Association of maximal stress ergometry performance with troponin T and abdominal aortic calcification score in advanced chronic kidney disease

Abstract

Background Cardiac biomarkers Troponin T (TnT) and N-terminal pro-B-type natriuretic peptide (proBNP) and abdominal aortic calcification score (AAC) are associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). The effects of cardiac biomarkers and AAC on maximal exercise capacity in CKD are unknown and were studied. Methods One hundred seventy-four CKD 4–5 patients not on maintenance dialysis underwent maximal bicycle ergometry stress testing, lateral lumbar radiograph to study AAC, echocardiography and biochemical assessments. Results The subjects with proportional maximal ergometry workload (WMAX%) less than 50% of the expected values had higher TnT, proBNP, AAC, left ventricular end-diastolic diameter, left ventricular mass index, E/e’ and pulse pressure, and lower global longitudinal strain compared to the better performing patients. TnT (β = − 0.09, p = 0.02), AAC (β = − 1.67, p < 0.0001) and diabetes (β = − 11.7, p < 0.0001) remained significantly associated with WMAX% in the multivariable model. Maximal ergometry workload (in Watts) was similarly associated with TnT and AAC in addition to age, male gender, hemoglobin and diastolic blood pressure in a respective multivariate model. AAC and TnT showed fair predictive power for WMAX% less than 50% of the expected value with AUCs of 0.70 and 0.75, respectively. Conclusions TnT and AAC are independently associated with maximal ergometry stress test workload in patients with advanced CKD. Trial registration http://www.ClinicalTrials.gov NCT04223726.

Maximal Exercise Capacity in Chronic Kidney Disease Stage 4–5 Patients Transitioning to Renal Replacement Therapy or Continuing Conservative Care: A Longitudinal Follow-Up Study

“…This study has the limitations of an observational study. The sample size was moderately limited in comparison to the initial cohort of the study on ergometry performance [12] due to mortality and morbidity of the study patients. Baseline eGFR was slightly higher in the patients not receiving RRT in this real-world study.…”

“…This is a follow-up study of the previously published report of the CADKID study on the determinants of maximal stress ergometry performance in 174 non-dialysis CKD stage 4–5 patients [12]. All study patients in the initial report were scheduled for a follow-up maximal stress ergometry test within a time interval of 3 years from baseline.…”