The haemodynamic response to submaximal exercise during isovolaemic haemodialysis

Banerjee, Anindya; Kong, Chiew H.; Farrington, Ken

doi:10.1093/ndt/gfh237

Cited by 27 publications

(20 citation statements)

References 16 publications

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“…Other studies have also observed an increase in SBP during a bout of intradialytic exercise from as little as 10 min duration [30,31,32]. These studies concluded that exercise during HD is met with a stable haemodynamic response; the cardiovascular response to exercise is normal and superimposed onto the response to HD.…”

Section: Discussionmentioning

confidence: 85%

The Impact of Exercising During Haemodialysis on Blood Pressure, Markers of Cardiac Injury and Systemic Inflammation - Preliminary Results of a Pilot Study

Dungey¹,

Bishop

Young³

et al. 2015

Kidney Blood Press Res

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Background/Aims: Patients requiring haemodialysis have cardiovascular and immune dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise has numerous health benefits but in other populations has a profound impact upon blood pressure, inflammation and immune function; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population. Methods: Fifteen patients took part in a randomised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis. We assessed blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation. Results: Exercise increased blood pressure immediately post-exercise; however, 1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm Hg). No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms. Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress neutrophil function. Conclusions: This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise. However, since the fall in blood pressure occurred without evidence of cardiac injury, we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well tolerated.

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Section: Discussionmentioning

confidence: 85%

The Impact of Exercising During Haemodialysis on Blood Pressure, Markers of Cardiac Injury and Systemic Inflammation - Preliminary Results of a Pilot Study

Dungey¹,

Bishop

Young³

et al. 2015

Kidney Blood Press Res

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“…For intradialytic exercise, it is safer to train during the first 2 h of the HD session because, after 2 h of dialysis, shifting of fluid from the microvasculature to the interstitium during exercise can cause a rapid reduction in relative blood volume [87] with accompanying cardiovascular decompensation which may preclude further exercise. …”

Section: Practical Methods For Applying Exercise Therapymentioning

confidence: 99%

Physical Exercise in Patients with Severe Kidney Disease

et al. 2010

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Patients with advanced chronic kidney disease (CKD), especially those on long-term dialysis, often suffer from muscle wasting and excessive fatigue. It is known that inactivity, muscle wasting and reduced physical functioning are associated with increased mortality in CKD. Known causes include uraemic myopathy and neuropathy, inactivity, and anaemia. Exercise in patients receiving regular dialysis treatment for end-stage renal disease was first introduced 3 decades ago, but is still only offered in a minority of renal units around the world, despite a significant body of evidence to support its use. Work is needed to increase awareness of the potential benefits of increased physical activity for patients with advanced CKD. This review summarizes the mechanisms of exercise intolerance and debility in advanced CKD patients, the methods used for the estimation of functional capacity, the options currently available for exercise training, and their influence on the well-being of this group of patients.

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“…Monitored plasma protein concentrations would not change if this were the sole effect of food intake. Alternatively, food-induced fluid translocation from the microcirculation to the interstitium would lead to a rise in both haematocrit and plasma protein concentrations [8] . We used continuous segmental bioimpedance (CSBI) techniques to track changes in extracellular fluid (ECF) resistance during HD [9] , and non-invasively tracked CO by a thoracic bioimpedance technique, the findings of which correlate well with those of conventional thermodilution [10] .…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic Effects of Food Intake during Haemodialysis

Sivalingam

Banerjee²,

Nevett³

et al. 2008

Blood Purif

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Background: There is some doubt whether food intake during haemodialysis (HD) is detrimental to haemodynamic stability. Methods: We studied 20 stable non-diabetic HD patients during a single session. A standard meal was given 45 min into dialysis. Relative blood volume (RBV), cardiac output (CO), systemic vascular resistance (SVR) and extracellular fluid (ECF) resistance were monitored continuously. Total protein and albumin were measured. Results: There was a significant reduction in RBV after food ingestion (maximum reduction 3.4 ± 1.1%; p < 0.001). There was no significant change in ECF resistance, heart rate, CO or SVR. Mean arterial pressure was significantly different from pre-food levels 30 min after food (p = 0.04). The rate of change of total protein and albumin concentration was significantly higher immediately after food ingestion. Conclusions: Food intake during HD caused significant reductions in RBV, possibly related to fluid shifts from intestinal microcirculation to interstitium. CO and SVR remained stable perhaps because of the opposing effects of food ingestion and UF.

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The haemodynamic response to submaximal exercise during isovolaemic haemodialysis

Abstract: The haemodynamic response to exercise during haemodialysis is comparable with that in normal individuals. The rapid reduction in RBV on exercise occurs in spite of a significant increase in CO, mainly as a consequence of fluid shifts from the microvasculature to the interstitium.

Cited by 27 publications

References 16 publications

The Impact of Exercising During Haemodialysis on Blood Pressure, Markers of Cardiac Injury and Systemic Inflammation - Preliminary Results of a Pilot Study

The Impact of Exercising During Haemodialysis on Blood Pressure, Markers of Cardiac Injury and Systemic Inflammation - Preliminary Results of a Pilot Study

Physical Exercise in Patients with Severe Kidney Disease

Haemodynamic Effects of Food Intake during Haemodialysis

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