UHCW publication: Hemodynamic instability during dialysis

Hemodynamic instability during dialysis: is intra-dialytic exercise the answer?
Scott McGuire, Elizabeth Horton, Derek Renshaw, Alfonso Jimenez, Nithya S. Krishnan, Gordon McGregor
BioMed Research International 2018 Jan


Abstract
Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intra-dialytic hypotension (IDH) can be as high as 20-30%, contributing to sub-clinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodelling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are sub-optimal. Whilst a programme of intra-dialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intra-dialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intra-dialytic exercise with a view to determining the potential for this non-medical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion and reduce cardiovascular morbidity and mortality in ESRD.

Full text PDF available at http://downloads.hindawi.com/journals/bmri/aip/8276912.pdf (free access)