Clinical and demographic predictors of exercise capacity in end-stage renal disease

Sietsema, Kathy E.; Hiatt, William R.; Esler, Anne; Adler, Sharon G.; Amato, Antonino; Brass, Eric P.

doi:10.1053/ajkd.2002.29884

Cited by 80 publications

(51 citation statements)

References 50 publications

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“…Glomerular filtration rate (GFR) was estimated using the MDRD calculation. 25 The homeostasis model assessment of insulin resistance index (HOMA-IR) was calculated as described previously [fasting insulin (IU/mL)ϫfasting glucose (mmol/L)/22.5]. 26 …”

Section: Variable Definitionmentioning

confidence: 99%

Interleukin-18, the Metabolic Syndrome, and Subclinical Atherosclerosis

Zirlik

Abdullah

Gerdes

et al. 2007

ATVB

103

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Objective-Although IL-18 promotes atherogenesis in animal studies and predicts cardiovascular risk in humans, it is unknown whether elevated IL-18 levels are associated with coronary atherosclerosis in the general population. Methods and Results-IL-18 plasma levels were determined by ELISA in 2231 subjects from the Dallas Heart Study. The proinflammatory cytokine IL-18 participates in adaptive immunity, 3 and several lines of evidence support a proatherogenic role for IL-18. Expression of IL-18 and the IL-18 receptor subunits is increased in atherosclerotic arteries compared with normal arterial segments. 4,5 Stimulation of cell types found in atheromata with IL-18 induces proinflammatory cytokines such as interferon (IFN)-␥ and IL-6, adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1), and enzymes capable of degrading extracellular matrix (MMPs). 4,6,7 In addition, studies in mice demonstrate that lack of IL-18 or inhibition of IL-18 signaling decreases atherosclerotic plaque formation, whereas administration of exogenous IL-18 promotes atherogenesis and yields more fatty than fibrous lesions. 8 -11 Recent evidence also suggests that IL-18 may serve as a biomarker of cardiovascular risk. IL-18 levels increase in patients with stable and unstable angina and in those with myocardial infarction (MI), 12-14 and higher IL-18 levels correlate with poorer prognosis in patients with established coronary artery disease (CAD). [15][16][17] Several recent studies demonstrated a strong association between IL-18 and several CV risk factors, especially those linked with the metabolic syndrome. 18 Although IL-18 levels carry prognostic information in patients with and without established CAD, 15 conflicting data have been reported regarding the association of IL-18 and the burden of atherosclerosis. 19,20 This study investigates whether IL-18 adds to traditional risk factors in determining atherosclerotic burden in the large populationbased cohort of the Dallas Heart Study. Methods Study PopulationThe Dallas Heart Study (DHS) is a multiethnic population-based probability sample of Dallas County, with intentional over sampling of self-identified African-Americans, so that they comprise Ϸ50% of the final cohort. Details of the DHS are described elsewhere. 21 Briefly, 6101 subjects participated in an initial detailed in-home health survey (visit 1). Of these, 3557 subjects returned for blood and Original

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Section: Variable Definitionmentioning

confidence: 99%

Interleukin-18, the Metabolic Syndrome, and Subclinical Atherosclerosis

Zirlik

Abdullah

Gerdes

et al. 2007

ATVB

103

View full text Add to dashboard Cite

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“…8 The impairedVO 2 maxinthesepatientswasassociatedwithseveralfactors,includinglowerserumalbumin,anemia,and chronic heart failure. 9 Symptomatic heart disease is a rare event in pediatric patients with CKD. However abnormal cardiac structure and function in children with CKD is well recognized.…”

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confidence: 99%

Decreased Maximal Aerobic Capacity in Pediatric Chronic Kidney Disease

Weaver

Kimball

Knilans

et al. 2008

Journal of the American Society of Nephrology

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Adult and pediatric patients with ESRD have impaired maximum oxygen consumption (VO 2 max), a reflection of the cardiopulmonary system's ability to meet increased metabolic demands. We sought to determine factors associated with decreased VO 2 max in pediatric patients with different stages of CKD. VO 2 max was measured using a standardized exercise testing protocol in patients with stage 2 to 4 chronic kidney disease (CKD) (n ϭ 46), in renal transplant recipients (n ϭ 22), in patients treated with maintenance hemodialysis (n ϭ 12), and in age-matched healthy controls (n ϭ 33). VO 2 max was similar between children with stage 2 CKD and controls, whereas lower VO 2 max was observed among children with stage 3 to 4 CKD, those treated with hemodialysis, and transplant recipients. In univariate analysis, VO 2 max was significantly associated with body mass index, resting heart rate, C-reactive protein, serum triglycerides, serum creatinine, and measures of diastolic function; no significant associations with left ventricular structure or systolic function were identified. In multivariate regression analysis, patient category versus control and the presence of diastolic dysfunction were independent predictors of lower VO 2 max. These results suggest that aerobic capacity is decreased in the early stages of CKD in children and that lower VO 2 max can be predicted by the presence of diastolic dysfunction, even if systolic function is normal. Maximal aerobic capacity (VO 2 max) represents the cardiovascularsystem'sabilitytotakeup,distribute,andutilize oxygen to perform work during maximal exercise. Healthy individuals can sustain a three-fold increase in heart rate (HR) and a two-fold increase in stroke volume to generate maximal aerobic capacity. 1 Therefore, VO 2 max has been used to assess the capacity of the cardiovascular system to respond to metabolic challenge in numerous disease states including ESRD. 2,3 Impaired maximal aerobic capacity was observed in adult and adolescent patients with ESRD as well as after renal transplantation. [4][5][6][7] The significance of these findings was underscored by studies suggesting lower survival rates in adults with ESRD and decreased VO 2 max. 8 The impairedVO 2 maxinthesepatientswasassociatedwithseveralfactors,includinglowerserumalbumin,anemia,and chronic heart failure. 9 Symptomatic heart disease is a rare event in pediatric patients with CKD. However abnormal cardiac structure and function in children with CKD is well recognized. These patients have left ventricular (LV) diastolic dysfunction and increased LV mass even before the onset of ESRD. 10,11 LV systolic function is generally preserved at rest, but altered contractile reserve was observed during exercise in di-

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“…MS risk factors, such as glucose intolerance, itself an extremely common complication of renal transplantation (10) that contributes significantly to the cardiovascular risk factor profile of this patient group (11), are particularly important because they occur frequently in RTR (12). However, other factors that are relevant to renal transplantation, such as immunosuppression, renal dysfunction, and subclinical atherosclerosis, also may determine CF in RTR (13,14). To date, no studies have explored specifically the correlates of reduced CF in RTR.…”

mentioning

confidence: 99%

Cardiorespiratory Fitness Is Related to Physical Inactivity, Metabolic Risk Factors, and Atherosclerotic Burden in Glucose-Intolerant Renal Transplant Recipients

Armstrong¹,

Rakhit²,

Jeffriess³

et al. 2006

Clinical Journal of the American Society of Nephrology

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The mechanisms of reduced cardiorespiratory fitness (CF) in renal transplant recipients (RTR) have not been studied closely. This study evaluated the relationships between CF and specific cardiovascular risk factors (metabolic syndrome [MS], physical inactivity, myocardial ischemia, and atherosclerotic burden) in glucose-intolerant RTR. Data were recorded on 71 glucose-intolerant RTR (mean age 55 yr; 55% male; median transplant duration 5.7 yr). MS was defined using National Cholesterol Education Programme Adult Treatment Panel III criteria. Resting and exercise stress echocardiography were performed, and myocardial ischemia was identified by new or worsening wall motion abnormalities. Cardiorespiratory fitness was determined using peak oxygen uptake (VO 2 ) by expired gas analysis. Atherosclerotic burden was assessed by carotid intima-media thickness (IMT). Mean peak VO 2 was 19 ؎ 7 ml/kg per min and was significantly lower than predicted peak VO 2 (29 ؎ 6 ml/kg per min; P < 0.001). Patients with MS (63%) had reduced CF (17 ؎ 6 versus 22 ؎ 8 ml/kg per min; P ‫؍‬ 0.001) and were more likely to be physically inactive (76 versus 48%; P ‫؍‬ 0.02). CF was reduced in 14 patients with myocardial ischemia (15 ؎ 3 versus 20 ؎ 7 ml/kg per min; P ‫؍‬ 0.05). CF was positively correlated with male gender, height, and physical activity and inversely correlated with number of MS risk factors and IMT (adjusted R 2 ‫؍‬ 0.66). Carotid IMT added incremental value to clinical variables in determining VO 2 (adjusted R 2 ‫؍‬ 0.65 versus 0.63; P ‫؍‬ 0.04). Reduced CF is associated with physical inactivity, MS, and atherosclerotic burden in glucose-intolerant RTR. Further studies should address whether increasing exercise and modifying MS risk factors improve CF in RTR.

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Clinical and demographic predictors of exercise capacity in end-stage renal disease

Cited by 80 publications

References 50 publications

Interleukin-18, the Metabolic Syndrome, and Subclinical Atherosclerosis

Interleukin-18, the Metabolic Syndrome, and Subclinical Atherosclerosis

Decreased Maximal Aerobic Capacity in Pediatric Chronic Kidney Disease

Cardiorespiratory Fitness Is Related to Physical Inactivity, Metabolic Risk Factors, and Atherosclerotic Burden in Glucose-Intolerant Renal Transplant Recipients

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