Endothelial dysfunction correlates with exaggerated exercise pressor response during whole body maximal exercise in chronic kidney disease

Abstract

Chronic kidney disease (CKD) patients have exercise intolerance associated with increased cardiovascular mortality. Previous studies demonstrate that blood pressure (BP) and sympathetic nerve responses to handgrip exercise are exaggerated in CKD. These patients also have decreased nitric oxide (NO) bioavailability and endothelial dysfunction, which could potentially lead to an impaired ability to vasodilate during exercise. We hypothesized that CKD patients have exaggerated BP responses during maximal whole body exercise and that endothelial dysfunction correlates with greater exercise pressor responses in these patients. Brachial artery flow-mediated dilation (FMD) was assessed before maximal treadmill exercise in 56 participants: 38 CKD (56.7 ± 1.2 yr old, 38 men) and 21 controls (52.8 ± 1.8 yr old, 20 men). During maximal treadmill exercise, the slope-of-rise in systolic BP (+10.32 vs. +7.75 mmHg/stage, < 0.001), mean arterial pressure (+3.50 vs. +2.63 mmHg/stage, = 0.004), and heart rate (+11.87 vs. +10.69 beats·min·stage, = 0.031) was significantly greater in CKD compared with controls. Baseline FMD was significantly lower in CKD (2.76 ± 0.42% vs. 5.84 ± 0.97%, = 0.008). Lower FMD values were significantly associated with a higher slope-of-rise in systolic BP (+11.05 vs. 8.71 mmHg/stage, = 0.003) during exercise in CKD, as well as poorer exercise capacity measured as peak oxygen uptake (V̇o; 19.47 ± 1.47 vs. 24.57 ± 1.51 ml·min·kg, < 0.001). These findings demonstrate that low FMD in CKD correlates with augmented BP responses during exercise and lower V̇o, suggesting that endothelial dysfunction may contribute to exaggerated exercise pressor responses and poor exercise capacity in CKD patients.

The effect of exercise on blood pressure in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials

“…For example, several studies have shown that the physiologic elevation in heart rate and BP that normally occur during exercise is exaggerated in people with CKD, potentially due to the lower bioavailability of nitrous oxide and the sympathetic nervous system over-activation in this population. [56–58] Whether these alterations in endothelial function and neurohormonal systems influence the longer-term training response to exercise in CKD is not known. However, in other conditions associated with endothelial dysfunction, such as cardiovascular disease and diabetes, exercise training has been associated with improvements in endothelial function.…”

Characterising skeletal muscle haemoglobin saturation during exercise using near-infrared spectroscopy in chronic kidney disease

“…Along with mitochondrial capacity, O 2 delivery and muscle perfusion can also be modulated by the vasculature [ 10 ]. Endothelial dysfunction is well established in CKD groups [ 53 ] and consequently may contribute to poor exercise capacity by reducing the delivery of oxygenated Hb to the muscles [ 53 ]. Future studies should combine measures of mitochondrial capacity with endothelial function and regional blood flow measurements [ 9 ].…”

Peripheral endothelial function is positively associated with maximal aerobic capacity in patients with chronic obstructive pulmonary disease

“…The few studies that investigated peripheral endothelial dysfunction in COPD collected a limited set of vascular or functional performance measurements, and as a result, they may have missed potential confounding factors [7,[12][13][14][15]. Therefore, in this study we used a comprehensive set of patient characteristics, (micro)vascular and functional performance measurements to determine the relation between peripheral endothelial function estimated based on finger arterial pulsatile volume changes and 1) patient characteristics and cardiovascular risk factors; 2) vascular structure and function; and 3) exercise and performance measurements, as earlier studies in patients with heart and kidney diseases demonstrated an association between vascular and functional performance measurements and peripheral endothelial function [16][17][18].…”