Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease

Nelson, Alexander J.; Otto, James M.; Whittle, John; Stephens, Robert; Martin, Daniel; Prowle, John R.; Ackland, Gareth L.

doi:10.1136/openhrt-2015-000370

Cited by 16 publications

(19 citation statements)

References 46 publications

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“…In CKD but not in healthy controls; peak HR, HR reserve, haemoglobin level and vascular stiffness were related to aerobic ExCap after adjusting for age, gender and height (Table 4). Reduced peak HR, as was seen already in mild-moderate CKD in our study, is a known feature of non-dialysis CKD [4, 37, 38]. Chinnappa et al reported that HR reserve was an independent determinant of aerobic ExCap in a male CKD population [4] which, to the best of our knowledge, is the only previous study in non-dialysis CKD that has reported a direct association between peak HR and ExCap.…”

Section: Discussionsupporting

confidence: 85%

Gradual reduction in exercise capacity in chronic kidney disease is associated with systemic oxygen delivery factors

et al. 2018

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BackgroundThe cause of reduced exercise capacity (ExCap) in chronic kidney disease (CKD) is multifactorial. The aim of this study was to investigate determinants of aerobic ExCap in patients with mild to severe CKD not undergoing dialysis.MethodsWe included 52 individuals with CKD stage 2–3, 47 with stage 4–5, and 54 healthy controls. Peak workload and peak heart rate (HR) were assessed by a maximal cycle exercise test. Cardiac function including stroke volume (SV) and vascular stiffness were evaluated by ultrasound at rest. Handgrip strength, body composition, haemoglobin level and self-reported physical activity were assessed.ResultsPeak workload (221±60, 185±59, 150±54 W for controls, CKD 2–3 and CKD 4–5 respectively), peak HR (177±11, 161±24, 144±31 beats/min) and haemoglobin level (14.2±1.2, 13.5±1.4, 12.2±1.3 g/dL) were all three significantly lower in CKD 2–3 than in controls, (p = 0.001, 0.001 and 0.03 respectively) and were even lower in stages 4–5 CKD than in CKD 2–3 (p = 0.01, 0.001 and <0.001 respectively). Resting SV and lean body mass did not differ between groups and handgrip strength was significantly lower only in CKD 4–5 compared to controls (p = 0.02). Peak workload was strongly associated with the systemic oxygen delivery factors: SV, peak HR and haemoglobin level. These three factors along with age, sex and height2 explained 82% of variation in peak workload. Peak HR contributed most to the variation; the peripheral variables handgrip strength and vascular stiffness did not improve the explanatory value in regression analysis.ConclusionsIn this cross-sectional study of CKD patients not on dialysis, aerobic ExCap decreased gradually with disease severity. ExCap was associated mainly with systemic oxygen delivery factors, in particular peak HR. Neither muscle function and mass, nor vascular stiffness were independent determinants of aerobic ExCap in this group of CKD patients.

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Section: Discussionsupporting

confidence: 85%

Gradual reduction in exercise capacity in chronic kidney disease is associated with systemic oxygen delivery factors

et al. 2018

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“…Patients with cardiovascular limitations may require additional effort or time to complete an IADL task and an efficient cardiorespiratory endurance capacity may be crucial for the prevention of early IADL disability. A study identified lower peak oxygen consumption values in patients with CKD stages 3–5 ( Nelson et al, 2016 ), which suggests numerous patients with CKD who have poor cardiovascular fitness may experience difficulty efficiently completing time-sensitive IADL tasks, such as crossing roads or driving in heavy traffic; that study indicated that decreased cardiovascular endurance observed in patients with CKD may be an early warning sign of a future need for assistance in specific IADL tasks. At this early stage of decline, interventions to promote cardiovascular functional fitness may be a potentially cost-effective approach.…”

Section: Discussionmentioning

confidence: 99%

Identifying early decline of daily function and its association with physical function in chronic kidney disease: performance-based and self-reported measures

Hsiao

Kuo

et al. 2018

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ObjectiveTo verify self-reported basic and instrumental activities of daily living (IADL) with a disability and the results of performance-based tests (namely the Taiwan performance-based IADL (TPIADL), the 2-minute step test (2MST), the 30-second chair-stand test (30-s CST), and handgrip dynamometer measurement) to identify disability early and assess the associations with functional fitness in patients with advanced chronic kidney disease (CKD).MethodsA cross-sectional study of 99 patients with stage 4–5 CKD and 57 healthy elderly adults were recruited. Self-reported measures were used to collect information on basic (Barthel Index) and IADL (Lawton–Brody scale). Objective measures of the TPIADL and functional fitness (2MST, 30-s CST, handgrip dynamometer) were also assessed.ResultsOnly IADL, as detected by the TPIADL, were impaired to a greater extent in the CKD patients than those of healthy elderly adults. Among all the patients with CKD, a greater impairment in the TPIADL remained statistically associated with a lower ability in the 2MST. A one step increase in the 2MST score was significantly associated with an improvement of 0.2 s in the total performance time of the TPIADL.ConclusionPerformance-based measures, such as the TPIADL, may detect a functional limitation before it becomes measurable by traditional self-reported basic and IADL scales; functional limitation is mainly associated with cardiac endurance for advanced CKD.

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“…Few studies have assessed cardiovascular functional capacity in pre-dialytic CKD patients. In a study by Nelson et al (2016) the authors analyzed CPET data from 933 pre-operative patients and found that 93/933 (9.97%) had CKD stage 3 (Nelson et al, 2016). The authors reported that patients with CKD stage 3 had a significantly lower VO 2 Peak (mean difference 6%, 95% CI 1-11%, p = 0.02), lower peak heart rate (mean difference 9 bpm, 95% CI 3-14%, p = 0.03) and impaired heart rate recovery (mean difference 4 bpm, 95% CI 1-7, p < 0.001) compared to patients with a GFR > 60.…”

Section: Chronic Kidney Disease (Ckd)mentioning

confidence: 99%

Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing

et al. 2020

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The development of cardiovascular disease during renal impairment involves striking multi-tiered, multi-dimensional complex alterations encompassing the entire oxygen transport system. Complex interactions between target organ systems involving alterations of the heart, vascular, musculoskeletal and respiratory systems occur in Chronic Kidney Disease (CKD) and collectively contribute to impairment of cardiovascular function. These systemic changes have challenged our diagnostic and therapeutic efforts, particularly given that imaging cardiac structure at rest, rather than ascertainment under the stress of exercise, may not accurately reflect the risk of premature death in CKD. The multi-systemic nature of cardiovascular disease in CKD patients provides strong rationale for an integrated approach to the assessment of cardiovascular alterations in this population. State-of-the-art cardiopulmonary exercise testing (CPET) is a powerful, dynamic technology that enables the global assessment of cardiovascular functional alterations and reflects the integrative exercise response and complex machinery that form the oxygen transport system. CPET provides a wealth of data from a single assessment with mechanistic, physiological and prognostic utility. It is an underutilized technology in the care of patients with kidney disease with the potential to help advance the field of cardio-nephrology. This article reviews the integrative physiology and pathophysiology of cardio-renal impairment, critical new insights derived from CPET technology, and contemporary evidence for potential applications of CPET technology in patients with kidney disease.

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Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease

Cited by 16 publications

References 46 publications

Gradual reduction in exercise capacity in chronic kidney disease is associated with systemic oxygen delivery factors

Gradual reduction in exercise capacity in chronic kidney disease is associated with systemic oxygen delivery factors

Identifying early decline of daily function and its association with physical function in chronic kidney disease: performance-based and self-reported measures

Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing

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