Intradialytic Exercise and Remote Ischaemic Preconditioning: a Cardioprotective Role ? (EXPI-DIAL)

The aim of this clinical trial is to evaluate whether intermittent exercise and remote ischaemic preconditioning (rIPC) during haemodialysis (HD) can provide cardioprotection in adult patients (aged 20-79 years) undergoing HD for at least 3 months. The main questions to be answered are

Does intermittent exercise or rIPC reduce myocardial stunning during HD? Do these interventions have a beneficial effect on haemorheology, arrhythmias, systemic inflammation and HD efficiency? The investigators will compare three HD sessions: no intervention (HD-CONT), with moderate-intensity intermittent exercise (HD-EX), and with rIPC using cuff inflation (HD-rIPC) to see if HD6EX and HD-rIPC approaches offer enhanced cardioprotection.

Participants will:

Undergo three randomised HD sessions. Participate in 5 blocks of moderate-intensity exercise or rIPC during the HD sessions.

Have cardiac function and biomarkers assessed before, during and after HD.

Study Overview

• Status: Completed
• Conditions: Hemodialysis
• Intervention / Treatment: Other: Remote ischaemic preconditioning; Other: Exercise; Other: standard dialysis

• Study Type: Interventional
• Enrollment (Actual): 33
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Montpellier, France
    • Aider Sante
  • Nîmes, France
    • Aider Sante
  • Strasbourg, France
    • CHU Strasbourg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients aged between 20 and 79 years.
• Patients on hemodialysis for more than 3 months.
• No engagement in regular exercise outside of dialysis.
• No prior exposure to intradialytic exercise within the past six months.
• No medical contraindications to physical activity.
• Life expectancy greater than 6 months.
• Patients with relative good echogenicity

Exclusion Criteria

• Patient is participating in another Category I interventional study, or has participated in another interventional study within the past 3 months
• The patient is in an exclusion period determined by a previous study
• The patient is under legal protection or under guardianship or curatorship It turns out to be impossible to give the patient informed information, or the patient refuses to sign the consent
• Pregnant, parturient or breastfeeding patient
• Patients with unstable coronary artery disease.
• Patients with peripheral artery disease (stage III or IV) in the lower limbs.
• Patients with limb amputation.
• Patients with musculoskeletal disorders impairing exercise.
• Presence of a pacemaker, cardiac stimulation device, or implantable cardioverter defibrillator (ICD).
• History of heart transplant.
• Patients with uncontrolled hypertension.
• Refractory anemia.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Patients issued from dialysis units (clinic); Randomised, controlled, crossover, bicentric, single-blind, prospective, open-label, superiority clinical trial comparing 3 dialysis modalities: Procedure A: Standard dialysis Procedure B: Dialysis with intradialytic intermittent physical exercise Procedure C: Dialysis with intradialytic ischaemia/reperfusion sequence of the upper limb Each subject will realize the 3 sessions in a random order.

Other: Remote ischaemic preconditioning; The dialysis protocol integrates a sequence of five ischaemia/reperfusion blocks applied to the upper limb. Each block consists of a 5-minute period of cuff inflation at a supra-systolic pressure individualized to each patient-20 mmHg above the limb occlusion pressure-followed by a 25-minute period of cuff deflation. This intervention begins 30 minutes after the start of dialysis and is referred to as hemodialysis remote ischaemic preconditioning (HD-rIPC).; Other: Exercise; The exercise protocol consists of five sequential bouts of physical activity, initiated 30 minutes after the start of dialysis. Each bout comprises a 5-minute cycling exercise at moderate intensity, corresponding to a Borg Scale rating of 12-14, followed by a 25-minute passive recovery phase. This structured intervention is referred to as hemodialysis exercise (HD-EX).; Other: standard dialysis; The hemodialysis control condition (HD-CONT) consists of standard hemodialysis treatment without the integration of any additional interventions, such as exercise or ischaemia/reperfusion protocols.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in regional myocardial stunning.	The investigators will use echocardiography to assess the number of left ventricular myocardial segments (using a 18-segment model), that demonstrate a reduction in longitudinal deformation greater than 20% at peak stress during hemodialysis, relative to baseline measurements obtained at the start of the dialysis session. Their aim is to compare changes in regional wall motion abnormalities across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hemorheology - blood viscosity	The investigators will assess variations in whole blood viscosity, measured using a cone-plate viscometer, from the beginning to the peak stress of dialysis. Their aim is to compare these changes in whole blood viscosity across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of dialysis and just before its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Hemorheology - erythrocyte deformability	The investigators will assess variations in erythrocyte deformability, measured using an ektacytometer, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of dialysis and just before its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Hemorheology - erythrocyte aggregation	The investigators will assess variations in erythrocyte aggregation, measured using an ektacytometer, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of dialysis and just before its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - fibrinogen	The investigators will assess variations in fibrinogen, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of dialysis and just before its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - miRNA	The investigators will assess variations in levels of circulating mi-RNAs, quantified by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Intraventricular pressure gradient	The investigators will assess variations in the left intraventricular pressure gradient, measured by postprocessing color Doppler M-mode echocardiographic images, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Hemodynamic parameters - cardiac output	The investigators will measure cardiac output every 30minutes from the beginning to the end of dialysis during the 3 conditions. Their aim is to compare the changes during HD across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). For HD-EX and HD-RIPC, the investigators will add a measure immediately after the interventions (exercise or vascular occlusion) to control for the effect of the intervention. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Hemodynamic parameters - blood pressure	The investigators will measure blood pressure every 30minutes from the beginning to the end of dialysis during the 3 conditions. Their aim is to compare the changes during HD across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). For HD-EX and HD-RIPC, the investigators will add a measure immediately after the interventions (exercise or vascular occlusion) to control for the effect of the intervention. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Intraventricular flow	The investigators will assess variations in the velocity vector fields of blood flow in the LV, calculated by postprocessing color Doppler echocardiographic images, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Sublingual microvasculature - proportion of perfused vessels	The investigators will assess the variation in the proportion of perfused vessels, measured using a videomicroscope, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Sublingual microvasculature - functional capillary density	The investigators will assess the variation in functional capillary density, measured using a videomicroscope, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Sublingual microvasculature - De Baker's score	The investigators will assess the variation in De Baker's score, measured using a videomicroscope, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Sublingual microvasculature - per-capillary microcirculatory flow index	The investigators will assess the variation in per-capillary microcirculatory flow index, measured using a videomicroscope, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Sublingual microvasculature - red blood cell mean velocity	The investigators will assess the variation in red blood cell mean velocity, measured using a videomicroscope, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Sublingual microvasculature - total vessel density	The investigators will assess the variation in total vessel density, measured using a videomicroscope, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
standard echocardiography - LA morphology and function	The investigators will evaluate the left atrial (LA) volumes during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the LA morphology and function of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - LV volumes	The investigators will evaluate the left ventricular (LV) volumes using echocardiography during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - LV global diastolic function - E wave	The investigators will evaluate the variation in E wave by pulsed Doppler ehocardiography from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
standard echocardiography - LV global diastolic function - tricuspid regurgitation	The investigators will evaluate the tricuspid regurgitation by continuous-wave Doppler ehocardiography during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. It will be used to characterize left ventricular global diastolic function. Measurements will be conducted 30 minutes before the onset of dialysis	From enrollment
standard echocardiography - RV systolic function - TAPSE	The investigators will evaluate the Tricuspid Annular Plane Systolic Excursion using echocardiography during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. It will be used to characterize right ventricular global systolic function. Measurements will be conducted 30 minutes before the onset of dialysis	From enrollment
standard echocardiography - RV morphology - areas	The investigators will evaluate the right ventricular (RV) area at end-systole and end-diastole during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - RV global diastolic function - Et wave	The investigators will evaluate the Et wave by pulsed Doppler ehocardiography during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. It will be used to characterize right ventricular global diastolic function. Measurements will be conducted 30 minutes before the onset of dialysis	From enrollment
Biological data - uraemic toxins - beta2-microglobulin	The investigators will assess variations in beta2-microglobulin level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - uraemic toxins - Indoxyl sulfate	The investigators will assess variations in indoxyl sulfate level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - uraemic toxins - p-Cresyl sulfate	The investigators will assess variations in p-Cresyl sulfate level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - uraemic toxins - myoglobin	The investigators will assess variations in myoglobin level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - uraemic toxins - free light chains	The investigators will assess variations in free light chains, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - cardiac biomarkers - NT-pro-BNP	The investigators will assess variations in NT-pro-BNP level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - cardiac biomarkers - BNP level	The investigators will assess variations in BNP level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - cardiac biomarkers - cardiac troponin T	The investigators will assess variations in cardiac troponin T level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - cardiac biomarkers - sST2	The investigators will assess variations in levels of soluble ST2, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
biological data - characterization of patients - sodium	The investigators will evaluate the blood level of sodium during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - potassium	The investigators will evaluate the serum level of potassium during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - calcium	The investigators will evaluate the serum level of calcium during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - phosphate	The investigators will evaluate the serum level of phosphate during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - vitamin D	The investigators will evaluate the serum level of vitamin D during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - parathyroid hormone	The investigators will evaluate the serum level of parathyroid hormone during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - creatinine	The investigators will evaluate the serum level of creatinine during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - creatinine clearance	The investigators will evaluate the creatinine clearance during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - urea	The investigators will evaluate the blood level of urea during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - Kt/V	The investigators will evaluate the Kt/V urea during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients.	From enrollment
biological data - characterization of patients - nPCR	The investigators will evaluate the normalized proteïn catabolic rate during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - albumin	The investigators will evaluate the serum level of albumin during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - characterization of patients - CRP	The investigators will evaluate the serum level of c-reactiv protein during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the progression of the disease in the patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - hematology - complete blood count	The investigators will evaluate the complete blood count during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the blood of patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - hematology - ferritin	The investigators will evaluate the serum ferritin level during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the blood of patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - hematology - transferrin saturation	The investigators will evaluate the transferrine saturation during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the blood of patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
Hematology - hematocrit	The investigators will assess variations in hematocrit, measured using an hemoglobinometer, from the beginning to the peak stress of dialysis. Their aim is to compare these changes in whole blood viscosity across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Hematology - hemoglobin	The investigators will assess variations in hemoglobin level, measured using an hemoglobinometer, from the beginning to the peak stress of dialysis. Their aim is to compare these changes in whole blood viscosity across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset and at the end of dialysis. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
biological data - lipidic profile - LDL cholesterol	The investigators will evaluate the LDL cholesterol during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the lipidic profile. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - lipidic profile - HDL cholesterol	The investigators will evaluate the HDL cholesterol during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the lipidic profile of patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - lipidic profile - triglycerides	The investigators will evaluate the triglycerides level during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrolment. They will be used to characterize the lipidic profile of patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
Biological data - inflamation - ultra-sensitive c-reactive protein	The investigators will assess variations in ultra-sensitive c-reactive protein level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of the dialysis and at its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - inflamation - interleukin-6	The investigators will assess variations in interleukin-6 level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of the dialysis and at its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - inflamation - interleukin-10	The investigators will assess variations in interleukin-10 level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of the dialysis and at its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - inflamation - tumor necrosis factor-α	The investigators will assess variations in tumor necrosis factor-α level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of the dialysis and at its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - endothelial cell activation - intercellular adhesion molecule-1	The investigators will assess variations in intercellular adhesion molecule-1 level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of the dialysis and at its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - endothelial cell activation - vascular cell adhesion molecule-1	The investigators will assess variations in vascular cell adhesion molecule-1 level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of the dialysis and at its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - endothelial cell activation - endothelin	The investigators will assess variations in endothelin level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of the dialysis and at its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Biological data - endothelial cell activation - proendothelin	The investigators will assess variations in proendothelin level, measured by analysing blood sample, from the beginning to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A blood sample will be taken directly from the arterial line of the dialysis machine immediately at the onset of the dialysis and at its end. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
biological data - insulin resistance - glucose	The investigators will evaluate the glucose level during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to quantify the insulin resistance of patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - insulin resistance - glycated hemoglobin	The investigators will evaluate the glycated hemoglobin level during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to quantify the insulin resistance of patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
biological data - insulin resistance - insulin	The investigators will evaluate the insulin level during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to quantify the insulin resistance of patients. A blood sample will be taken directly from the arterial line of the dialysis machine at the onset of dialysis.	From enrollment
Hemodynamic parameters - heart rate	The investigators will measure heart rate every 30minutes from the beginning to the end of dialysis during the 3 conditions. Their aim is to compare the changes during HD across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). For HD-EX and HD-RIPC, the investigators will add a measure immediately after the interventions (exercise or vascular occlusion) to control for the effect of the intervention. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Hemodynamic parameters - stroke volume	The investigators will measure stroke volume every 30minutes from the beginning to the end of dialysis during the 3 conditions. Their aim is to compare the changes during HD across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). For HD-EX and HD-RIPC, the investigators will add a measure immediately after the interventions (exercise or vascular occlusion) to control for the effect of the intervention. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Strains - LV	The investigators will assess variations in left longitudinal strains, using speckle tracking echocardiography, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Strains (in %) measure the amount of myocardial longitudinal shortening of the cavity, are relatively load-independent, and can detect subclinical myocardial dysfunction, even when it is not apparent by conventional echocardiography. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Strains - RV	The investigators will assess variations in right ventricular longitudinal strains, using speckle tracking echocardiography, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Strains (in %) measure the amount of myocardial longitudinal shortening of the cavity, are relatively load-independent, and can detect subclinical myocardial dysfunction, even when it is not apparent by conventional echocardiography. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Strains - LA	The investigators will assess variations in left atrial longitudinal strains, using speckle tracking echocardiography, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Strains (in %) measure the amount of myocardial longitudinal shortening of the cavity, are relatively load-independent, and can detect subclinical myocardial dysfunction, even when it is not apparent by conventional echocardiography. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
standard echocardiography - LV morphology - diameter	The investigators will evaluate the left ventricular (LV) diameter at both end-diastole and end-systole during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the LV morphology of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - LV morphology - wal thicknessess	The investigators will evaluate the left ventricular (LV) wall thicknesses at both end-diastole and end-systole during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the LV morphology of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - RV morphology - diameters	The investigators will evaluate the right ventricular (RV) diameters at end-systole and end-diastole during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the RV morphology of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - LV global systolic function	The investigators will evaluate the left ventricular (LV) ejection fraction using echocardiography during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to evaluate the LV global systolic function. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - LV morphology - mass	The investigators will evaluate the left ventricular (LV) mass during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the LV morphology of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
Myocardial work - global myocardial work	The investigators will assess variations in global myocardial work, using speckle tracking echocardiography and blood pressure, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). It provides a more precise assessment of cardiac performance than strains by considering the left ventricular loading condition. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Myocardial work - global constructive work	The investigators will assess variations in global constructive work, using speckle tracking echocardiography and blood pressure, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). It provides a more precise assessment of cardiac performance than strains by considering the left ventricular loading condition. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Myocardial work - global wasted work	The investigators will assess variations in global wasted work, using speckle tracking echocardiography and blood pressure, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). It provides a more precise assessment of cardiac performance than strains by considering the left ventricular loading condition. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
Myocardial work - global work efficiency	The investigators will assess variations in global work efficiency, using speckle tracking echocardiography and blood pressure, from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). It provides a more precise assessment of cardiac performance than strains by considering the left ventricular loading condition. Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
standard echocardiography - LV global diastolic function - A wave	The investigators will evaluate the variation in A wave measured by pulsed Doppler ehocardiography from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
standard echocardiography - RV systolic function	The investigators will calculate the right ventricular fractional area change using echocardiography during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. It will be used to characterize right ventricular global systolic function. Measurements will be conducted 30 minutes before the onset of dialysis	From enrollment
standard echocardiography - RV global diastolic function	The investigators will evaluate the At wave by pulsed Doppler ehocardiography during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. It will be used to characterize right ventricular global diastolic function. Measurements will be conducted 30 minutes before the onset of dialysis	From enrollment
standard echocardiography - tissue Doppler imaging - LV e'	The investigators will evaluate the left ventricular (LV) e' wave by tissue Doppler imaging during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the LV regional function of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - tissue Doppler imaging - LV a'	The investigators will evaluate the left ventricular (LV) a' wave by tissue Doppler imaging during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the LV function of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - tissue Doppler imaging - LV s'	The investigators will evaluate the left ventricular (LV) s' waves by tissue Doppler imaging during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the LV regional function of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - tissue Doppler imaging - RV e'	The investigators will evaluate the right ventricular (RV) e' wave by tissue Doppler imaging during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the RV regional function of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - tissue Doppler imaging- RV a'	The investigators will evaluate the right ventricular (RV) a' wave by tissue Doppler imaging during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the RV regional function of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - tissue Doppler imaging - RV s'	The investigators will evaluate the right ventricular (RV) s' wave by tissue Doppler imaging during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the RV regional function of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - RV morphology and function - diameters	The investigators will evaluate the right ventricular (RV) outflow tract diameters during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the RV morphology and function of the patients. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - RV global diastolic function - Et/At ratio	The investigators will evaluate the Et/At ratio by pulsed Doppler ehocardiography during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. It will be used to characterize right ventricular global diastolic function. Measurements will be conducted 30 minutes before the onset of dialysis	From enrollment
standard echocardiography - LV global diastolic function - E/A	The investigators will evaluate the E/A ratio by pulsed Doppler ehocardiography from before to the peak stress of dialysis. Their aim is to compare these changes across three experimental conditions: - Standard hemodialysis (HD-CONT), - Hemodialysis with intradialytic intermittent physical exercise (HD-EX), - Hemodialysis with an intradialytic ischemia/reperfusion sequence applied to the upper limb (HD-RIPC). Patients will participate in all three conditions in a randomized order. A two-week period of standard dialysis will separate the execution of two consecutive sessions.	From enrollment to the end of treatment at 7 weeks
standard echocardiography - diastolic function - LV E/e'	The investigators will evaluate the left ventricular (LV) E/e' ratio during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the LV filling pressure. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment
standard echocardiography - diastolic function - RV Et/e'	The investigators will evaluate the right ventricular (RV) Et/e' ratio during the first dialysis session (HD-CONT, HD-EX, or HD-rIPC, depending on the randomized order of the three sessions), after enrollment. They will be used to characterize the RV filling pressure. Measurements will be conducted 30 minutes before the onset of dialysis.	From enrollment

Collaborators and Investigators

• Sponsor: University of Avignon
• Investigators: Principal Investigator: Laure Patrier, MD, PhD, AIDER Santé - Fondation Charles Mion

Study record dates

Study Major Dates

• Study Start (Actual): February 17, 2025
• Primary Completion (Actual): June 26, 2025
• Study Completion (Actual): June 26, 2025

Study Registration Dates

• First Submitted: February 5, 2025
• First Submitted That Met QC Criteria: February 27, 2025
• First Posted (Actual): March 4, 2025

Study Record Updates

• Last Update Posted (Actual): April 29, 2026
• Last Update Submitted That Met QC Criteria: April 28, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: exercise; Hemodialysis; remote ischemic preconditioning; cardioprotection; myocardial stunning; myocardial function
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Myocardial Stunning; Motor Activity; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Exercise
• Other Study ID Numbers: AU-092024-CM; LAPEC/2024/DIAL (Other Identifier: Avignon University)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No