Exercise during hemodialysis does not affect the phenotype or prothrombotic nature of microparticles but alters their proinflammatory function

Abstract

Hemodialysis patients have dysfunctional immune systems, chronic inflammation and comorbidity‐associated risks of cardiovascular disease (CVD) and infection. Microparticles are biologically active nanovesicles shed from activated endothelial cells, immune cells, and platelets; they are elevated in hemodialysis patients and are associated with chronic inflammation and predictive of CVD mortality in this group. Exercise is advocated in hemodialysis to improve cardiovascular health yet acute exercise induces an increase in circulating microparticles in healthy populations. Therefore, this study aimed to assess acute effect of intradialytic exercise (IDE) on microparticle number and phenotype, and their ability to induce endothelial cell reactive oxygen species (ROS) in vitro. Eleven patients were studied during a routine hemodialysis session and one where they exercised in a randomized cross‐over design. Microparticle number increased during hemodialysis (2064–7071 microparticles/μL, P < 0.001) as did phosphatidylserine+ (P < 0.05), platelet‐derived (P < 0.01) and percentage procoagulant neutrophil‐derived microparticles (P < 0.05), but this was not affected by IDE. However, microparticles collected immediately and 60 min after IDE (but not later) induced greater ROS generation from cultured endothelial cells (P < 0.05), suggesting a transient proinflammatory event. In summary IDE does not further increase prothrombotic microparticle numbers that occurs during hemodialysis. However, given acute proinflammatory responses to exercise stimulate an adaptation toward a circulating anti‐inflammatory environment, microparticle‐induced transient increases of endothelial cell ROS in vitro with IDE may indicate the potential for a longer‐term anti‐inflammatory adaptive effect. These findings provide a crucial evidence base for future studies of microparticles responses to IDE in view of the exceptionally high risk of CVD in these patients.

Intradialytic cycling does not exacerbate microparticles or circulating markers of systemic inflammation in haemodialysis patients

“…Circulating concentrations of MPs derived from endothelial cells, platelets and monocytes are increased in patients with renal failure, and associate with vascular dysfunction (Daniel et al 2008). The MP results of this study mimic those investigating acute IDC (Martin et al 2018), and as such it may be that the exercise was not of a sufficient intensity in either case to elicit significant reductions in circulating MP concentrations, either acutely or on a long-term basis. However, as the mean power outputs achieved in this study were similar to those of previous IDC research (~ 21-22 W) (Dungey et al 2015;Martin et al 2018), this exercise intensity is likely to be representative of what can be reasonably expected of HD patients.…”

The role of physical activity and miRNAs in the vascular aging and cardiac health of dialysis patients

“…Intradialytic exercise intervention is considered to be an effective nonpharmacological treatment for cardiovascular comorbidities in CKD‐5D patients (Andrade et al, 2019); (Martin et al, 2018); (Shlipak et al, 2021). For this purpose, exceptional benefits were found for the combination of resistance and aerobic exercises during dialysis.…”

Influence of acute moderate- to high-intensity aerobic exercise on markers of immune function and microparticles in renal transplant recipients

“…Microparticles (MPs) are small (0.1-1.0 m) extracellular vesicles shed by all cell types upon cellular activation or apoptosis and exhibit prothrombotic functions via externally expressed tissue factor (TF) (25), thus promoting CVD. Circulating MP numbers are elevated and display prothrombotic properties in CKD and renal failure (6,22) and are only partially reduced after renal transplantation (1), although research in RTRs is scarce.…”

“…Furthermore, in the general population, acute aerobic exercise has had mixed effects on circulating MP counts (5,14), whereas regular aerobic exercise training reduces circulating MP levels and vascular resistance, possibly via reduced ACE-mediated renin-angiotensin system activation (4,9,45). Acute moderate-intensity aerobic exercise may also promote increased procoagulant activity via increased TF ϩ monocytederived MPs in untrained individuals (33) and increased MP reactive oxygen species release in patients undergoing hemodialysis (22), possibly indicating a transiently increased cardiovascular risk.…”