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Acute Effect of Intradialytic Aerobic Exercise on Cardiac Stunning in Patients With Chronic Kidney Disease: A
Davi de Souza Francisco1,2, Gabriella Cristina Nogueira Pereira1, Manuela Karloh3
1Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
Insights
Intradialytic aerobic exercise (IAE) may reduce cardiac stunning in hemodialysis patients by improving regional wall motion abnormalities. However, its effect on global longitudinal strain is not significant, and the evidence quality is low.
Area of Science:
- Nephrology
- Cardiology
- Exercise Physiology
Background:
- Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) are at risk for cardiac stunning.
- Intradialytic aerobic exercise (IAE) is a potential cardioprotective strategy.
- Limited data exists on IAE's acute effects on cardiac stunning during HD.
Purpose of the Study:
- To review the effect of a single IAE session versus standard HD on cardiac stunning in CKD patients.
- To analyze IAE prescription variables and their impact on cardiac stunning.
Main Methods:
- Systematic review of non-randomized, crossover, and randomized controlled trials.
- Included studies involving CKD patients undergoing HD.
- Primary outcomes: regional wall motion abnormalities (RWMA) and global longitudinal strain (GLS).
- Meta-analyses performed using random-effects models.
Main Results:
- Three studies with 97 patients were included.
- IAE significantly reduced RWMA compared to standard HD (MD -1.86 segments, p=0.003).
- No significant effect of IAE on GLS was observed at the end of exercise or HD session.
Conclusions:
- A single IAE session can reduce RWMA in CKD patients undergoing HD.
- IAE did not significantly impact GLS.
- The current evidence is of low methodological quality with a high risk of bias.
Background And Purpose:
Intradialytic aerobic exercise (IAE) has emerged as a possible cardioprotective strategy for patients with chronic kidney disease (CKD). However, there is still no summary of the IAE prescription variables and their acute effect on reducing cardiac stunning in patients undergoing hemodialysis (HD). The aim of this review was to analyze the effect of a single IAE session compared to the HD without exercise on cardiac stunning in patients with CKD.
Methods:
Non-randomized intervention studies, crossover trials, and randomized controlled trials involving patients with CKD undergoing HD were included. The primary outcomes were regional wall motion abnormalities (RWMA) and global longitudinal strain (GLS). The search was conducted on April 5, 2024 in eight databases. Studies in English, Portuguese, or Spanish were included with no date restriction. The Physiotherapy Evidence Database scale and the Cochrane collaboration risk of bias tool were used. Meta-analyses were performed using RevMan version 5.4 with random-effects models, reporting mean difference (MD) and 95% confidence interval (95% CI).
Results:
Three studies were included, totaling 97 patients (67 males). In echocardiography performed near the end of the HD session, IAE favored a reduction in the RWMA compared to the HD without exercise (MD -1.86 segments, 95% CI -3.09 to -0.62, p = 0.003). However, the decline in GLS at the end of the exercise (MD -0.50%, 95% CI -1.56 to 0.56, p = 0.35), and near the end of the HD session (MD -0.86%, 95% CI -1.85 to 0.14, p = 0.09) was not affected.
Discussion:
A single session of IAE can reduce RWMA at the end of the HD session, compared to the HD session without exercise. No significant effect on GLS was observed. The data supporting these findings are of low methodological quality and have a high risk of bias.
Trial Registration:
This systematic review was registered in PROSPERO (CRD42024496368).
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