Cargando…
Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise
Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intradialytic hypotension (IDH) can be as high as 20–30%, contributing to subclinical, transient myocardial ischemia. In the long term, this results in progressive...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848102/ https://www.ncbi.nlm.nih.gov/pubmed/29682559 http://dx.doi.org/10.1155/2018/8276912 |
_version_ | 1783305822137221120 |
---|---|
author | McGuire, Scott Horton, Elizabeth Jane Renshaw, Derek Jimenez, Alofonso Krishnan, Nithya McGregor, Gordon |
author_facet | McGuire, Scott Horton, Elizabeth Jane Renshaw, Derek Jimenez, Alofonso Krishnan, Nithya McGregor, Gordon |
author_sort | McGuire, Scott |
collection | PubMed |
description | Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intradialytic hypotension (IDH) can be as high as 20–30%, contributing to subclinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodeling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are suboptimal. Whilst a programme of intradialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intradialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intradialytic exercise with a view to determining the potential for this nonmedical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion, and reduce cardiovascular morbidity and mortality in ESRD. |
format | Online Article Text |
id | pubmed-5848102 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-58481022018-04-22 Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise McGuire, Scott Horton, Elizabeth Jane Renshaw, Derek Jimenez, Alofonso Krishnan, Nithya McGregor, Gordon Biomed Res Int Review Article Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intradialytic hypotension (IDH) can be as high as 20–30%, contributing to subclinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodeling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are suboptimal. Whilst a programme of intradialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intradialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intradialytic exercise with a view to determining the potential for this nonmedical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion, and reduce cardiovascular morbidity and mortality in ESRD. Hindawi 2018-02-27 /pmc/articles/PMC5848102/ /pubmed/29682559 http://dx.doi.org/10.1155/2018/8276912 Text en Copyright © 2018 Scott McGuire et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Article McGuire, Scott Horton, Elizabeth Jane Renshaw, Derek Jimenez, Alofonso Krishnan, Nithya McGregor, Gordon Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise |
title | Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise |
title_full | Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise |
title_fullStr | Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise |
title_full_unstemmed | Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise |
title_short | Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise |
title_sort | hemodynamic instability during dialysis: the potential role of intradialytic exercise |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848102/ https://www.ncbi.nlm.nih.gov/pubmed/29682559 http://dx.doi.org/10.1155/2018/8276912 |
work_keys_str_mv | AT mcguirescott hemodynamicinstabilityduringdialysisthepotentialroleofintradialyticexercise AT hortonelizabethjane hemodynamicinstabilityduringdialysisthepotentialroleofintradialyticexercise AT renshawderek hemodynamicinstabilityduringdialysisthepotentialroleofintradialyticexercise AT jimenezalofonso hemodynamicinstabilityduringdialysisthepotentialroleofintradialyticexercise AT krishnannithya hemodynamicinstabilityduringdialysisthepotentialroleofintradialyticexercise AT mcgregorgordon hemodynamicinstabilityduringdialysisthepotentialroleofintradialyticexercise |