McGuire Scott, Horton Elizabeth J, Renshaw Derek, Chan Klaris, Jimenez Alfonso, Maddock Helen, Krishnan Nithya, McGregor Gordon
Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK.
Department of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Clin Kidney J. 2019 Dec 17;14(5):1335-1344. doi: 10.1093/ckj/sfz159. eCollection 2021 May.
Cardiovascular risk is elevated in end-stage renal disease. Left ventricular (LV) dysfunction is linked to repetitive transient ischaemia occurring during haemodialysis (HD). Cardiomyocyte ischaemia results in 'cardiac stunning', evidenced by regional wall motion abnormalities (RWMAs). Ischaemic RWMA have been documented during HD resulting in maladaptive cardiac remodelling and increased risk of heart failure. Intra-dialytic exercise is well tolerated and can improve quality of life and functional capacity. It may also attenuate HD-induced cardiac stunning.
This exploratory study aimed to assess the effect of intra-dialytic cycle ergometry on cardiac stunning. Twenty exercise-naïve participants on maintenance HD (mean ± SD, 59 ± 11 years) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain-derived RWMAs at four time points during (i) standard HD and (ii) HD with 30 min of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90% oxygen uptake at the anaerobic threshold (VOAT). Central haemodynamics and cardiac troponin I were also assessed.
Compared with HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5 h of HD (total 110 ± 4, mean 7 ± 4 segments versus total 77 ± 3, mean 5 ± 3, respectively; P = 0.008). Global cardiac function, intra-dialytic haemodynamics and LV volumetric parameters were not significantly altered with exercise.
Intra-dialytic exercise reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90% VOAT was sufficient to elicit acute cardio-protection. These data potentially demonstrate a novel therapeutic effect of intra-dialytic exercise.
终末期肾病患者心血管风险升高。左心室（LV）功能障碍与血液透析（HD）期间反复出现的短暂性缺血有关。心肌缺血导致“心肌顿抑”，表现为局部室壁运动异常（RWMA）。HD期间缺血性RWMA已有记录，可导致适应性不良的心脏重塑和心力衰竭风险增加。透析期间运动耐受性良好，可改善生活质量和功能能力。它还可能减轻HD诱导的心肌顿抑。
本探索性研究旨在评估透析期间进行自行车测力计运动对心肌顿抑的影响。20名未进行过运动的维持性HD患者（平均±标准差，59±11岁）接受静息超声心动图检查和最大心肺运动试验。随后，在以下两个时间段的四个时间点，通过心肌应变衍生的RWMA评估心肌顿抑：（i）标准HD期间；（ii）HD期间进行30分钟次最大强度的透析期间自行车测力计运动，运动强度相当于无氧阈值（VOAT）时摄氧量的90%。同时评估中心血流动力学和心肌肌钙蛋白I。
与单纯HD相比，透析期间运动的HD在HD 2.5小时后显著减少了RWMA（分别为总计110±4，平均7±4节段与总计77±3，平均5±3；P = 0.008）。运动对整体心脏功能、透析期间血流动力学和左心室容积参数无显著影响。
透析期间运动减轻了心肌顿抑。在VOAT的90%强度下进行30分钟次最大强度运动足以引发急性心脏保护作用。这些数据可能证明了透析期间运动的一种新的治疗效果。
