Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD).\nPrevalence of intradialytic hypotension (IDH) can be as high as 20ââ?¬â??30%, contributing to subclinical, transientmyocardial ischemia.\nIn the long term, this results in progressive, maladaptive cardiac remodeling and impairment of left ventricular function. This is\nthought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies\nto acutely attenuate haemodynamic instability during HD are suboptimal. Whilst a programme of intradialytic exercise training\nappears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular,\nthe potential for intradialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial\nischemia, has not been explored. This narrative reviewaims to summarise the characteristics and causes of acute haemodynamic\ninstability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological\nresponse to intradialytic exercise with a view to determining the potential for this nonmedical intervention to stabilise cardiovascular\nhaemodynamics during HD, improve coronary perfusion, and reduce cardiovascular morbidity and mortality in ESRD.
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