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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...

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Autores principales: McGuire, Scott, Horton, Elizabeth Jane, Renshaw, Derek, Jimenez, Alofonso, Krishnan, Nithya, McGregor, Gordon
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
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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.
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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
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