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

Abstract

<b><i>Introduction:</i></b> Chronic kidney disease (CKD) is associated with impaired maximal exercise capacity (MEC). However, data are scarce on the development of MEC in CKD stage 4–5 patients transitioning to renal replacement therapy (RRT). <b><i>Methods:</i></b> We explored the change in MEC measured in watts (Wlast4) with 2 consecutive maximal bicycle stress ergometry tests in 122 CKD stage 4–5 patients transitioning to dialysis and transplantation in an observational follow-up study. <b><i>Results:</i></b> Mean age was 58.9 ± 13.9 years and 43 (35.2%) were female. Mean time between the baseline and follow-up ergometry tests was 1,012 ± 327 days and 29 (23.8%) patients had not initiated RRT, 50 (41.0%) were undergoing dialysis, and 43 (35.2%) had received a kidney transplant at the time of the follow-up ergometry test. The mean Wlast4 was 91 ± 37 W and 84 ± 37 W for the baseline and follow-up ergometry tests, respectively (<i>p</i> < 0.001). The mean Wlast4 declined between the baseline and follow-up ergometry tests in patients not requiring RRT (<i>p</i> = 0.001) and transplant recipients (<i>p</i> = 0.005), but not in dialysis patients (<i>p</i> = 0.478). There were no differences in the ratio of Wlast4 of the follow-up to the baseline ergometry tests (∆Wlast4) between patients on different treatment modalities at the time of the follow-up test (<i>p</i> = 0.097). Mean capillary blood bicarbonate was significantly associated with ∆Wlast4 after adjusting for age and treatment modality in the multivariate linear regression analysis (β = 0.226, <i>p</i> = 0.012). <b><i>Conclusion:</i></b> MEC declined or remained poor in advanced CKD patients transitioning to RRT or continuing conservative care in this observational study. Mean capillary blood bicarbonate was independently associated with the development of MEC.

Analysis of the Effectiveness of the Nurse-Led “Outpatient-Ward-Home” Management Model in Chronic Kidney Patients

“…e main clinical manifestation of CKD patients is reduced renal function, and BUN, Scr, and GFR are effective indicators to detect renal function. Some studies [23,24] have shown that lifestyle changes and dietary control of patients can improve their clinical and biochemical indicators and that this effect is independent of the effect of drug therapy.…”

Intradialytic exercise in haemodialysis patients: applicability and effects on muscle function

“…To be specific, we found that patients' age and sex play an important role in the effectiveness of IDE. This implies that future interventional studies should clarify the role of patients' age, sex, physical activity behaviour, exercise tolerability, CKD diagnosis, present comorbidities and type of dialysis therapy on the effectiveness of IDE on muscle function (Johansen et al, 2001;Adenwalla et al, 2021;Hellman et al, 2022;Maia Neves Menezes et al, 2022;Thompson et al, 2023). Special attention might be given to the current state of physical performance of patients participating in IDE.…”