigating the prognostic relevance and histology validation of mapping techniques in CKD are awaited.

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Section: T 1 and T 2 Mappingmentioning

confidence: 99%

T1 and T2 Mapping in Uremic Cardiomyopathy: An Update

Arcari¹,

Camastra²,

Ciolina³

et al. 2022

Card Fail Rev

View full text Add to dashboard Cite

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“…A recent RCT in 130 participants receiving prevalent haemodialysis has indicated that a six-month programme of 30 min moderate intensity (at an RPE of 12–14) intradialytic cycling was able to reduce left ventricular mass (between group reduction of − 11.1 g, P < 0.001 for between group change) and improve other measures of cardiovascular health compared to a usual care control group [ 96 ]. This is in agreement with the results of two smaller studies showing the benefits of single intradialytic cycling sessions on cardiovascular health [ 97 , 98 ].…”

Section: Haemodialysismentioning

confidence: 99%

“…This is in agreement with the results of two smaller studies showing the benefits of single intradialytic cycling sessions on cardiovascular health [ 97 , 98 ]. The six-month programme in the aforementioned RCT [ 19 ] was delivered and supervised by trained members of the research team and reported exercise programme adherence levels to be > 70% [ 96 ]. Furthermore, a cost analysis of this trial showed that the six-month programme of intradialytic cycling was cost-effective (which appeared to be driven by a reduction in hospitalisations) [ 99 ] - this analysis included the costs associated with implementing the intervention (equipment and staff).…”

Section: Haemodialysismentioning

confidence: 99%

“…Results from the recent PEDAL trial, which investigated the effect of a 6-month programme of intradialytic exercise on Kidney Disease Quality of Life Short Form Physical Composite Score (PCS) in 335 randomised participants demonstrated that aerobic-only intra-dialytic cycling did not statistically improve HRQoL in a deconditioned population receiving haemodialysis therapy [ 110 ]. Moreover, the recent Cycle-HD trial [ 96 ] (which was not powered for HRQoL) also reported that a 6-month programme of aerobic intradialytic cycling did not statistically improve the EQ-5D-5L score, or both the physical and mental component scores of the SF-12. Resultantly, we have not provided a recommendation for HRQoL in this guideline.…”

Section: Haemodialysismentioning

confidence: 99%

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Clinical practice guideline exercise and lifestyle in chronic kidney disease

et al. 2022

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“…In this setting, it appears that exercise training protects executive function ( 126 ). Moreover, exercise training can also be delivered during dialysis, often using cycling, and has also a wide range of potential benefits including greater cardiovascular and vascular health ( 127 ). Cognitive training has been shown to have beneficial impact on multiple domains of cognitive function, including executive function, memory, abstraction, and verbal reasoning in older adults ( 128 )—although evidence of persistence of effect or translation to improvements in function is lacking.…”

Section: Improving the Outcomes—management Of Cognitive Impairment In Kfrtmentioning

confidence: 99%

“Is It Removed During Dialysis?”—Cognitive Dysfunction in Advanced Kidney Failure—A Review Article

et al. 2021

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Cognitive impairment is independently associated with kidney disease and increases in prevalence with declining kidney function. At the stage where kidney replacement therapy is required, with dialysis or transplantation, cognitive impairment is up to three times more common, and can present at a younger age. This is not a new phenomenon. The cognitive interactions of kidney disease are long recognized from historical accounts of uremic encephalopathy and so-called “dialysis dementia” to the more recent recognition of cognitive impairment in those undergoing kidney replacement therapy (KRT). The understanding of cognitive impairment as an extra-renal complication of kidney failure and effect of its treatments is a rapidly developing area of renal medicine. Multiple proposed mechanisms contribute to this burden. Advanced vascular aging, significant multi-morbidity, mood disorders, and sleep dysregulation are common in addition to the disease-specific effects of uremic toxins, chronic inflammation, and the effect of dialysis itself. The impact of cognitive impairment on people living with kidney disease is vast ranging from increased hospitalization and mortality to decreased quality of life and altered decision making. Assessment of cognition in patients attending for renal care could have benefits. However, in the context of a busy clinical service, a pragmatic approach to assessing cognitive function is necessary and requires consideration of the purpose of testing and resources available. Limited evidence exists to support treatments to mitigate the degree of cognitive impairment observed, but promising interventions include physical or cognitive exercise, alteration to the dialysis treatment and kidney transplantation. In this review we present the history of cognitive impairment in those with kidney failure, and the current understanding of the mechanisms, effects, and implications of impaired cognition. We provide a practical approach to clinical assessment and discuss evidence-supported treatments and future directions in this ever-expanding area which is pivotal to our patients' quality and quantity of life.

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A randomized controlled trial to investigate the effects of intra-dialytic cycling on left ventricular mass

Cited by 47 publications

References 45 publications

T1 and T2 Mapping in Uremic Cardiomyopathy: An Update

T1 and T2 Mapping in Uremic Cardiomyopathy: An Update

Clinical practice guideline exercise and lifestyle in chronic kidney disease

“Is It Removed During Dialysis?”—Cognitive Dysfunction in Advanced Kidney Failure—A Review Article

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