Early and asymptomatic cardiac dysfunction in chronic kidney disease

Chinnappa, Shanmugakumar; White, Edward; Lewis, Nigel; Baldo, Omer; Tu, Yu–Kang; Glorieux, Griet; Vanholder, Raymond; Nahas, Meguid El; Mooney, Andrew

doi:10.1093/ndt/gfx064

Cited by 25 publications

(28 citation statements)

References 46 publications

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“…A specialised cardiopulmonary exercise test (CPX) was employed to measure peak cardiac power (CPO max ) and cardiac haemodynamics noninvasively using the CO 2 rebreathing method. Full methodological details have been described in previous reports [9,26,27]. A summary of the methodology is presented here.…”

Section: Methodsmentioning

confidence: 99%

“…In our recently published paper we demonstrated the presence of asymptomatic cardiac dysfunction in CKD patients (stages 2–5 (pre-dialysis)) with no pre-existing cardiac disease or diabetes mellitus [9]. The study also evaluated the association between asymptomatic cardiac dysfunction in CKD and the conventional renal biochemical parameters such as serum creatinine, urea, inorganic phosphate, calcium, and bicarbonate.…”

Section: Introductionmentioning

confidence: 99%

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Association between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients with Chronic Kidney Disease

Chinnappa

Yeh

et al. 2018

Toxins

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Although the relationship between protein-bound uremic toxins (PBUTs) and cardiac structure and cardiac mortality in chronic kidney disease (CKD) has been studied in the past, the association between cardiac dysfunction and PBUTs has not yet been studied. We therefore evaluated the association between impaired peak cardiac performance and the serum free and total concentrations of potentially cardiotoxic PBUTs. In a cross-sectional study of 56 male CKD patients (stages 2–5 (pre-dialysis)) who were asymptomatic with no known cardiac diseases or diabetes we measured peak cardiac power (CPOmax), aerobic exercise capacity (VO2max), and echocardiographic parameters of cardiac morphology and evaluated their association with PBUTs. The serum total and free concentrations of indoxyl sulfate (IXS), p-cresyl sulfate (PCS), p-cresyl glucuronide, indole acetic acid, and hippuric acid showed significant negative correlation with CPOmax and VO2max. IXS and PCS were independently associated with CPOmax and VO2max even after controlling for eGFR. No correlation between left ventricular mass index (LVMI) and PBUTs was seen. The present study for the first time has demonstrated the association between subclinical cardiac dysfunction in CKD and serum levels of a panel of PBUTs. Further studies are required to evaluate the mechanism of cardiotoxicity of the individual uremic toxins.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients with Chronic Kidney Disease

Chinnappa

Yeh

et al. 2018

Toxins

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“…The observation that traditional CV risk factors, often present in patients with chronic kidney disease (CKD), do not fully account for their burden of CV disease (and that their treatment does not necessarily improve CV outcome) enhances this concern. Further, the high prevalence of congestive heart failure (CHF) and its associated high mortality in dialysis patients raise specific concerns about a “lifeline” that increases hemodynamic demands on the heart …”

Section: Introductionmentioning

confidence: 99%

The complex relationship among arteriovenous access, heart, and circulation

Basile

Lomonte

2017

Seminars in Dialysis

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There are currently near 400 000 patients on hemodialysis in the United States. More than 50% of those treated by chronic hemodialysis die because of a cardiovascular (CV) event. The majority of these patients have functional arteriovenous fistulas (AVFs).AVFs have an adverse effect on cardiac function, but their exact contribution to CV morbidity is not clear. It has long been known that a vascular access with an inappropriately high-flow rate may cause high-output heart failure. Paradoxically, there may be hemodynamic and cardiopulmonary benefits conferred by AVF particularly in severe chronic obstructive pulmonary disease. While Brescia-Cimino`s basic idea of the AVF has saved millions of lives, we would like to stress that there are dangers from their often high blood flow rates, which unfortunately have proved difficult to evaluate.

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“…While both aerobic ExCap and peak HR are known to be more reduced in the later stages of CKD than in the earlier stages [1,3,29], only one small study has reported the changes in aerobic ExCap over time in non-dialysis CKD patients [13]. That study found a reduction in VO 2 peak of 9% over two years, a stable haemoglobin level and a fall of 28% in the calculated creatinine clearance.…”

Section: Discussionmentioning

confidence: 97%

“…We and others have previously shown that aerobic exercise capacity (ExCap), measured as peak oxygen uptake (VO 2 peak) or peak ExCap, is already reduced in the early stages of non-dialysis chronic kidney disease (CKD) [1][2][3]. Reduced VO 2 peak is associated with increased mortality in CKD and reduced physical capacity has a negative impact on daily-life activities [4,5].…”

Section: Introductionmentioning

confidence: 99%

Aerobic exercise capacity is maintained over a 5-year period in mild-to-moderate chronic kidney disease: A longitudinal study

Wallin

Jansson

Wallquist

et al. 2020

Preprint

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Background: Aerobic exercise capacity is reduced in non-dialysis chronic kidney disease (CKD), but little is known about the magnitude of changes in exercise capacity over time. Our main hypothesis was that aerobic ExCap would decline over 5 years in individuals with mild-to-moderate CKD along with a decline in renal function. A secondary hypothesis was that such a decline in ExCap would be associated with a decline in muscle strength, cardiovascular function and physical activity. Methods: We performed a 5-year-prospective study on individuals with mild-to-moderate CKD, who were closely monitored at a nephrology clinic. Fiftytwo individuals with CKD stage 2–3 and 54 age- and sex-matched healthy controls were included. Peak workload was assessed through a maximal cycle exercise test. Muscle strength and lean body mass, cardiac function, vascular stiffness, self-reported physical activity level, renal function and haemoglobin level were evaluated. Tests were repeated after 5 years. Statistical analysis of longitudinal data was performed using linear mixed models.Results: Exercise capacity did not change significantly over time in either the CKD group or controls, although the absolute workloads were significantly lower in the CKD group. Only in a CKD subgroup reporting low physical activity at baseline, exercise capacity declined. Renal function decreased in both groups, with a faster decline in CKD (p = 0.05 between groups). Peak heart rate, haemoglobin level, handgrip strength, lean body mass and cardiovascular function did not decrease significantly over time in CKD individuals. Conclusions: On a group level, aerobic exercise capacity and peak heart rate were maintained over 5 years in patients with well-controlled mild-to-moderate CKD, despite a slight reduction in glomerular filtration rate, mirroring the lack of progression of cardiovascular and muscular dysfunction in this group. In patients with mild-to-moderate CKD, physical activity level at baseline seems to have a predictive value for exercise capacity at follow-up.

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Early and asymptomatic cardiac dysfunction in chronic kidney disease

Cited by 25 publications

References 46 publications

Association between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients with Chronic Kidney Disease

Association between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients with Chronic Kidney Disease

The complex relationship among arteriovenous access, heart, and circulation

Aerobic exercise capacity is maintained over a 5-year period in mild-to-moderate chronic kidney disease: A longitudinal study

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