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Initiation of dialysis is associated with impaired cardiovascular functional capacity
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Arroyo, Eliott, Umukoro, Peter E., Burney, Heather N., Li, Yang, Li, Xiaochun, Lane, Kathleen A., Sher, S. Jawad, Lu, Tzong‐shi, Moe, Sharon M., Moorthi, Ranjani, Coggan, Andrew R., McGregor, Gordon, Hiemstra, Thomas F., Zehnder, Daniel and Lim, Kenneth (2022) Initiation of dialysis is associated with impaired cardiovascular functional capacity. Journal of the American Heart Association, 11 (14). e025656. doi:10.1161/jaha.122.025656 ISSN 2047-9980.
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Official URL: https://doi.org/10.1161/JAHA.122.025656
Abstract
Background The transition to dialysis period carries a substantial increased cardiovascular risk in patients with chronic kidney disease. Despite this, alterations in cardiovascular functional capacity during this transition are largely unknown. The present study therefore sought to assess ventilatory exercise response measures in patients within 1 year of initiating dialysis. Methods and Results We conducted a cross‐sectional study of 241 patients with chronic kidney disease stage 5 from the CAPER (Cardiopulmonary Exercise Testing in Renal Failure) study and from the intradialytic low‐frequency electrical muscle stimulation pilot randomized controlled trial cohorts. Patients underwent cardiopulmonary exercise testing and echocardiography. Of the 241 patients (age, 48.9 [15.0] years; 154 [63.9%] men), 42 were predialytic (mean estimated glomerular filtration rate, 14 mL·min −1 ·1.73 m −2 ), 54 had a dialysis vintage ≤12 months, and 145 had a dialysis vintage >12 months. Dialysis vintage ≤12 months exhibited a significantly impaired cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (18.7 [5.8] mL·min −1 ·kg −1 ) compared with predialysis (22.7 [5.2] mL·min −1 ·kg −1 ; P <0.001). Dialysis vintage ≤12 months also exhibited reduced peak workload, impaired peak heart rate, reduced circulatory power, and increased left ventricular mass index ( P <0.05 for all) compared with predialysis. After excluding those with prior kidney transplant, dialysis vintage >12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min −1 ·kg −1 ) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min −1 ·kg −1 ; P =0.033). Conclusions Initiating dialysis is associated with a significant impairment in oxygen uptake at peak exercise and overall decrements in ventilatory and hemodynamic exercise responses that predispose patients to functional dependence. The magnitude of these changes is comparable to the differences between low‐risk New York Heart Association class I and higher‐risk New York Heart Association class II to IV heart failure.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | ||||||||
Library of Congress Subject Headings (LCSH): | Hemodialysis, Cerebrovascular disease -- Exercise therapy, Exercise tests, Heart function tests, Pulmonary function tests, Kidneys -- Diseases, Renal insufficiency -- Treatment, Chronic renal failure -- Treatment -- Psychological aspects | ||||||||
Journal or Publication Title: | Journal of the American Heart Association | ||||||||
Publisher: | Ovid Technologies (Wolters Kluwer Health) | ||||||||
ISSN: | 2047-9980 | ||||||||
Official Date: | 19 July 2022 | ||||||||
Dates: |
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Volume: | 11 | ||||||||
Number: | 14 | ||||||||
Article Number: | e025656 | ||||||||
DOI: | 10.1161/jaha.122.025656 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Copyright Holders: | Copyright © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell | ||||||||
Date of first compliant deposit: | 3 August 2022 | ||||||||
Date of first compliant Open Access: | 3 August 2022 | ||||||||
RIOXX Funder/Project Grant: |
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