{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:53:29Z","timestamp":1791600809028,"version":"4.3.4"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2018,12,23]],"date-time":"2018-12-23T00:00:00Z","timestamp":1545523200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Exercise preconditioning provides immediate protection against cardiac ischemia in clinical\/preclinical studies in subjects without chronic kidney disease. In individuals requiring renal replacement therapy, hemodialysis (HD) results in significant circulatory stress, causing acute ischemia with resultant recurrent and cumulative cardiac injury (myocardial stunning). Intradialytic exercise (IDE) has been utilized to improve functional status in individuals receiving HD. The objective of this study was to explore the role of IDE as a preconditioning intervention and assess its effect on HD-induced myocardial stunning.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a single-center cross-sectional exploratory study in adults on chronic HD participating in a clinical IDE program. HD-induced cardiac stunning was evaluated over two HD sessions within the same week: a control visit (no exercise) and an exposure visit (usual intradialytic cycling). Echocardiography was performed at the same three time points for each visit. Longitudinal strain values for 12 left ventricular segments were generated using speckle-tracking software to assess the presence of HD-induced regional wall motion abnormalities (RWMAs), defined as a \u226520% reduction in strain; two or more RWMAs represent myocardial stunning.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 19 patients were analyzed (mean age 57.2\u2009\u00b1\u200911.8\u2009years, median dialysis vintage 3.8\u2009years). The mean number of RWMAs during the control visit was 4.5\u2009\u00b1\u20092.6, falling to 3.6\u2009\u00b1\u20092.7 when incorporating IDE (a reduction of \u22120.95\u2009\u00b1\u20092.9; P\u2009=\u20090.17). At peak HD stress, the mean number of RWMAs was 5.8\u2009\u00b1\u20092.7 in the control visit versus 4.0 \u00b1 1.8 during the exposure visit (a reduction of \u22121.8\u2009\u00b1\u20092.8; P\u2009=\u20090.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We demonstrated for the first time that IDE is associated with a significant reduction in HD-induced acute cardiac injury.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ndt\/gfy376","type":"journal-article","created":{"date-parts":[[2018,11,19]],"date-time":"2018-11-19T15:11:34Z","timestamp":1542640294000},"page":"1917-1923","source":"Crossref","is-referenced-by-count":42,"title":["Intradialytic exercise preconditioning: an exploratory study on the effect on myocardial stunning"],"prefix":"10.1093","volume":"34","author":[{"given":"Jarrin D","family":"Penny","sequence":"first","affiliation":[{"name":"Lilibeth Caberto Kidney Clinical Research Unit, University of Western Ontario, London, Ontario, Canada"},{"name":"Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio R","family":"Salerno","sequence":"additional","affiliation":[{"name":"Lilibeth Caberto Kidney Clinical Research Unit, University of Western Ontario, London, Ontario, Canada"},{"name":"Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranveer","family":"Brar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Manitoba Renal Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Rossum","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W","family":"McIntyre","sequence":"additional","affiliation":[{"name":"Lilibeth Caberto Kidney Clinical Research Unit, University of Western Ontario, London, Ontario, Canada"},{"name":"Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada"},{"name":"Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada"},{"name":"Lawson Health Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara J","family":"Bohm","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"},{"name":"Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada"},{"name":"Manitoba Renal Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,12,22]]},"reference":[{"key":"2019110402560630700_gfy376-B1","first-page":"S16","article-title":"Epidemiology of cardiovascular disease in chronic renal disease","volume":"9","author":"Foley","year":"1998","journal-title":"J Am Soc Nephrol"},{"key":"2019110402560630700_gfy376-B2","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1046\/j.1523-1755.2003.00803.x","article-title":"Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients","volume":"63","author":"Kalantar-Zadeh","year":"2003","journal-title":"Kidney Int"},{"key":"2019110402560630700_gfy376-B3","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1038\/kisup.2015.2","article-title":"United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease","volume":"5","author":"Collins","year":"2015","journal-title":"Kidney Int Suppl"},{"key":"2019110402560630700_gfy376-B4","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1038\/ki.2009.207","article-title":"Effects of hemodialysis on cardiac function","volume":"76","author":"McIntyre","year":"2009","journal-title":"Kidney Int"},{"key":"2019110402560630700_gfy376-B5","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1093\/ndt\/gfn501","article-title":"Haemodialysis is associated with a pronounced fall in myocardial perfusion","volume":"24","author":"Dasselaar","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"2019110402560630700_gfy376-B6","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1111\/j.1525-139X.2010.00782.x","article-title":"Recurrent circulatory stress: the dark side of dialysis","volume":"23","author":"McIntyre","year":"2010","journal-title":"Semin Dial"},{"key":"2019110402560630700_gfy376-B7","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/sdi.12197","article-title":"Hemodialysis-associated cardiomyopathy: a newly defined disease entity","volume":"27","author":"McIntyre","year":"2014","journal-title":"Semin Dial"},{"key":"2019110402560630700_gfy376-B8","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2215\/CJN.03170707","article-title":"Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow","volume":"3","author":"McIntyre","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"2019110402560630700_gfy376-B9","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1681\/ASN.2016060686","article-title":"Intradialytic cardiac magnetic resonance imaging to assess cardiovascular responses in a short-term trial of hemodiafiltration and hemodialysis","volume":"28","author":"Buchanan","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2019110402560630700_gfy376-B10","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1097\/00003246-200107000-00015","article-title":"Splanchnic perfusion during hemodialysis: evidence for marginal tissue perfusion","volume":"29","author":"Jakob","year":"2001","journal-title":"Crit Care"},{"key":"2019110402560630700_gfy376-B11","first-page":"1017","article-title":"Coronary flow reserve abnormalities in patients with diabetes mellitus who have end-stage renal disease and normal epicardial coronary arteries","volume-title":"Am Heart J","author":"Ragosta","year":"2004"},{"key":"2019110402560630700_gfy376-B12","first-page":"253","article-title":"Are there neurological consequences of recurrent intradialytic hypotension?","volume-title":"Semin Dial","author":"Eldehni","year":"2012"},{"key":"2019110402560630700_gfy376-B13","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1053\/j.ajkd.2006.01.012","article-title":"Occurrence of regional left ventricular dysfunction in patients undergoing standard and biofeedback dialysis","volume":"47","author":"Selby","year":"2006","journal-title":"Am J Kidney Dis"},{"key":"2019110402560630700_gfy376-B14","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.2215\/CJN.02010606","article-title":"Dialysis-induced regional left ventricular dysfunction is ameliorated by cooling the dialysate","volume":"1","author":"Selby","year":"2006","journal-title":"Clin J Am Soc Nephrol"},{"key":"2019110402560630700_gfy376-B15","doi-asserted-by":"crossref","first-page":"914","DOI":"10.2215\/CJN.03900808","article-title":"Hemodialysis-induced cardiac injury: determinants and associated outcomes","volume":"4","author":"Burton","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"2019110402560630700_gfy376-B16","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1001\/jamacardio.2017.4495","article-title":"Association of exercise preconditioning with immediate cardioprotection","volume":"3","author":"Thijssen","year":"2017","journal-title":"JAMA Cardiol"},{"key":"2019110402560630700_gfy376-B17","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1038\/nrneph.2013.226","volume":"9","author":"Crowley","year":"2013","journal-title":"Nat Rev Nephrol"},{"key":"2019110402560630700_gfy376-B18","first-page":"163","article-title":"Echocardiography evaluation and exercise in hemodialysis patients","volume":"8","author":"Ghahrodi","year":"2014","journal-title":"Iran J Kidney Dis"},{"key":"2019110402560630700_gfy376-B19","first-page":"207","article-title":"Effect of intradialytic exercise on echocardiographic findings in hemodialysis patients","volume":"8","author":"Momeni","year":"2014","journal-title":"Iran J Kidney"},{"key":"2019110402560630700_gfy376-B20","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S0167-5273(99)00090-X","article-title":"Cardiac effects of exercise rehabilitation in hemodialysis patients","volume":"70","author":"Deligiannis","year":"1999","journal-title":"Int J Cardiol"},{"key":"2019110402560630700_gfy376-B21","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1053\/j.ackd.2009.08.009","article-title":"Exercise and end-stage kidney disease: functional exercise capacity and cardiovascular outcomes","volume":"16","author":"Parsons","year":"2009","journal-title":"Adv Chronic Kidney Dis"},{"key":"2019110402560630700_gfy376-B22","first-page":"CD003236","article-title":"Exercise training for adults with chronic kidney disease","volume":"5","author":"Heiwe","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2019110402560630700_gfy376-B23","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1080\/08860220802212908","article-title":"Hemodialysis-induced left ventricular dysfunction is associated with an increase in ventricular arrhythmias","volume":"30","author":"Burton","year":"2008","journal-title":"Ren Fail"},{"key":"2019110402560630700_gfy376-B24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2215\/CJN.03170707","article-title":"Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow","volume":"3","author":"McIntyre","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"2019110402560630700_gfy376-B25","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.2215\/CJN.04470709","article-title":"Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function","volume":"4","author":"Burton","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"2019110402560630700_gfy376-B26","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.2215\/CJN.00200115","article-title":"Randomized controlled trial of individualized dialysate cooling for cardiac protection in hemodialysis patients","volume":"10","author":"Odudu","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"2019110402560630700_gfy376-B27","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1681\/ASN.2013101086","article-title":"Randomized clinical trial of dialysate cooling and effects on brain white matter","volume":"26","author":"Eldehni","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"2019110402560630700_gfy376-B28","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1159\/000324199","article-title":"Individualised dialysate temperature improves intradialytic haemodynamics and abrogates haemodialysis-induced myocardial stunning, without compromising tolerability","volume":"32","author":"Jefferies","year":"2011","journal-title":"Blood Purif"},{"key":"2019110402560630700_gfy376-B29","first-page":"105","article-title":"Biofeedback controlled hemodialysis (BF-HD) reduces symptoms and increases both hemodynamic tolerability and dialysis adequacy in non-hypotension prone stable patients","volume":"60","year":"1992","journal-title":"Clin Nephrol"},{"key":"2019110402560630700_gfy376-B30","author":"Crowley","year":"2015"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ndt\/article-pdf\/34\/11\/1917\/30335741\/gfy376.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ndt\/article-pdf\/34\/11\/1917\/30335741\/gfy376.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,11,4]],"date-time":"2019-11-04T02:56:25Z","timestamp":1572836185000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/34\/11\/1917\/5258055"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,22]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2018,12,22]]},"published-print":{"date-parts":[[2019,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfy376","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,11]]},"published":{"date-parts":[[2018,12,22]]}}}