Intradialytic Exercise and Remote Ischaemic Preconditioning: a Cardioprotective Role ?

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.