EFFECT OF A 12-WEEK INTRADIALYTIC CYCLING INTERVENTION ON HEMODIALYSIS-INDUCED MYOCARDIAL STUNNING: A MULTI-CENTRE RANDOMIZED CONTROLLED TRIAL (TICKERS_HD)

 

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EFFECT OF A 12-WEEK INTRADIALYTIC CYCLING INTERVENTION ON HEMODIALYSIS-INDUCED MYOCARDIAL STUNNING: A MULTI-CENTRE RANDOMIZED CONTROLLED TRIAL (TICKERS_HD)

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Clara
Bohm
Paul N. Bennett paul.bennett@griffith.edu.au University of South Australia Clinical and Health Sciences Adelaide Australia -
Jarrin D. Penny Jarrin.Penny@lhsc.on.ca University of Western Ontario Arthur Labatt Family School of Nursing London Canada -
Christopher W. McIntyre christopher.mcintyre@lhsc.on.ca University of Western Ontario Schulich School of Medicine and Dentistry London Canada -
Jessica Vanderlinden 15jav@queensu.ca University of Western Ontario Schulich School of Medicine and Dentistry London Canada -
Megan Borkum mborkum@gmail.com University of British Columbia Division of Nephrology Vancouver Canada -
Shilpanjali Jesudason Shilpa.Jesudason@sa.gov.au Royal Adelaide Hospital Central Northern Adelaide Renal and Transplant Service Adelaide Australia -
Mercedeh Kiaii mkiaii@providencehealth.bc.ca University of British Columbia Division of Nephrology Vancouver Canada -
Justin Presseau jpresseau@ohri.ca Ottawa Hospital Research Institute Clinical Epidemiology Program Ottawa Canada -
Claudio Rigatto crigatto@sbgh.mb.ca University of Manitoba Department of Internal Medicine Winnipeg Canada -
Mitra Shirazi masoumeh.shirazi@sa.gov.au Royal Adelaide Hospital Department of Cardiology Adelaide Australia -
Anita Soni asoni@sbgh.mb.ca University of Manitoba Division of Cardiology Winnipeg Canada -
Brett Tarca Brett.Tarca@unisa.edu.au University of South Australia Alliance for Research in Exercise, Nutrition and Activity Adelaide Australia -
Stephanie Thompson th11@ualberta.ca University of Alberta Department of Medicine Edmonton Canada -
Jennifer M. MacRae jmmacrae@ucalgary.ca University of Calgary Cumming School of Medicine Calgary Canada -
Clara Bohm cbohm@sogh.mb.ca University of Manitoba Department of Internal Medicine Winnipeg Canada *

People with kidney failure receiving maintenance hemodialysis (HD) have  significantly higher cardiovascular morbidity, symptom burden and cognitive impairment compared to the general population. HD-induced ischemia contributes to myocardial stunning, which decreases vital organ perfusion, worsens cardiovascular outcomes and increases symptom burden. Intradialytic cycling has the potential to mitigate cardiac stunning, but its effects have not been assessed in randomized controlled trials (RCTs). This multicenter RCT evaluated the impact of 12 weeks of intradialytic cycling on HD-induced myocardial stunning in adults receiving maintenance HD.

Using RCT methodology, 1-to-1 parallel design, allocation concealment and assessor blinding we evaluated the effect of thrice weekly supervised intradialytic cycling for 12 weeks’ duration on myocardial stunning in adults (> 18 years old) receiving maintenance HD compared with standard care (no intradialytic exercise) in 6 HD centres in Canada and Australia. The primary outcome was change in mean number of cardiac regional wall motion abnormalities (RWMA) at peak HD stress (last 30 min HD) from baseline to 12 weeks measured by echocardiography using speckle tracking analysis. Secondary outcomes included HD recovery time, cognitive function, symptom burden and physical function.

Independent two-tailed t-test and Poisson generalized linear mixed model will be used to analyze the primary outcome.  Multiple linear regression will be performed to determine the role of intradialytic exercise and RWMA severity on absolute change in post-dialysis recovery time, cognitive function, symptoms and physical function.

Trial registration number: NCT04877041

Of 355 individuals approached, 125 participants consented to participate in the study (Adelaide n=10; Winnipeg Site 1 n=31, Site 2 n=16; Calgary n=10; Edmonton n=21; London n=26; and Vancouver n=11).  At present 101 participants have completed or remain in the study, with 98 having completed the study protocol and 3 to complete the protocol in early 2026. 

Analysis of results will be completed in January 2026, and abstract will be updated with results on Jan 14, 2026.

To be added once analysis complete.  We anticipate that this trial will provide critical evidence regarding the benefits of exercise during HD, potentially informing clinical practice and guidelines for hemodialysis care.

Kewords