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Malheiro LFL, Fernandes MM, Oliveira CA, Barcelos IDS, Fernandes AJV, Silva BS, Ávila JS, Soares TDJ, Amaral LSDB. Renoprotective mechanisms of exercise training against acute and chronic renal diseases - A perspective based on experimental studies. Life Sci 2024; 346:122628. [PMID: 38614303 DOI: 10.1016/j.lfs.2024.122628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/22/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
Regular exercise training can lead to several health benefits, reduce mortality risk, and increase life expectancy. On the other hand, a sedentary lifestyle is a known risk factor for chronic diseases and increased mortality. Acute kidney injury (AKI) and chronic kidney disease (CKD) represent a significant global health problem, affecting millions of people worldwide. The progression from AKI to CKD is well-recognized in the literature, and exercise training has emerged as a potential renoprotective strategy. Thus, this article aims to review the main molecular mechanisms underlying the renoprotective actions of exercise training in the context of AKI and CKD, focusing on its antioxidative, anti-inflammatory, anti-apoptotic, anti-fibrotic, and autophagy regulatory effects. For that, bibliographical research was carried out in Medline/PubMed and Scielo databases. Although the pathophysiological mechanisms involved in renal diseases are not fully understood, experimental studies demonstrate that oxidative stress, inflammation, apoptosis, and dysregulation of fibrotic and autophagic processes play central roles in the development of tissue damage. Increasing evidence has suggested that exercise can beneficially modulate these mechanisms, potentially becoming a safe and effective non-pharmacological strategy for kidney health protection and promotion. Thus, the evidence base discussed in this review suggests that an adequate training program emerges as a valuable tool for preserving renal function in experimental animals, mainly through the production of antioxidant enzymes, nitric oxide (NO), irisin, IL-10, and IL-11. Future research can continue to explore these mechanisms to develop specific guidelines for the prescription of exercise training in different populations of patients with kidney diseases.
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Affiliation(s)
- Lara Fabiana Luz Malheiro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Brazil
| | - Mariana Masimessi Fernandes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Caroline Assunção Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Brazil
| | - Isadora de Souza Barcelos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Ana Jullie Veiga Fernandes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Bruna Santos Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Júlia Spínola Ávila
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Telma de Jesus Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Brazil; Programa de Pós-Graduação em Biociências, Brazil
| | - Liliany Souza de Brito Amaral
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Brazil; Programa de Pós-Graduação em Biociências, Brazil.
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Kirkman DL, Chavez DA. Exercise for chronic kidney disease: effects on vascular and cardiopulmonary function. Am J Physiol Heart Circ Physiol 2024; 326:H138-H147. [PMID: 37975707 DOI: 10.1152/ajpheart.00400.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
Patients with chronic kidney disease (CKD) have an exacerbated prevalence of cardiovascular disease (CVD). Vascular dysfunction, characterized by impaired endothelial function and arterial stiffness, and markedly low cardiorespiratory fitness levels are hallmark manifestations of the disease that contribute to the CVD burden. Despite advancements in blood pressure and lipid lowering pharmacological therapies, CVD remains markedly prevalent across the spectrum of CKD. This highlights a stagnation in effective clinical strategies to improve cardiovascular health and reinforces the critical need for adjuvant lifestyle strategies such as physical activity and exercise training to be incorporated into routine clinical care. This narrative review provides an overview of the known effects of exercise on vascular and cardiopulmonary function across the spectrum of CKD. The physiological mechanisms of vascular dysfunction that serve as exercise-specific therapeutic targets are highlighted and future perspectives are discussed.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Domenico A Chavez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
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Andrade FP, Borba CF, Ribeiro HS, Rovedder PME. Cardiorespiratory fitness and mortality risk in patients receiving hemodialysis: a prospective cohort. J Bras Nefrol 2024; 46:39-46. [PMID: 37497828 PMCID: PMC10962417 DOI: 10.1590/2175-8239-jbn-2022-0124en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 05/12/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Kidney failure reduces life expectancy by one-third compared with the general population, and cardiovascular complications and poor cardiorespiratory fitness (CRF) are the main causes. We aimed to evaluate the association between severely low CRF and all-cause mortality risk in HD patients. METHODS This observational prospective cohort study followed-up patients receiving HD from August 2015 until March 2022. Cardiorespiratory fitness was evaluated through the cardiopulmonary exercise test, and the peak oxygen uptake (VO2peak) value was used to determine severely low CRF (< 15 mL∙kg-1∙min-1). Cox regression and univariate Kaplan-Meier analysis were used to evaluate the association of severely low CRF with mortality risk and survival rate. RESULTS Forty-eight patients were followed-up for a median of 33.0 [14.3 - 49.3] months. A total of 26 patients had severely low CRF. During the follow-up period, 11 patients (22.92%) died from all causes. From these, eight (30.8%) had severely low CRF. Even so, severely low CRF was not associated with crude death rates for patients stratified by CRF levels (p = 0.189), neither in unadjusted (HR 2.18; CI 95% 0.58-8.23) nor in adjusted (HR 1.32; CI 95% 0.31-5.59) Cox proportional hazard models. As a continuous variable, VO2peak was not associated with mortality risk (HR 1.01; CI 95% 0.84-1.21). Univariate Kaplan-Meier analysis showed that patients with severely low CRF did not have significantly worse survival rates than those with mild-moderate CRF (p = 0.186). CONCLUSION Our findings indicated that severely low CRF was not associated with all-cause mortality in patients on HD. Despite severely low CRF being prevalent, larger cohort studies are needed to establish strong conclusions on its association with all-cause mortality.
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Affiliation(s)
- Francini Porcher Andrade
- Universidade Federal do Rio Grande do Sul, Ciências Pneumológicas
Post-Graduation Program, Porto Alegre, RS, Brazil
| | - Carolina Ferraro Borba
- Universidade Federal do Rio Grande do Sul, Escola de Fisioterapia,
Porto Alegre, RS, Brazil
| | | | - Paula Maria Eidt Rovedder
- Universidade Federal do Rio Grande do Sul, Ciências Pneumológicas
Post-Graduation Program, Porto Alegre, RS, Brazil
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Tsai M, Gao W, Chien K, Kyaw TW, Baw C, Hsu C, Wen C. Resting Heart Rate Independent of Cardiovascular Disease Risk Factors Is Associated With End-Stage Renal Disease: A Cohort Study Based on 476 347 Adults. J Am Heart Assoc 2023; 12:e030559. [PMID: 38038184 PMCID: PMC10727324 DOI: 10.1161/jaha.123.030559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/31/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The relationship between resting heart rate (RHR) and the risk of end-stage renal disease (ESRD) among those without cardiovascular disease remains unclear. We aim to establish temporal consistency and elucidate the independent relationship between RHR and the risk of ESRD. METHODS AND RESULTS This cohort enrolled participants from 476 347 individuals who had taken part in a screening program from 1996 to 2017. We identified 2504 participants who had ESRD, and the median follow-up was 13 years. RHR was extracted from electrocardiography results, and the study assessed the relationship between RHR and the risk of ESRD using the Cox proportional hazards model. Of the participants, 32.6% had an RHR of 60 to 69 beats per minute (bpm), and 22.2% had an RHR of ≥80 bpm. Participants with an RHR of ≥80 bpm had a higher stage of chronic kidney disease, lower estimated glomerular filtration rate, and more proteinuria than those with an RHR of 60 to 69 bpm. Participants with an RHR of 80 to 89 and ≥90 bpm had a 24% (hazard ratio [HR], 1.24 [95% CI, 1.09-1.42]) and 64% (HR, 1.64 [95% CI, 1.42-1.90]) higher risk of ESRD, respectively. The risk of ESRD remained significantly elevated (HR, 1.32 [95% CI, 1.10-1.58] per 10-beat increase from 60 bpm) after excluding participants who smoked; had hypertension, diabetes, or hyperlipidemia; or were overweight. CONCLUSIONS An RHR of ≥80 bpm is significantly associated with an increased risk of ESRD. These results suggest that RHR may serve as a risk factor for kidney disease in individuals without established cardiovascular disease risk factors.
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Affiliation(s)
- Min‐Kuang Tsai
- College of Public HealthTaipei Medical UniversityTaipeiTaiwan
- Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
| | - Wayne Gao
- College of Public HealthTaipei Medical UniversityTaipeiTaiwan
| | - Kuo‐Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
- Population Health Research CenterNational Taiwan UniversityTaipeiTaiwan
| | - Thu Win Kyaw
- College of Public HealthTaipei Medical UniversityTaipeiTaiwan
| | - Chin‐Kun Baw
- Hospital MedicineThe Southeast Permanente Medical GroupGAAtlantaUSA
| | - Chih‐Cheng Hsu
- Institute of Population Health SciencesNational Health Research InstitutesMiaoliTaiwan
| | - Chi‐Pang Wen
- Institute of Population Health SciencesNational Health Research InstitutesMiaoliTaiwan
- China Medical University HospitalTaichungTaiwan
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Kirkman DL, Stock JM, Shenouda N, Bohmke NJ, Kim Y, Kidd J, Townsend RR, Edwards DG. Effects of a mitochondrial-targeted ubiquinol on vascular function and exercise capacity in chronic kidney disease: a randomized controlled pilot study. Am J Physiol Renal Physiol 2023; 325:F448-F456. [PMID: 37560769 DOI: 10.1152/ajprenal.00067.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/27/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
Mitochondria-derived oxidative stress has been implicated in vascular and skeletal muscle abnormalities in chronic kidney disease (CKD). The purpose of this study was to investigate the effects of a mitochondria-targeted ubiquinol (MitoQ) on vascular function and exercise capacity in CKD. In this randomized controlled trial, 18 patients with CKD (means ± SE, age: 62 ± 3 yr and estimated glomerular filtration rate: 45 ± 3 mL/min/1.73 m2) received 4 wk of 20 mg/day MitoQ (MTQ group) or placebo (PLB). Outcomes assessed at baseline and follow-up included macrovascular function measured by flow-mediated dilation, microvascular function assessed by laser-Doppler flowmetry combined with intradermal microdialysis, aortic hemodynamics assessed by oscillometry, and exercise capacity assessed by cardiopulmonary exercise testing. Compared with PLB, MitoQ improved flow-mediated dilation (baseline vs. follow-up: MTQ, 2.4 ± 0.3% vs. 4.0 ± 0.9%, and PLB, 4.2 ± 1.0% vs. 2.5 ± 1.0%, P = 0.04). MitoQ improved microvascular function (change in cutaneous vascular conductance: MTQ 4.50 ± 2.57% vs. PLB -2.22 ± 2.67%, P = 0.053). Central aortic systolic and pulse pressures were unchanged; however, MitoQ prevented increases in augmentation pressures that were observed in the PLB group (P = 0.026). MitoQ did not affect exercise capacity. In conclusion, this study demonstrates the potential for a MitoQ to improve vascular function in CKD. The findings hold promise for future investigations of mitochondria-targeted therapies in CKD.NEW & NOTEWORTHY In this randomized controlled pilot study, we investigated the effects of a mitochondria-targeted ubiquinol (MitoQ) on vascular function and exercise capacity in chronic kidney disease. Our novel findings showed that 4-wk supplementation of MitoQ was well tolerated and improved macrovascular endothelial function, arterial hemodynamics, and microvascular function in patients with stage 3-4 chronic kidney disease. Our mechanistic findings also suggest that MitoQ improved microvascular function in part by reducing the NADPH oxidase contribution to vascular dysfunction.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Ninette Shenouda
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Natalie J Bohmke
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Youngdeok Kim
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Jason Kidd
- Department of Internal Medicine, Virginia Commonwealth University Health Systems, Richmond, Virginia, United States
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
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Wu X, Zhang Y, Wang F, Xiang J. Cardiopulmonary exercise testing to observe subclinical abnormalities in cardiopulmonary function in patients undergoing peritoneal dialysis. Clin Physiol Funct Imaging 2022; 42:269-277. [PMID: 35419944 DOI: 10.1111/cpf.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Decreased cardiorespiratory fitness (CRF) related to cardiopulmonary function increases the risk of cardiovascular disease in patients with end-stage kidney disease. Thus, early detection of the cause of impaired cardiopulmonary function in patients undergoing peritoneal dialysis (PD) is of important clinical significance. METHODS In this cross-sectional study, Symptom-restricted cardiopulmonary exercise testing (CPET) was performed in 30 patients undergoing PD and in 23 age- and sex-matched healthy control subjects.A fixed workload was added every minute until fatigue, and breath-by-breath respiratory gas was analyzed with an automated gas analyzer at 10-second intervals. RESULTS The peak oxygen uptake ( 16.39±0.83 vs 25.77±1.33 ml/kg/min p<0.001) and the oxygen uptake at the anerobic threshold of patients undergoing PD (9.61±0.34 vs 14.55± 0.64 ml/kg/min; p<0.001) were lower than in healthy control subjects, and both of these parameters correlated with body mass index and left atrial dimension. A steeper minute ventilation / carbon dioxide production slope (27.20±0.68 vs 24.29±0.69;p<0.01) and a lower end-tidal carbon dioxide partial pressure (37.93±0.54 vs 41.27±0.83mmHg;p<0.05) were observed in patients undergoing PD. The oxygen pulse and oxygen uptake efficiency slope was smaller in patients undergoing PD. The Maximum heart rate (126.07±4.01 vs 149.96±5.29 bpm;p<0.01) and 1-minute heart rate recovery (13.93±1.52 vs 24.39±1.61bpm;p<0.01) were also lower in patients undergoing PD. CONCLUSION Subclinical cardiopulmonary dysfunction may exist in patients with PD, and a reduction in CRF in patients undergoing PD is affected by both central and peripheral functions. CPET has potential value in revealing the mechanism of impaired CRF and in discovering subclinical abnormalities in cardiopulmonary function. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xin Wu
- Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Quanshan District, Xuzhou, China, 221004
| | - Ying Zhang
- Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, Jiangsu, China
| | - FengLi Wang
- Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Xiang
- Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Arroyo E, Troutman AD, Moorthi RN, Avin KG, Coggan AR, Lim K. Klotho: An Emerging Factor With Ergogenic Potential. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:807123. [PMID: 36188832 PMCID: PMC9397700 DOI: 10.3389/fresc.2021.807123] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022]
Abstract
Sarcopenia and impaired cardiorespiratory fitness are commonly observed in older individuals and patients with chronic kidney disease (CKD). Declines in skeletal muscle function and aerobic capacity can progress into impaired physical function and inability to perform activities of daily living. Physical function is highly associated with important clinical outcomes such as hospitalization, functional independence, quality of life, and mortality. While lifestyle modifications such as exercise and dietary interventions have been shown to prevent and reverse declines in physical function, the utility of these treatment strategies is limited by poor widespread adoption and adherence due to a wide variety of both perceived and actual barriers to exercise. Therefore, identifying novel treatment targets to manage physical function decline is critically important. Klotho, a remarkable protein with powerful anti-aging properties has recently been investigated for its role in musculoskeletal health and physical function. Klotho is involved in several key processes that regulate skeletal muscle function, such as muscle regeneration, mitochondrial biogenesis, endothelial function, oxidative stress, and inflammation. This is particularly important for older adults and patients with CKD, which are known states of Klotho deficiency. Emerging data support the existence of Klotho-related benefits to exercise and for potential Klotho-based therapeutic interventions for the treatment of sarcopenia and its progression to physical disability. However, significant gaps in our understanding of Klotho must first be overcome before we can consider its potential ergogenic benefits. These advances will be critical to establish the optimal approach to future Klotho-based interventional trials and to determine if Klotho can regulate physical dysfunction.
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Affiliation(s)
- Eliott Arroyo
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ashley D. Troutman
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, Indianapolis, IN, United States
| | - Ranjani N. Moorthi
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Keith G. Avin
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, Indianapolis, IN, United States
| | - Andrew R. Coggan
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis, Indianapolis, IN, United States
| | - Kenneth Lim
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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Chiba I, Lee S, Bae S, Makino K, Katayama O, Harada K, Tomida K, Morikawa M, Yamashiro Y, Takayanagi N, Shimada H. Association of Daily Physical Activity with Disability in Community-Dwelling Older Adults With/Without Chronic Kidney Disease. J Nutr Health Aging 2022; 26:521-528. [PMID: 35587766 DOI: 10.1007/s12603-022-1790-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Physical activity is recommended for disability prevention in the older adult population; however, the level of physical activity required for older adults with chronic kidney disease (CKD) remains unknown. This study aimed to examine the associations between daily physical activity and disability incidence in older adults with and without CKD to determine relevant daily physical activity levels. DESIGN Prospective observational study. SETTING AND PARTICIPANTS 3,786 community-dwelling older adults aged ≥65 years. MEASUREMENTS Mean daily times spent in light- (LPA) and moderate-to-vigorous physical activity (MVPA) were measured using triaxial accelerometers. CKD was defined by a creatinine estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Disability incidence was identified as long-term care insurance certification during a 60-month follow-up period. Associations between physical activity and disability incidence were examined using Cox proportional hazard models stratified by the CKD status. Non-linear and linear associations were tested using the restricted cubic spline. RESULTS A total of 1,054 individuals were identified to have CKD. Disability incidence was higher in the CKD group than in the non-CKD group. The adjusted cox proportional hazard models indicated that a 10-minute increase in MVPA time was associated with lower disability incidence in the non-CKD group (hazard ratio [HR], 0.838; 95% confidence interval [CI]: 0.764-0.918) and the CKD group (HR, 0.859; 95% CI: 0.766-0.960). Linear associations were observed in MVPA for the non-CKD and CKD groups. CONCLUSION Increasing MVPA was associated with lower disability incidence in older adults with and without CKD. These findings can help devise disability prevention strategies for older CKD patients.
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Affiliation(s)
- I Chiba
- Ippei Chiba, Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, City, Aichi 474-8511, Japan, E-mail: ; Tel.: +81-562-44-5651
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Chu DJ, Ahmed AM, Qureshi WT, Brawner CA, Keteyian SJ, Nasir K, Blumenthal RS, Blaha MJ, Ehrman JK, Cainzos-Achirica M, Patel KV, Al Rifai M, Al-Mallah MH. Prognostic Value of Cardiorespiratory Fitness in Patients with Chronic Kidney Disease: The FIT (Henry Ford Exercise Testing) Project. Am J Med 2022; 135:67-75.e1. [PMID: 34509447 DOI: 10.1016/j.amjmed.2021.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/01/2021] [Accepted: 07/31/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE We conducted this study to investigate the association of cardiorespiratory fitness and all-cause mortality among patients with chronic kidney disease. METHODS We studied a retrospective cohort of patients from the Henry Ford Health System who underwent clinically indicated exercise stress testing with baseline cardiorespiratory fitness and estimated glomerular filtration rate measurement. Cardiorespiratory fitness was expressed as metabolic equivalents of task, and kidney function was categorized into stages according to estimated glomerular filtration rate. Multivariable-adjusted Cox proportional hazard models were used to examine the association between metabolic equivalents of task and all-cause mortality among patients with chronic kidney disease stages 3-5. Discrimination of mortality was assessed using receiver operating characteristic curves, while reclassification was evaluated using net reclassification index (NRI). RESULTS Among 50,121 participants, the mean age was 55 ± 12.6 years; 47.5% were women, 64.5% were white, and 6877 (13.7%) participants had chronic kidney disease stage 3-5. Over a median follow-up of 6.7 years, 6308 participants died (12.6%). Each 1-unit higher metabolic equivalents of task was associated with a significant 15% reduction in all-cause mortality (hazard ratio 0.85; 95% confidence interval [CI], 0.84-0.87). Metabolic equivalents of task improved discriminatory ability of mortality prediction when added to traditional risk factors and estimated glomerular filtration rate (area under the curve 0.7996; 95% CI, 0.789-0.810 vs 0.759; 95% CI, 0.748-0.770, respectively; P < .001). The addition of metabolic equivalents of task to traditional risk factors resulted in significant reclassification (6% for events, 5% for non-events: NRI = 0.13, P < .001). CONCLUSIONS Cardiorespiratory fitness improves mortality risk prediction among patients with chronic kidney disease. Cardiorespiratory fitness provides incremental prognostic information when added to traditional risk factors and may help guide treatment options among patients with renal dysfunction.
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Affiliation(s)
- Daniel J Chu
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Amjad M Ahmed
- King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Waqas T Qureshi
- Department of Cardiology, University of Massachusetts, Worcester
| | | | | | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md; Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md
| | | | | | - Kershaw V Patel
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Mahmoud Al Rifai
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas.
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Chakkera HA, Kaplan B, Budhiraja P, Behmen S, Fitz-Patrick D, Butterfield RJ. VO 2peak prior to transplant differentiates survival post kidney transplant. Clin Transplant 2021; 36:e14517. [PMID: 34679190 DOI: 10.1111/ctr.14517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
The OPTN/UNOS utilizes the calculated estimated posttransplant survival (EPTS) score as the measure of post-kidney transplant survival to guide allocation of deceased donor kidney transplantation. This score does not include any metric of functional capacity. Peak oxygen uptake (VO2peak ), is an established predictor of survival among both the general and diseased populations. We assessed the association and discriminative capacity of VO2peak and that of EPTS score and all-cause mortality post-kidney transplant. Additionally, we assessed the "mortality risk" lower VO2peak conferred on those patients with low EPTS score. Among a cohort of 293 transplant recipients with at least 3-years post-transplant follow-up, the median VO2peak was 15.0 ml/Kg/min. Lower pre-transplant VO2peak and higher EPTS score conferred higher risk of post-transplant mortality. Among the cohort of "low-risk" patients (patients with EPTS score < 50) those with lower VO2peak had significantly higher risk of mortality (log rank p = 0.045). In fact, the mortality risk among those with low-EPTS (< 50) and low VO2peak < 12 ml/Kg/min was equivalent to those with high EPTS (> 80) score. We concluded functional capacity as defined by VO2peak is an important reflection of post-transplant survival. VO2peak is able to identify those with low EPTS who have similar survival to that of high EPTS phenotype.
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Affiliation(s)
| | - Bruce Kaplan
- CCTCARE, University of Colorado, Aurora, Colorado, USA
| | | | - Senaida Behmen
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Richard J Butterfield
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix, Arizona, USA
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11
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Myers J, Chan KN, Chen Y, Lit Y, Massaband P, Kiratli BJ, Tan JC, Rabkin R. Association of physical function and performance with peak VO 2 in elderly patients with end stage kidney disease. Aging Clin Exp Res 2021; 33:2797-2806. [PMID: 33686542 DOI: 10.1007/s40520-021-01801-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Physical function is impaired in end stage renal disease (ESRD). Various instruments have been used to assess the functional capabilities and health status of patients with ESRD, but it is not known which has the best association with peak VO2. AIMS To assess the association between functional measures in ESRD. METHODS Thirty nine elderly ESRD patients were evaluated with commonly used functional, health status, and quality of life measures, including maximal cardiopulmonary exercise testing (CPET), 6-min walk (6MWT), sit-to-stand test (STS), Veterans Specific Activity Questionnaire (VSAQ), upper and lower body strength, pulmonary function tests, and body composition determined by dual X-ray absorptiometry. The association between performance on these functional tools, clinical variables, and exercise test responses was assessed, and a non-exercise test multivariate model was developed to predict peak VO2. RESULTS Peak VO2 was modestly related to VSAQ score (r = 0.59, p < 0.01), indices of upper and lower body strength (r = 0.45, p < 0.01 for both), and FEV1 (r = 0.51, p < 0.01). Functional and quality of life questionnaires were generally poorly related to one another and to peak VO2. In a multivariate model, 6MWT performance, forced expiratory volume in 1 s (FEV1), and VSAQ score were the best predictors of peak VO2, yielding a multiple R = 0.82, accounting for 67% of the variance in peak VO2. CONCLUSION Exercise capacity can be reasonably estimated using non-exercise test variables in patients with ESRD, including a symptom questionnaire (VSAQ), 6MWT and FEV1. CLINICAL TRIAL INFORMATION ClinicalTrials.gov identifier: NCT01990495. Registered Nov 21, 2013.
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Affiliation(s)
- Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.
- Cardiology Division, Stanford University, Stanford, CA, USA.
| | - Khin N Chan
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Yu Chen
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Yiming Lit
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Nephrology Division, Stanford University, Stanford, CA, USA
| | - Payam Massaband
- Radiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - B Jenny Kiratli
- Spinal Cord Injury Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jane C Tan
- Division of Nephrology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Ralph Rabkin
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Nephrology Division, Stanford University, Stanford, CA, USA
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12
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Alexandrou ME, P Theodorakopoulou M, Boutou A, Pella E, Boulmpou A, Papadopoulos CE, Zafeiridis A, Papagianni A, Sarafidis P. Cardiorespiratory fitness assessed by cardiopulmonary exercise testing between different stages of pre-dialysis chronic kidney disease: A systematic review and meta-analysis. Nephrology (Carlton) 2021; 26:972-980. [PMID: 34288260 DOI: 10.1111/nep.13951] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022]
Abstract
AIM The burden of several cardiovascular risk factors increases in parallel to renal function decline. Exercise intolerance is common in patients with chronic kidney disease (CKD) and has been associated with increased risk of adverse outcomes. Whether indices of cardiorespiratory capacity deteriorate with advancing CKD stages is unknown. METHODS We conducted a systematic review and meta-analysis of studies assessing cardiorespiratory capacity in adult patients with pre-dialysis CKD using cardiopulmonary exercise testing (CPET) and reporting data for different stages. Our primary outcome was differences in peak oxygen uptake (VO2 peak) between patients with CKD Stages 2-3a and those with Stages 3b-5(pre-dialysis). Literature search was undertaken in PubMed, Web of Science and Scopus databases, and abstract books of relevant meetings. Quality assessment was undertaken with Newcastle-Ottawa-Scale. RESULTS From 4944 records initially retrieved, six studies with 512 participants fulfilling our inclusion criteria were included in the primary meta-analysis. Peak oxygen uptake (VO2 peak) was significantly higher in patients with CKD Stages 2-3a versus those with Stages 3b-5(pre-dialysis) [weighted-mean-difference, WMD: 2.46, 95% CI (1.15, 3.78)]. Oxygen consumption at ventilatory threshold (VO2 VT) was higher in Stages 2-3a compared with those in Stages 3b-5(pre-dialysis) [standardized-mean-difference, SMD: 0.59, 95% CI (0.06, 1.1)], while no differences were observed for maximum workload and respiratory-exchange-ratio. A secondary analysis comparing patients with CKD Stages 2-3b and Stages 4-5(pre-dialysis), yielded similar results [WMD: 1.78, 95% CI (1.34, 2.22)]. Sensitivity analysis confirmed the robustness of these findings. CONCLUSION VO2 peak and VO2 VT assessed with CPET are significantly lower in patients in CKD Stages 3b-5 compared with Stages 2-3a. Reduced cardiorespiratory fitness may be another factor contributing to cardiovascular risk increase with advancing CKD.
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Affiliation(s)
- Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology and Biochemistry Laboratory, Department of Sports Science, Aristotle University, Serres, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Ramick MG, Kirkman DL, Stock JM, Muth BJ, Farquhar WB, Chirinos JA, Doulias PT, Ischiropoulos H, Edwards DG. The effect of dietary nitrate on exercise capacity in chronic kidney disease: a randomized controlled pilot study. Nitric Oxide 2021; 106:17-23. [PMID: 33080411 PMCID: PMC10026360 DOI: 10.1016/j.niox.2020.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/12/2020] [Accepted: 10/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic Kidney Disease (CKD) patients exhibit a reduced exercise capacity that impacts quality of life. Dietary nitrate supplementation has been shown to have favorable effects on exercise capacity in disease populations by reducing the oxygen cost of exercise. This study investigated whether dietary nitrates would acutely improve exercise capacity in CKD patients. METHODS AND RESULTS In this randomized, double-blinded crossover study, 12 Stage 3-4 CKD patients (Mean ± SEM: Age, 60 ± 5yrs; eGFR, 50.3 ± 4.6 ml/min/1.73 m2) received an acute dose of 12.6 mmol of dietary nitrate in the form of concentrated beetroot juice (BRJ) and a nitrate depleted placebo (PLA). Skeletal muscle mitochondrial oxidative function was assessed using near-infrared spectroscopy. Cardiopulmonary exercise testing was performed on a cycle ergometer, with intensity increased by 25 W every 3 min until volitional fatigue. Plasma nitric oxide (NO) metabolites (NOm; nitrate, nitrite, low molecular weight S-nitrosothiols, and metal bound NO) were determined by gas-phase chemiluminescence. Plasma NOm values were significantly increased following BRJ (BRJ vs. PLA: 1074.4 ± 120.4 μM vs. 28.4 ± 6.6 μM, p < 0.001). Total work performed (44.4 ± 10.6 vs 39.6 ± 9.9 kJ, p = 0.03) and total exercise time (674 ± 85 vs 627 ± 86s, p = 0.04) were significantly greater following BRJ. Oxygen consumption at the ventilatory threshold was also improved by BRJ (0.90 ± 0.08 vs. 0.74 ± 0.06 L/min, p = 0.04). These changes occurred in the absence of improved skeletal muscle mitochondrial oxidative capacity (p = 0.52) and VO2peak (p = 0.35). CONCLUSIONS Our findings demonstrate that inorganic nitrate can acutely improve exercise capacity in CKD patients. The effects of chronic nitrate supplementation on CKD related exercise intolerance should be investigated in future studies.
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Affiliation(s)
- Meghan G Ramick
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; Department of Kinesiology, West Chester University, West Chester, PA, USA
| | - Danielle L Kirkman
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Bryce J Muth
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; School of Health Sciences, Stockton University, Stockton, NJ, USA
| | - William B Farquhar
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Julio A Chirinos
- Division of Cardiovascular Medicine. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paschalis-Thomas Doulias
- Laboratory of Biochemistry, Department of Chemistry, School of Sciences, University of Ioannina, Ioannina, 45110, Greece; Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | - Harry Ischiropoulos
- Laboratory of Biochemistry, Department of Chemistry, School of Sciences, University of Ioannina, Ioannina, 45110, Greece; Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
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14
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Kirkman DL, Ramick MG, Muth BJ, Stock JM, Townsend RR, Edwards DG. A randomized trial of aerobic exercise in chronic kidney disease: evidence for blunted cardiopulmonary adaptations. Ann Phys Rehabil Med 2020; 64:101469. [PMID: 33316435 DOI: 10.1016/j.rehab.2020.101469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with chronic kidney disease have reduced cardiorespiratory fitness levels that contribute to mortality. OBJECTIVES The purpose of this study was to investigate the effects of aerobic exercise on cardiopulmonary function in patients with chronic kidney disease. METHODS A total of 36 patients (mean [SD] estimated glomerular filtration rate 44 [12] ml/min/1.73m2) were randomly allocated to an exercise training or a control arm over 12 weeks. The exercise training group performed aerobic exercise for 45 min 3 times/week at 65% to 80% heart rate reserve. The control group received routine care. Outcome measures were assessed at baseline and 12 weeks. Cardiopulmonary exercise testing was performed on a cycle ergometer with workload increased by 15 W/min. A battery of physical function tests were administered. Habitual physical activity levels were recorded via accelerometry. Data are mean (SD). RESULTS Exercise training improved VO2peak as compared with the control group (exercise: 17.89 [4.18] vs 19.98 [5.49]; control: 18.29 [6.49] vs 17.36 [5.99] ml/kg/min; p<0.01). Relative O2 pulse improved following exercise, suggestive of improved left ventricular function (exercise: 0.12 [0.02] vs 0.14 [0.04]; control: 0.14 [0.05] vs 0.14 [0.04] ml/beat/kg; p=0.03). Ventilation perfusion mismatching (VE/VCO2) remained evident after exercise (exercise: 32 [5] vs 33 [5]; control: 32 [7] vs 34 [5] AU; p=0.1). Exercise did not affect the ventilatory cost of oxygen uptake (VE/VO2; exercise: 40 [7] vs 42 [8]; control: 3 [7] vs 41 [8] AU; p=0.5) and had no effect on autonomic function assessed by maximal and recovery heart rates. We found no changes in physical function or habitual physical activity levels. CONCLUSIONS Cardiopulmonary adaptations appeared to be attenuated in patients with chronic kidney disease and were not fully restored to levels observed in healthy individuals. Improvements in exercise capacity did not confer benefits to physical function. Interventions coupled with exercise may be required to enhance adaptations in chronic kidney disease. Performed according to CONSORT guidelines; ClinicalTrials.gov: NCT02050035.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA.
| | - Meghan G Ramick
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; Department of Kinesiology, West Chester University, West Chester, PA, USA.
| | - Bryce J Muth
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; School of Health Sciences, Stockton University, Galloway, NJ, USA.
| | - Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
| | | | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
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15
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Kirkman DL, Bohmke N, Carbone S, Garten RS, Rodriguez-Miguelez P, Franco RL, Kidd JM, Abbate A. Exercise intolerance in kidney diseases: physiological contributors and therapeutic strategies. Am J Physiol Renal Physiol 2020; 320:F161-F173. [PMID: 33283641 DOI: 10.1152/ajprenal.00437.2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Exertional fatigue, defined as the overwhelming and debilitating sense of sustained exhaustion that impacts the ability to perform activities of daily living, is highly prevalent in chronic kidney disease (CKD) and end-stage renal disease (ESRD). Subjective reports of exertional fatigue are paralleled by objective measurements of exercise intolerance throughout the spectrum of the disease. The prevalence of exercise intolerance is clinically noteworthy, as it leads to increased frailty, worsened quality of life, and an increased risk of mortality. The physiological underpinnings of exercise intolerance are multifaceted and still not fully understood. This review aims to provide a comprehensive outline of the potential physiological contributors, both central and peripheral, to kidney disease-related exercise intolerance and highlight current and prospective interventions to target this symptom. In this review, the CKD-related metabolic derangements, cardiac and pulmonary dysfunction, altered physiological responses to oxygen consumption, vascular derangements, and sarcopenia are discussed in the context of exercise intolerance. Lifestyle interventions to improve exertional fatigue, such as aerobic and resistance exercise training, are discussed, and the lack of dietary interventions to improve exercise tolerance is highlighted. Current and prospective pharmaceutical and nutraceutical strategies to improve exertional fatigue are also broached. An extensive understanding of the pathophysiological mechanisms of exercise intolerance will allow for the development of more targeted therapeutic approached to improve exertional fatigue and health-related quality of life in CKD and ESRD.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Natalie Bohmke
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Salvatore Carbone
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia.,Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Ryan S Garten
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Robert L Franco
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Jason M Kidd
- Division of Nephrology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Antonio Abbate
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.,Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
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16
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Wilkinson TJ, Watson EL, Vadaszy N, Baker LA, Viana JL, Smith AC. Response of the oxygen uptake efficiency slope to exercise training in patients with chronic kidney disease. Kidney Res Clin Pract 2020; 39:305-317. [PMID: 32550710 PMCID: PMC7530363 DOI: 10.23876/j.krcp.20.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/27/2020] [Accepted: 05/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) patients have poor cardiorespiratory fitness. Although cardiopulmonary exercise testing (CPET) is a universal assessment of cardiorespiratory fitness, values taken at 'peak' effort are strongly influenced by motivation and the choice of test endpoint. The oxygen uptake efficiency slope (OUES) integrates cardiovascular, musculoskeletal, and respiratory function into a single index to provide a more pragmatic and safer alternative to maximal testing. No research has explored whether exercise can improve the OUES in CKD patients. METHODS Thirty-two patients with non-dialysis CKD were recruited into a 12-week exercise program consisting of mixed aerobic and resistance training three times a week. CPET was conducted at baseline, and then, following a 6-week control period, at pre- and post-exercise intervention. Direct measurements of oxygen consumption (V̇O2) and ventilatory parameters were collected. The OUES was calculated as the relationship between V̇O2 and the log10 of minute ventilation (V̇E). RESULTS No changes were observed in any variable during the control period, although modest increases in V̇O2peak were observed. No meaningful changes were observed as a result of exercise in any cardiorespiratory value obtained. The OUES calculated at 100%, 90%, 75%, and 50% of exercise duration did not change significantly after 12 weeks of exercise training. CONCLUSION Our results show that 12 weeks of exercise training had no beneficial effects on the OUES, which supports the modest change observed in V̇O2peak. The lack of change in the OUES and other parameters could indicate a dysfunctional cardiorespiratory response to exercise in patients with CKD, likely mediated by dysfunctional peripheral metabolic mechanisms.
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Affiliation(s)
- Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Science, University of Leicester, Leicester, UK
| | - Emma L Watson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Noemi Vadaszy
- Leicester Kidney Lifestyle Team, Department of Health Science, University of Leicester, Leicester, UK
| | - Luke A Baker
- Leicester Kidney Lifestyle Team, Department of Health Science, University of Leicester, Leicester, UK
| | - João L Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI, Maia, Portugal
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Science, University of Leicester, Leicester, UK
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17
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Andrade FP, Rezende PDS, Ferreira TDS, Borba GC, Müller AM, Rovedder PME. Effects of intradialytic exercise on cardiopulmonary capacity in chronic kidney disease: systematic review and meta-analysis of randomized clinical trials. Sci Rep 2019; 9:18470. [PMID: 31804617 PMCID: PMC6895108 DOI: 10.1038/s41598-019-54953-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 11/04/2019] [Indexed: 01/27/2023] Open
Abstract
Patients with chronic kidney disease show poorer functional and cardiorespiratory capacity than healthy individuals, and these impairments result in sedentarism. The aim of this study was to conduct a systematic review and meta-analysis of randomized clinical trials on the effects of different intradialytic exercise protocols on cardiopulmonary capacity in chronic kidney disease patients. The primary outcome was peak oxygen consumption (VO2peak) and the secondary outcomes were exercise duration and ventilation in the cardiopulmonary test. The quality of the evidence was evaluated using the GRADE guidelines. Seven studies with a total of 124 participants met the inclusion criteria. Compared to the non-exercise group, the exercise group improved in mean VO2peak (MD 4.06 [IC 0.81; 7.31]). In a separate analysis according to exercise modality, aerobic exercise plus strength training performed better than aerobic exercise alone (MD 5.28 [IC 3.90; 6.66]). In the exercise group, both exercise tolerance values (MD 3.10 [IC 1.70; 4.51]) and ventilation values in the cardiopulmonary test were better than those of the control group (MD 13.10 [IC 7.12; 19.09]). Thus, intradialytic exercise protocols can improve cardiopulmonary function, exercise tolerance and ventilatory efficiency in chronic kidney disease patients.
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Affiliation(s)
- Francini Porcher Andrade
- Programa de Pós Graduação em Ciências Pneumológicas at Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, postcode 90040-060, Brazil.
| | - Patrícia de Souza Rezende
- Physiotherapy Course, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, postcode 90040-060, Brazil
| | - Tatiane de Souza Ferreira
- Programa de Pós Graduação em Ciências Pneumológicas at Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, postcode 90040-060, Brazil
| | - Gabrielle Costa Borba
- Programa de Pós Graduação em Ciências Pneumológicas at Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, postcode 90040-060, Brazil
| | - Alice Mânica Müller
- Programa de Pós Graduação em Ciências Pneumológicas at Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, postcode 90040-060, Brazil
| | - Paula Maria Eidt Rovedder
- Programa de Pós Graduação em Ciências Pneumológicas at Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, postcode 90040-060, Brazil. .,Physiotherapy Course, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, postcode 90040-060, Brazil. .,Hospital de Clínicas de Porto Alegre, Porto Alegre, postcode 90035-903, Brazil.
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18
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Xenophontos S, Wilkinson TJ, Gould DW, Watson EL, Viana JL, Smith AC. Peak aerobic capacity from incremental shuttle walk test in chronic kidney disease. J Ren Care 2019; 45:185-192. [PMID: 31355544 DOI: 10.1111/jorc.12293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Assessment of cardiorespiratory fitness is an important outcome in chronic kidney disease (CKD). We aimed to develop a predictive equation to estimate peak oxygen uptake (VO2peak ) and power output (WPeak ), as measured during a cardiopulmonary exercise test (CPET), from the distance walked (DW) during the incremental shuttle walk test (ISWT). METHODS Thirty-six non-dialysing patients with CKD [17 male, age: 61 ± 12 years, eGFR: 25±7 ml/min/1.73 m2 , body mass index (BMI): 31 ± 6 kg/m2 ] carried out laboratory-based CPET on a cycle ergometer and ISWT on two separate occasions. RESULTS Linear regression revealed that DW/BMI was a significant predictor of VO2Peak (r = 0.78) (VO2Peak (ml/min/kg) = [0.5688 × (DW/BMI) (m)] + 11.50). No difference (p = 0.66) between CPET VO2Peak (19.9 ± 5.5 ml/min/kg) and predicted VO2Peak (19.9 ± 4.3 ml/min/kg) was observed. DW multiplied by body mass (BM) was a significant predictor of WPeak (r = 0.80) [WPeak (W) = (0.0018 × (DW × BM)) + 50.47]. No difference (p = 0.97) between CPET WPeak (116.2 ± 38.9 W) and estimated WPeak (113.9 ± 30.1 W) was seen. CONCLUSION The present study demonstrates that VO2Peak and WPeak can be accurately estimated using the DW during an ISWT in CKD populations.
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Affiliation(s)
- Soteris Xenophontos
- Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Douglas W Gould
- Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Emma L Watson
- Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK
| | - João L Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI, Maia, Portugal
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
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19
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Kubo H, Nozoe M, Kanai M, Yamamoto M, Kamo A, Noguchi M, Mase K, Shimada S. Association of renal function with ambulation in mild acute stroke patients. Top Stroke Rehabil 2019; 26:538-543. [PMID: 31246156 DOI: 10.1080/10749357.2019.1634361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Renal dysfunction has affected the functional outcome after stroke. However, the association of renal function with walking endurance after stroke is poorly understood. Objectives: This study aimed to investigate the relationship between renal function and walking endurance and speed in mild acute stroke patients. Methods: Eighty-nine patients with mild acute stroke were enrolled. Walking endurance and speed were assessed by the 6-minute walk test (6MWT) and comfortable and maximal 10-meter walk tests (10MWT) within 7 days of hospital admission. Stroke severity was assessed using the National Institutes of Health stroke scale (NIHSS) on admission. The estimated glomerular filtration rate (eGFR) was calculated based on creatinine levels as a renal function. Pearson's correlation coefficients were calculated between eGFR and walking ability. Multivariate regression analysis was used to investigate the relationship between eGFR and walking ability in mild acute stroke patients. Results: The 6MWT distance was significantly correlated with eGFR (r = 0.212, p = .046). On multivariate regression analysis, the 6MWT was significantly associated with age (p = .029), body mass index (p = .020), NIHSS score (p = .016), and eGFR (p = .028), whereas the comfortable 10MWT was significantly associated with the NIHSS score alone (p = .009) and the maximal 10MWT was significantly associated with age (p = .032) and NIHSS score (p = .007). Conclusion: The eGFR based on creatinine levels of acute stroke patients may be important factor to predict the walking endurance in mild acute stroke patients.
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Affiliation(s)
- Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital , Hyogo , Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University , Hyogo , Japan
| | - Masashi Kanai
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital , Hyogo , Japan
| | - Miho Yamamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital , Hyogo , Japan
| | - Arisa Kamo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital , Hyogo , Japan
| | - Madoka Noguchi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital , Hyogo , Japan
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University , Hyogo , Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital , Hyogo , Japan
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20
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Kirkman DL, Ramick MG, Muth BJ, Stock JM, Pohlig RT, Townsend RR, Edwards DG. Effects of aerobic exercise on vascular function in nondialysis chronic kidney disease: a randomized controlled trial. Am J Physiol Renal Physiol 2019; 316:F898-F905. [PMID: 30810061 PMCID: PMC6580257 DOI: 10.1152/ajprenal.00539.2018] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/26/2022] Open
Abstract
Endothelial dysfunction and arterial stiffness are nontraditional risk factors of chronic kidney disease (CKD)-related cardiovascular disease (CVD) that could be targeted with exercise. This study investigated the effect of moderate to vigorous aerobic exercise on vascular function in nondialysis CKD. In this randomized, controlled trial, 36 nondialysis patients with CKD (means ± SE, age: 58 ± 2 yr, estimated glomerular filtration rate: 44 ± 2 ml·min-1·1.73 m-2) were allocated to an exercise training (EXT) or control (CON) arm. The EXT group performed 3 × 45 min of supervised exercise per week at 60-85% heart rate reserve for 12 wk, whereas the CON group received routine care. Outcomes were assessed at 0 and 12 wk. The primary outcome, microvascular function, was assessed via cutaneous vasodilation during local heating measured by laser-Doppler flowmetry coupled with microdialysis. Participants were instrumented with two microdialysis fibers for the delivery of 1) Ringer solution and 2) the superoxide scavenger tempol. Conduit artery function was assessed via brachial artery flow-mediated dilation. Aortic pressure waveforms and pulse wave velocity were acquired with tonometry and oscillometry. Microvascular function improved after EXT (week 0 vs.week 12, EXT: 87 ± 2% vs. 91 ± 2% and CON: 86 ± 2% vs. 84 ± 3%, P = 0.03). At baseline, pharmacological delivery of tempol improved microvascular function (Ringer solution vs. tempol: 86 ± 1% vs. 90 ± 1%, P = 0.02) but was no longer effective after EXT (91 ± 2% vs. 87 ± 1%, P = 0.2), suggesting that an improved redox balance plays a role in EXT-related improvements. Brachial artery flow-mediated dilation was maintained after EXT (EXT: 2.6 ± 0.4% vs. 3.8 ± 0.8% and CON: 3.5 ± 0.6% vs. 2.3 ± 0.4%, P = 0.02). Central arterial hemodynamics and arterial stiffness were unchanged after EXT. Aerobic exercise improved microvascular function and maintained conduit artery function and should be considered as an adjunct therapy to reduce CVD risk in CKD.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University , Richmond, Virginia
| | - Meghan G Ramick
- Department of Kinesiology, West Chester University , West Chester, Pennsylvania
| | - Bryce J Muth
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
| | - Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
| | - Ryan T Pohlig
- College of Health Sciences, University of Delaware , Newark, Delaware
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennyslvania
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware
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21
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Beetham KS, Howden EJ, Fassett RG, Petersen A, Trewin AJ, Isbel NM, Coombes JS. High-intensity interval training in chronic kidney disease: A randomized pilot study. Scand J Med Sci Sports 2019; 29:1197-1204. [PMID: 31025412 DOI: 10.1111/sms.13436] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/28/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION High-intensity interval training (HIIT) increases mitochondrial biogenesis and cardiorespiratory fitness in chronic disease populations, however has not been studied in people with chronic kidney disease (CKD). The aim of this study was to compare the feasibility, safety, and efficacy of HIIT with moderate-intensity continuous training (MICT) in people with CKD. METHODS Fourteen individuals with stage 3-4 CKD were randomized to 3 supervised sessions/wk for 12 weeks, of HIIT (n = 9, 4 × 4 minute intervals, 80%-95% peak heart rate [PHR]) or MICT (n = 5, 40 minutes, 65% PHR). Feasibility was assessed via session attendance and adherence to the exercise intensity. Safety was examined by adverse event reporting. Efficacy was determined from changes in cardiorespiratory fitness (VO2 peak), exercise capacity (METs), and markers of mitochondrial biogenesis (PGC1α protein levels), muscle protein catabolism (MuRF1), and muscle protein synthesis (p-P70S6k Thr389 ). RESULTS Participants completed a similar number of sessions in each group (HIIT = 33.0[7.0] vs MICT = 33.5[3.3] sessions), and participants adhered to the target heart rates. There were no adverse events attributable to exercise training. There was a significant time effect for exercise capacity (HIIT = +0.8 ± 1.2; MICT = +1.3 ± 1.6 METs; P = 0.01) and muscle protein synthesis (HIIT = +0.6 ± 1.1; MICT = +1.4 ± 1.7 au; P = 0.04). However, there were no significant (P > 0.05) group × time effects for any outcomes. CONCLUSION This pilot study demonstrated that HIIT is a feasible and safe option for people with CKD, and there were similar benefits of HIIT and MICT on exercise capacity and skeletal muscle protein synthesis. These data support a larger trial to further evaluate the effectiveness of HIIT.
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Affiliation(s)
- Kassia S Beetham
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Erin J Howden
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Robert G Fassett
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Aaron Petersen
- Institute of Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Adam J Trewin
- Institute of Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Nicole M Isbel
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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22
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Katulka EK, Hirt AE, Kirkman DL, Edwards DG, Witman MAH. Altered vascular function in chronic kidney disease: evidence from passive leg movement. Physiol Rep 2019; 7:e14075. [PMID: 31016878 PMCID: PMC6478620 DOI: 10.14814/phy2.14075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 12/30/2022] Open
Abstract
Chronic kidney disease (CKD) is an independent risk factor for the development of cardiovascular disease and is characterized by reduced nitric oxide (NO) bioavailability and vascular dysfunction, typically assessed using brachial artery flow-mediated dilation (FMD). It has been previously reported that passive leg movement (PLM)-induced hyperemia, an assessment of lower extremity vascular function, is highly dependent on NO, but has not yet been utilized to assess vascular function in patients with CKD. The purpose of this study was to comprehensively assess vascular function in patients with CKD using PLM, in addition to the traditional FMD technique. Assessment of vascular function via PLM and FMD was performed on 12 patients (CKD, 66 ± 3 years) and 16 age-matched healthy controls (CON, 60 ± 2 years). Blood velocity and artery diameters during PLM and FMD were measured using duplex ultrasound of the femoral and brachial arteries, respectively. Habitual physical activity, assessed by accelerometry, was performed in a subset of each group. CKD patients had reduced peak leg blood flow (LBF) (384 ± 39 vs. 569 ± 77 mL/min, P < 0.05) and change in LBF from baseline to peak (∆peakLBF) (143 ± 22 vs. 249 ± 34 mL/min, P < 0.05) during PLM compared to CON. Additionally, PLM responses were significantly associated with kidney function and physical activity levels. As anticipated, FMD was significantly attenuated in CKD patients (5.2 ± 1.1 vs. 8.8 ± 1.2%, P < 0.05). In conclusion, both upper and lower extremity measures of vascular function indicate impairment in CKD patients when compared to controls. PLM appears to be a novel and feasible approach to assessing lower extremity vascular function in CKD.
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Affiliation(s)
- Elissa K. Katulka
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelaware
| | - Alexandra E. Hirt
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelaware
| | - Danielle L. Kirkman
- Department of Kinesiology and Heath SciencesVirginia Commonwealth UniversityRichmondVirginia
| | - David G. Edwards
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelaware
| | - Melissa A. H. Witman
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelaware
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23
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Gradual reduction in exercise capacity in chronic kidney disease is associated with systemic oxygen delivery factors. PLoS One 2018; 13:e0209325. [PMID: 30566512 PMCID: PMC6300328 DOI: 10.1371/journal.pone.0209325] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 12/04/2018] [Indexed: 01/26/2023] Open
Abstract
Background The 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. Methods We 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. Results Peak 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. Conclusions In 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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24
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Badawy SM, Payne AB, Rodeghier MJ, Liem RI. Exercise capacity and clinical outcomes in adults followed in the Cooperative Study of Sickle Cell Disease (CSSCD). Eur J Haematol 2018; 101:532-541. [PMID: 29999202 DOI: 10.1111/ejh.13140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine the factors associated with exercise capacity in adults with sickle cell disease (SCD) and its relationship to hospitalizations and mortality. METHODS A total of 223 participants in the Cooperative Study of Sickle Cell Disease (CSSCD) (64% female, 70% hemoglobin SS/Sβ0 thalassemia, mean age 43.3 ± 7.5 years) underwent maximal exercise testing using a treadmill protocol with a mean duration of 11.6 ± 5.2 minutes. RESULTS Female sex (β = -3.34, 95% CI [-1.80, -4.88], P < 0.001), older age (β = -0.14, 95% CI [-0.24, -0.04], P = 0.005), higher body mass index (β = -0.23, 95% CI [-0.37, -0.10]; P = 0.001), and lower hemoglobin (β = 0.56, 95% CI [0.08, 1.04], P = 0.02) were independently associated with lower fitness, while there was a trend with abnormal pulmonary function testing (β = -1.42, 95% CI [-2.92, 0.07]; P = 0.06). Lower percent-predicted forced expiratory volume in 1 second (FEV1 ) was independently associated with lower fitness (β = 0.08, 95% CI [0.03, 0.13], P = 0.001). Genotype and hospitalization rates for pain and acute chest syndrome (ACS) prior to testing were not associated with exercise capacity. Baseline exercise capacity predicted neither future pain or ACS nor survival in our cohort. Adults with SCD tolerated maximal exercise testing. CONCLUSIONS Prospective studies are needed to further evaluate the impact of regular exercise and improved fitness on clinical outcomes and mortality in SCD.
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Affiliation(s)
- Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School Medicine, Chicago, Illinois
| | - Amanda B Payne
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Robert I Liem
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School Medicine, Chicago, Illinois
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25
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Kirkman DL, Muth BJ, Stock JM, Townsend RR, Edwards DG. Cardiopulmonary exercise testing reveals subclinical abnormalities in chronic kidney disease. Eur J Prev Cardiol 2018; 25:1717-1724. [DOI: 10.1177/2047487318777777] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Reductions in exercise capacity associated with exercise intolerance augment cardiovascular disease risk and predict mortality in chronic kidney disease. This study utilized cardiopulmonary exercise testing to (a) investigate mechanisms of exercise intolerance; (b) unmask subclinical abnormalities that may precede cardiovascular disease in chronic kidney disease. Design The design of this study was cross-sectional. Methods Cardiopulmonary exercise testing was carried out in 31 Stage 3–4 chronic kidney disease patients (60 ± 11 years; estimated glomerular filtration rate 43 ± 13 ml/min/1.73 m2) and 21 matched healthy individuals (healthy controls; 56 ± 5 years; estimated glomerular filtration rate>90 ml/min/1.73 m2) on a cycle ergometer with workload increased by 15 W every minute until volitional fatigue. Breath-by-breath respiratory gas analysis was performed with an automated gas analyzer and averaged over 10 s intervals. Results Peak oxygen uptake was reduced in chronic kidney disease compared to healthy controls (17.43 ± 1.03 vs 28 ± 2.05 ml/kg/min; p < 0.01), as was oxygen uptake at the ventilatory threshold (9.44 ± 0.53 vs15.55 ± 1.34 ml/kg/min; p < 0.01). A steeper minute ventilation rate/carbon dioxide production slope (32 ± 0.8 vs 28 ± 1; p < 0.01) and a lower expired carbon dioxide pressure in chronic kidney disease (27 ± 0.6 vs 31 ± 0.9 vs 0.9; p < 0.01) indicated ventilation perfusion mismatching in these patients. The ventilatory cost of oxygen uptake was higher in chronic kidney disease (37 ± 0.8 vs 33 ± 1; p < 0.01). Maximum heart rate (134 ± 5 vs 159 ± 3 bpm) and one-minute heart rate recovery (15 ± 1 vs 20 ± 2 bpm) were reduced in chronic kidney disease ( p < 0.01). Conclusion This study suggests that both central and peripheral limitations likely contribute to reduced exercise capacity in non-dialysis chronic kidney disease. Additionally, cardiopulmonary exercise testing revealed subclinical cardiopulmonary abnormalities in these patients in the absence of overt cardiovascular disease. Cardiopulmonary exercise testing could potentially be a tool for unmasking cardiopulmonary abnormalities preceding cardiovascular disease in chronic kidney disease.
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Affiliation(s)
- Danielle L Kirkman
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
| | - Bryce J Muth
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
| | - Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
| | - Raymond R Townsend
- Clinical and Translational Research Center, University of Pennsylvania, USA
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, USA
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26
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Bailey TG, Perissiou M, Windsor MT, Schulze K, Nam M, Magee R, Leicht AS, Green DJ, Greaves K, Golledge J, Askew CD. Effects of acute exercise on endothelial function in patients with abdominal aortic aneurysm. Am J Physiol Heart Circ Physiol 2017; 314:H19-H30. [PMID: 28939648 DOI: 10.1152/ajpheart.00344.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endothelial dysfunction is observed in patients with abdominal aortic aneurysm (AAA), who have increased risk of cardiovascular events and mortality. This study aimed to assess the acute effects of moderate- and higher-intensity exercise on endothelial function, as assessed by flow-mediated dilation (FMD), in AAA patients (74 ± 6 yr old, n = 22) and healthy adults (72 ± 5 yr old, n = 22). Participants undertook three randomized visits, including moderate-intensity continuous exercise [40% peak power output (PPO)], higher-intensity interval exercise (70% PPO), and a no-exercise control. Brachial artery FMD was assessed at baseline and at 10 and 60 min after each condition. Baseline FMD was lower [by 1.10% (95% confidence interval: 0.72-.81), P = 0.044] in AAA patients than in healthy adults. There were no group differences in FMD responses after each condition ( P = 0.397). FMD did not change after no-exercise control but increased by 1.21% (95% confidence interval: 0.69-1.73, P < 0.001) 10 min after moderate-intensity continuous exercise in both groups and returned to baseline after 60 min. Conversely, FMD decreased by 0.93% (95% confidence interval: 0.41-1.44, P < 0.001) 10 min after higher-intensity interval exercise in both groups and remained decreased after 60 min. We found that the acute response of endothelial function to exercise is intensity-dependent and similar between AAA patients and healthy adults. Our findings provide evidence that regular exercise may improve vascular function in AAA patients, as it does in healthy adults. Improved FMD after moderate-intensity exercise may provide short-term benefit. Whether the decrease in FMD after higher-intensity exercise represents an additional risk and/or a greater stimulus for vascular adaptation remains to be elucidated. NEW & NOTEWORTHY Abdominal aortic aneurysm patients have vascular dysfunction. We observed a short-term increase in vascular function after moderate-intensity exercise. Conversely, higher-intensity exercise induced a prolonged reduction in vascular function, which may be associated with both short-term increases in cardiovascular risk and signaling for longer-term vascular adaptation in abdominal aortic aneurysm patients.
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Affiliation(s)
- Tom G Bailey
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Maria Perissiou
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Mark T Windsor
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Karl Schulze
- Sunshine Vascular Clinic, Buderim, Queensland, Australia
| | - Michael Nam
- Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Rebecca Magee
- Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Anthony S Leicht
- Sport and Exercise Science, James Cook University, Townville, Queensland, Australia
| | - Daniel J Green
- School of Sport Science, Exercise, and Health, University of Western Australia, Crawley, Western Australia, Australia.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University , Liverpool , United Kingdom
| | - Kim Greaves
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia.,Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University , Townsville, Queensland , Australia.,Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Queensland, Australia
| | - Christopher D Askew
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia
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Barroso R, Silva-Filho AC, Dias CJ, Soares N, Mostarda A, Azoubel LA, Melo L, Garcia ADMC, Rodrigues B, Mostarda CT. Effect of exercise training in heart rate variability, anxiety, depression, and sleep quality in kidney recipients: A preliminary study. J Health Psychol 2016; 24:299-308. [DOI: 10.1177/1359105316676329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Rodrigo Barroso
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Antonio C Silva-Filho
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Carlos José Dias
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Nivaldo Soares
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Alessandra Mostarda
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
- UNOPAR, Brazil
| | - Luana Anaisse Azoubel
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | - Leandro Melo
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
| | | | | | - Cristiano Texeira Mostarda
- Federal University of Maranhão, Brazil
- Laboratory of Cardiovascular Adaptations to Exercise (LACORE), Brazil
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28
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Martens CR, Kirkman DL, Edwards DG. The Vascular Endothelium in Chronic Kidney Disease: A Novel Target for Aerobic Exercise. Exerc Sport Sci Rev 2016; 44:12-9. [PMID: 26509484 DOI: 10.1249/jes.0000000000000065] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endothelial dysfunction occurs in chronic kidney disease (CKD) and increases the risk for cardiovascular disease. The mechanisms of endothelial dysfunction seem to evolve throughout kidney disease progression, culminating in reduced L-arginine transport and impaired nitric oxide bioavailability in advanced disease. This review examines the hypothesis that aerobic exercise may reverse endothelial dysfunction by improving endothelial cell L-arginine uptake in CKD.
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Affiliation(s)
- Christopher R Martens
- 1Department of Integrative Physiology, University of Colorado, Boulder, CO; and 2Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
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29
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Krishnasamy R, Hawley CM, Stanton T, Howden EJ, Beetham KS, Strand H, Leano R, Haluska BA, Coombes JS, Isbel NM. Association between left ventricular global longitudinal strain, health-related quality of life and functional capacity in chronic kidney disease patients with preserved ejection fraction. Nephrology (Carlton) 2016; 21:108-15. [DOI: 10.1111/nep.12557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Rathika Krishnasamy
- Department of Renal Medicine; The University of Queensland; Brisbane Queensland Australia
- Translational Research Institute; Brisbane Queensland Australia
| | - Carmel M Hawley
- Department of Renal Medicine; The University of Queensland; Brisbane Queensland Australia
- Translational Research Institute; Brisbane Queensland Australia
- Human Movement Studies; The University of Queensland; Brisbane Queensland Australia
| | - Tony Stanton
- The University of Queensland at Princess Alexandra Hospital, Schools of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Erin J Howden
- Nursing and Midwifery; The University of Queensland; Brisbane Queensland Australia
| | - Kassia S Beetham
- Cardiovascular Imaging Research Group; The University of Queensland; Brisbane Queensland Australia
| | - Haakan Strand
- Institute for Exercise and Environmental Medicine; University of Texas Southwestern Medical Center; Dallas Texas USA
| | - Rodel Leano
- The University of Queensland at Princess Alexandra Hospital, Schools of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Brian A Haluska
- The University of Queensland at Princess Alexandra Hospital, Schools of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Jeff S Coombes
- Cardiovascular Imaging Research Group; The University of Queensland; Brisbane Queensland Australia
| | - Nicole M Isbel
- Department of Renal Medicine; The University of Queensland; Brisbane Queensland Australia
- Translational Research Institute; Brisbane Queensland Australia
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30
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Moraes Dias CJ, Anaisse Azoubel LM, Araújo Costa H, Costa Maia E, Rodrigues B, Silva-Filho AC, Dias-Filho CAA, Claúdia Irigoyen M, Leite RD, de Oliveira Junior MS, Mostarda CT. Autonomic modulation analysis in active and sedentary kidney transplanted recipients. Clin Exp Pharmacol Physiol 2015; 42:1239-44. [DOI: 10.1111/1440-1681.12481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/30/2015] [Accepted: 08/11/2015] [Indexed: 12/21/2022]
Affiliation(s)
| | | | | | - Ednei Costa Maia
- Medical School of Federal University of São Paulo; São Paulo Brazil
| | - Bruno Rodrigues
- School of Physical Education; University of Campinas - UNICAMP; Campinas Brazil
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31
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The role of exercise training in the management of chronic kidney disease. Curr Opin Nephrol Hypertens 2015; 24:480-7. [DOI: 10.1097/mnh.0000000000000165] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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32
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Parnham SFC, Gleadle JM, De Pasquale CG, Selvanayagam JB. Myocardial Ischemia Assessment in Chronic Kidney Disease: Challenges and Pitfalls. Front Cardiovasc Med 2014; 1:13. [PMID: 26664863 PMCID: PMC4668858 DOI: 10.3389/fcvm.2014.00013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/07/2014] [Indexed: 01/15/2023] Open
Abstract
Coronary artery disease is the leading cause of mortality and morbidity in the chronic kidney disease (CKD) population and often presents with atypical symptoms. Current diagnostic investigations of myocardial ischemia in CKD lack sensitivity and specificity or may have adverse effects. We present a case vignette and explore the challenges of diagnostic myocardial stress investigation in patients with CKD.
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Affiliation(s)
- Susie F C Parnham
- Department of Cardiovascular Medicine, Flinders Medical Centre , Bedford Park, SA , Australia ; School of Medicine, Flinders University , Bedford Park, SA , Australia
| | - Jonathan M Gleadle
- School of Medicine, Flinders University , Bedford Park, SA , Australia ; Department of Renal Medicine, School of Medicine, Flinders University , Bedford Park, SA , Australia
| | - Carmine G De Pasquale
- Department of Cardiovascular Medicine, Flinders Medical Centre , Bedford Park, SA , Australia ; School of Medicine, Flinders University , Bedford Park, SA , Australia
| | - Joseph B Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre , Bedford Park, SA , Australia ; School of Medicine, Flinders University , Bedford Park, SA , Australia
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