Cardiovascular Functional Reserve Before and After Kidney Transplant

Lim, Kenneth; Ting, Stephen; Hamborg, Thomas; McGregor, G.; Oxborough, David; Tomkins, Claudia; Xu, Dihua; Thadhani, Ravi; Lewis, Gregory D.; Bland, Rosemary; Banerjee, Prithwish; Fletcher, Simon; Krishnan, Nithya; Higgins, Robert; Zehnder, Daniel; Hiemstra, Thomas F.

doi:10.1001/jamacardio.2019.5738

Cited by 20 publications

(38 citation statements)

References 29 publications

(63 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the CAPER study, Lim et al (2020) reported significantly improved cardiovascular functional capacity as assessed by VO 2 Peak in the kidney transplant group 1 year after transplantation (20.7 ± 5.8 to 22.5 ± 6.3 mL.min −1. kg −1 , p < 0.001).…”

Section: Kidney Transplant Recipientsmentioning

confidence: 98%

“…These maladaptive processes coupled with widespread arterial calcification and stiffening that contribute to increased afterload, lead to further reductions in cardiac output (Ferro et al, 2012). Impairment of the musculoskeletal system from sarcopenia with muscle mitochondrial dysfunction and progressive anemia are common complications of advanced CKD, can also have profound effects on maximal arterial minus mixed venous oxygen content (Cao 2 -Cvo 2 max) (Lim et al, 2020). All pathophysiological states that impair oxygen transport from air to mitochondria, and oxygen use during exercise can contribute to cardiovascular dysfunction and reduced cardiovascular functional capacity.…”

Section: Applying the Fick Principle To Patients With Ckdmentioning

confidence: 99%

“…Taken together, these results suggest that maladaptive LV changes and blunted chronotropic responses are involved in impairment of cardiovascular function in dialysis patients. The CAPER (Cardiopulmonary Exercise Testing in Renal Failure and After Kidney Transplantation) study by Lim et al (2020) was the first study to assess cardiovascular functional changes using CPET before and after kidney transplantation. CAPER was a prospective, non-randomized, single-center, 3-arm controlled cohort study that recruited a total of 253 patients: 81 stage 5 CKD patients who underwent kidney transplantation, 85 non-transplanted waitlisted stage 5 CKD patients, and 87 hypertensive controls.…”

Section: End-stage Kidney Disease (Eskd)mentioning

confidence: 99%

“…Among the variables that were correlated with transplanted-associated VO 2 Peak improvement at 1 year in the CAPER study were cardiac variables (improved LV ejection fraction, maximum heart rate) as well as corrected calcium level ( Lim et al, 2020 ). This latter finding of an association between calcium and change in VO 2 Peak is intriguing given that disordered bone mineral metabolism is a cardinal feature of the failing kidney, and that calcium is centrally involved in regulating cardiac myocyte contractility and relaxation ( Hohendanner et al, 2013 ) and may play a role in regulating myocardial function in uremia.…”

Section: Cardiovascular Functional Changes In Ckdmentioning

confidence: 99%

“…Interactions between these organ systems underlie critical homeostatic processes such as endocrine loops that tightly regulate mineral metabolism and other organ cross-talk. Their collective failure originates from kidney dysfunction and contributes to overall cardiovascular impairment (Ting et al, 2015;Lim et al, 2020). These organ system interactions, therefore, provide strong rationale for an integrated physiologic approach to assessing cardiovascular changes in CKD.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing

et al. 2020

Self Cite

View full text Add to dashboard Cite

The development of cardiovascular disease during renal impairment involves striking multi-tiered, multi-dimensional complex alterations encompassing the entire oxygen transport system. Complex interactions between target organ systems involving alterations of the heart, vascular, musculoskeletal and respiratory systems occur in Chronic Kidney Disease (CKD) and collectively contribute to impairment of cardiovascular function. These systemic changes have challenged our diagnostic and therapeutic efforts, particularly given that imaging cardiac structure at rest, rather than ascertainment under the stress of exercise, may not accurately reflect the risk of premature death in CKD. The multi-systemic nature of cardiovascular disease in CKD patients provides strong rationale for an integrated approach to the assessment of cardiovascular alterations in this population. State-of-the-art cardiopulmonary exercise testing (CPET) is a powerful, dynamic technology that enables the global assessment of cardiovascular functional alterations and reflects the integrative exercise response and complex machinery that form the oxygen transport system. CPET provides a wealth of data from a single assessment with mechanistic, physiological and prognostic utility. It is an underutilized technology in the care of patients with kidney disease with the potential to help advance the field of cardio-nephrology. This article reviews the integrative physiology and pathophysiology of cardio-renal impairment, critical new insights derived from CPET technology, and contemporary evidence for potential applications of CPET technology in patients with kidney disease.

show abstract

Section: Kidney Transplant Recipientsmentioning

confidence: 98%

Section: Applying the Fick Principle To Patients With Ckdmentioning

confidence: 99%

Section: End-stage Kidney Disease (Eskd)mentioning

confidence: 99%

Section: Cardiovascular Functional Changes In Ckdmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations