Hemodynamic Instability during Dialysis: The Potential Role of Intradialytic Exercise

Table 1

Summary of relevant previous research investigating the acute physiological responses to exercise in end stage renal disease patients.

Study (year)	Subjects	Outcome measures	Exercise	Results	Significant findings	Limitations
Banerjee et al. (2004) [59]	, Group 1 (4 males, 6 females, age ), group 2: (6 males, 4 females, age ),	% RBV,; CO (echo).	Cycling at 20% above predialysis HR for 10 mins during isovolumic HD.	Drop in RBV at the end of exercise ( vs. , ), CO increased after both periods of exercise ( and versus and  l/min; )	Fall in RBV occurred immediately after the onset of submax exercise during isovolumic HD CO increased but did not result in increased vascular resistance	Relatively young individuals, small cohort
Dungey et al. (2015) [60]	HD (9 males, 6 females; age:  y),	HR, BP, RPP. Markers of cardiac injury, inflammation, haematology, neutrophil degranulation	30 mins cycling at RPE 13 during HD.	Increase in HR (~15%) and BP (~13%) during exercise. 1 h after exercise SBP dropped below control SBP ( versus , ). No increase in inflammatory markers after exercise	Exercise placed an additional demand on the heart at a time when it is at an increased risk of myocardial stunning Markers of cardiac injury did not differ	Exercise stimulus not sufficient ( W), small cohort
Kettner et al. (1984) [61]	HD (age years). Control: HS (age years)	RER, VO2, HR, BP, adrenaline, noradrenaline, glucose, insulin, glucagon	Cycling at 50% VO2 max for 60 mins off HD	HR (~10%) and VO2 (~45%) blunted in HD patients. Depressed RER at rest in HD patients compared to controls (~0.75 versus ~0.85), increased adrenaline, noradrenaline, glucose, insulin, glucagon in HD patients compared to controls ()	VO2 lower in HD patients. Elevated plasma levels of hormones related to reduced renal clearance of active and inactive hormones	Small cohort
Ookawara et al. (2016) [62]	HD (age years). Control: (age ).	HR, BP, ΔBV.	Cycling at 10% higher HR then baseline during HD for 25 mins	Increase in HR during exercise ( versus , ). A ~1% increase in BV after exercise	Attenuation in ultrafiltration induced BV reduction at the end of HD via increased plasma refilling from the interstitium to the blood vessels	Low intensity of exercise, small cohort

Notes. RBV: relative blood volume; BV: blood volume; CO: cardiac output; RPP: rate pressure product; HD: haemodialysis; GFR: glomerular filtration rate; HS: healthy subjects; ESRD: end stage renal disease; Echo: echocardiogram; HR: heart rate; BP: blood pressure; SBP: systolic blood pressure; RPE: rating of perceived exertion; RER: respiratory exchange ratio.