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. 2025 Jul 4:gfaf126.
doi: 10.1093/ndt/gfaf126. Online ahead of print.

Cardioprotection from intradialytic exercise: a randomized trial

Claire Maufrais  1 , Matthieu Josse  1 , Laure Patrier  2   3 , Myriam Isnard  4 , Antoine Grandperrin  1 , Cécile Turc-Baron  2   5 , Stéphane Nottin  1 , Jean-Paul Cristol  2   5   6 , Doria Boulghobra  1 , Cyril Reboul  1 , Philippe Obert  1
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Free article

Cardioprotection from intradialytic exercise: a randomized trial

Claire Maufrais et al. Nephrol Dial Transplant. .
Free article

Abstract

Background and hypothesis: Left ventricular (LV) regional wall motion abnormalities (RWMAs) related to transient ischemic events are well-documented during hemodialysis (HD). Intradialytic exercise (IDE) reduces the global occurrence of HD-induced RWMAs. However, the regionalization of its cardioprotective effects within the LV wall, and its underlying mechanisms remain unclear.

Methods: We conducted a prospective, crossover, randomized trial. 72 patients underwent two sessions: standard HD (HD-CONT) and HD with 30min of aerobic exercise (HD-EX). Segmental longitudinal strains (LS) were measured before (T0) and at peak stress (30min before HD-ending, Tpeak). An 18-segment model identified RWMAs, defined as a 20% LS reduction at Tpeak compared to T0. To evaluate the impact of circulating factors, we measured fractional shortening, Ca2+ transients and spontaneous Ca2+ waves (SCaW) following anoxia/reoxygenation (A/R) in isolated rat cardiomyocytes pre-treated with human plasma ultrafiltrates (obtained at Tpeak in both sessions).

Results: IDE significantly reduced RWMAs during HD-EX compared to HD-CONT (estimated difference: 1.1 segment, 95%CI: 0.33/1.90, p=0.009). A baso-apical gradient of RWMAs was observed during HD-CONT, with higher prevalence at the apex compared to the base (p=0.03). This gradient was abolished during HD-EX, suggesting greater apical cardioprotection. Pre-treatment of cardiomyocytes with ultrafiltrates from HD-EX improved fractional shortening, Ca2+ handlings and SCaW following A/R compared to cells pre-treated with ultrafiltrates from HD-CONT.

Conclusions: IDE limits HD-induced RWMAs, and circulating humoral factors may contribute to this cardioprotection. IDE-induced benefits on RWMAs were greater at the apex. Further studies are needed to elucidate the mechanisms underlying the heterogeneous benefits of IDE on regional myocardial function.

Keywords: cardioprotection; humoral factors; intradialytic exercise; myocardial stunning; regional analysis.

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