Ookawara Susumu, Miyazawa Haruhisa, Ito Kiyonori, Ueda Yuichiro, Kaku Yoshio, Hirai Keiji, Hoshino Taro, Mori Honami, Yoshida Izumi, Morishita Yoshiyuki, Tabei Kaoru
From the *Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan; and †Department of Internal Medicine, Nishikawa Town Hospital, Yamagata, Japan.
ASAIO J. 2016 Mar-Apr;62(2):190-6. doi: 10.1097/MAT.0000000000000320.
Intradialytic exercise-induced blood volume (BV) reduction may cause intradialytic hypotension in hemodialysis (HD) patients. However, BV recovery time after intradialytic exercise remains unknown. Hemodialysis patients were recruited, and their relative BV change (%ΔBV) were measured with intradialytic exercise (n = 12). After confirming the linearity of %ΔBV for 30 min, patients exercised using a stationary cycle in the supine position. The target exercise intensity was a 10% increase in heart rate (HR), corresponding to relatively low-intensity exercise. Baseline %ΔBV (assumed baseline) were calculated for the 30 min before exercise using linear regression analysis. The mean intradialytic exercise start and end times after HD initiation were 93.0 ± 8.4 and 116.4 ± 8.3 min, respectively, a mean exercise duration of 23.5 ± 2.6 min. Percentage change in blood volume declined rapidly upon exercise initiation and gradually increased above the assumed baseline throughout HD. At the end of HD, %ΔBV in the exercise group was significantly higher than the assumed baseline (measured - assumed baseline %ΔBV: 2.17 ± 0.62%; p = 0.02). Intradialytic exercise with low intensity in the supine position attenuated ultrafiltration-induced BV reduction at the end of HD. Therefore, intradialytic exercise may prevent intradialytic hypotension during later HD, although its intensity was relatively low level.
透析期间运动引起的血容量(BV)减少可能会导致血液透析(HD)患者出现透析期间低血压。然而,透析期间运动后BV恢复时间仍不清楚。招募了血液透析患者,并对他们在透析期间运动时的相对BV变化(%ΔBV)进行了测量(n = 12)。在确认%ΔBV在30分钟内呈线性关系后,患者在仰卧位使用固定自行车进行运动。目标运动强度是心率(HR)增加10%,相当于相对低强度运动。使用线性回归分析计算运动前30分钟的基线%ΔBV(假定基线)。HD开始后透析期间运动的平均开始和结束时间分别为93.0±8.4分钟和116.4±8.3分钟,平均运动持续时间为23.5±2.6分钟。运动开始时血容量百分比变化迅速下降,在整个HD过程中逐渐高于假定基线。在HD结束时,运动组的%ΔBV显著高于假定基线(测量值 - 假定基线%ΔBV:2.17±0.62%;p = 0.02)。仰卧位低强度的透析期间运动在HD结束时减弱了超滤引起的BV减少。因此,透析期间运动可能会预防HD后期的透析期间低血压,尽管其强度相对较低。