Ting, SMS and Hamborg, T and McGregor, G and Oxborough, D and Lim, K and Koganti, S and Aldridge, N and Imray, C and Bland, R and Fletcher, S and Krishnan, NS and Higgins, RM and Townend, J and Banerjee, P and Zehnder, D (2015) Reduced Cardiovascular Reserve in Chronic Kidney Failure: A Matched Cohort Study. AMERICAN JOURNAL OF KIDNEY DISEASES, 66 (2). pp. 274-284. ISSN 0272-6386
Cardiovascul_Main_AJKD_Re-Revision_Clean.pdf - Accepted Version
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Patients with chronic kidney failure (CKF) experience impaired functional cardiovascular reserve with reduced oxygen consumption at peak exercise (Vo2peak). No studies have examined whether this is related to impaired cardiovascular compliance as a consequence of loss of adaptive structural alterations, resulting from chronic uremia or hypertension.
Prospective matched-cohort study.
Setting & Participants
We assessed CKF in parallel with patients with essential hypertension but without cardiovascular disease. Patients with CKF were either scheduled for kidney transplantation or transplant waitlisted. 80 patients with CKF and 80 with essential hypertension matched in age, sex, and body mass index were evaluated. 61 patients with CKF (76.3%) were dialysis dependent.
CKF versus essential hypertension without cardiovascular disease.
Measurements & Outcomes
Vo2peak was measured during maximal exercise testing. 2-dimensional echocardiography and arterial applanation tonometry were performed prior to exercise testing. To evaluate for the difference in Vo2peak between study groups, statistically significant predictors of Vo2peak in multiple regression models were additionally assessed by fitting models comprising the interaction term of patient group with the predictor variable of interest.
Vo2peak was significantly lower in patients with CKF than those with essential hypertension (18.8 vs 24.5 mL/min·kg; P < 0.001). Independent predictors of Vo2peak for CKF included left ventricular (LV) filling pressure (E/mean e′; unstandardized regression coefficient: change in Vo2peak [in mL/min·kg] per 1-unit change of variable = −5.1) and pulse wave velocity (−4.0); in essential hypertension, these were LV mass index (0.2), LV end-diastolic volume index (0.4), peak heart rate (0.2), and pulse wave velocity (−8.8). The interaction effect of Vo2peak between patient groups with LV mass index (P < 0.001), LV end-diastolic volume index (P < 0.001), and peak heart rate (P < 0.01) were significantly stronger in the hypertension group, whereby higher values led to greater Vo2peak.
Skeletal muscle strength was not assessed.
This study suggests that maladaptive LV changes, as well as blunted chronotropic response, are important mechanistic factors resulting in reduced cardiovascular reserve in patients with CKF, beyond predominantly vascular changes associated with hypertension.
|Uncontrolled Keywords:||1103 Clinical Sciences|
|Subjects:||Q Science > QP Physiology|
|Divisions:||Sport & Exercise Sciences|
|Publisher:||W B SAUNDERS CO-ELSEVIER INC|
|Date Deposited:||15 Mar 2016 14:43|
|Last Modified:||18 Apr 2016 23:50|
|DOI or Identification number:||10.1053/j.ajkd.2015.02.335|
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