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Exaggerated blood pressure response to dynamic exercise despite chronic refractory hypotension : results of a human case study
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Rogan, Alice, McGregor, Gordon, Weston, Charles, Krishnan, Nithya, Higgins, Rob, Zehnder, Daniel and Ting, Stephen M. S. (2015) Exaggerated blood pressure response to dynamic exercise despite chronic refractory hypotension : results of a human case study. BMC Nephrology, 16 (1). Article number 76. doi:10.1186/s12882-015-0076-7 ISSN 1471-2369.
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Official URL: http://dx.doi.org/10.1186/s12882-015-0076-7
Abstract
BACKGROUND:
Chronic refractory hypotension is a rare but significant mortality risk in renal failure patients. Such aberrant physiology usually deems patient unfit for renal transplant surgery. Exercise stimulates the mechano-chemoreceptors in the skeletal muscle thereby modulating the sympathetic effects on blood pressure regulation. The haemodynamic response to dynamic exercise in such patients has not been previously investigated. We present a case with severe chronic hypotension who underwent exercise testing before and after renal transplantation, with marked differences in blood pressure response to exercise.
CASE PRESENTATION:
A 40-year old haemodialysis-dependent patient with a 2 year history of refractory hypotension (≤80/50 mmHg) was referred for living donor renal transplantation at our tertiary centre. Each dialysis session was often less than 2 h and 30 min due to symptomatic hypotension. As part of the cardiovascular assessment, she underwent haemodynamic evaluation with cardiopulmonary exercise testing. Blood pressure normalized during unloaded pedalling but was exaggerated at maximal workload whereby it rose from 82/50 mmHg to a peak of 201/120 mmHg. Transthoracic echocardiography, tonometric measure of central vascular compliance and myocardial perfusion scan were normal. She subsequently underwent an antibody-incompatible renal transplantation and was vasopressor reliant for 14 days during the post-operative period. Eight weeks following transplant, resting blood pressure was normal and a physiological exercise-haemodynamic response was observed during a repeat cardiopulmonary exercise testing.
CONCLUSION:
This case highlights the potential therapeutic role of unloaded leg cycling exercise during dialysis session to correct chronic hypotension, allowing patients to have greater tolerance to fluid shift. It also adds to existing evidence that sympathetic dysfunction is reversible with renal transplant. Furthermore chronic hypotension with preserved exercise-haemodynamic response and cardiovascular reserve should not preclude these patients from renal transplant surgery.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RE Ophthalmology |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Blood pressure, Hypertension, Hypertension--exercise therapy, Renal Dialysis--Methods--Complications, Hemodialysis, Chronic renal failure--Pathophysiology | ||||||||
| Journal or Publication Title: | BMC Nephrology | ||||||||
| Publisher: | BioMed Central Ltd. | ||||||||
| ISSN: | 1471-2369 | ||||||||
| Official Date: | 9 June 2015 | ||||||||
| Dates: |
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| Volume: | 16 | ||||||||
| Number: | 1 | ||||||||
| Article Number: | Article number 76 | ||||||||
| DOI: | 10.1186/s12882-015-0076-7 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 29 December 2015 | ||||||||
| Date of first compliant Open Access: | 29 December 2015 | ||||||||
| Funder: | British Heart Foundation , University Hospitals Coventry and Warwickshire NHS Trust | ||||||||
| Grant number: | G/11/66/28982 (BHF) |
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