Reduced Cardiovascular Reserve in Chronic Kidney Failure: A Matched Cohort Study

Ting, Stephen; Hamborg, Thomas; McGregor, G.; Oxborough, David; Lim, Kenneth; Koganti, Sudheer; Aldridge, Nicolas; Imray, Chris; Bland, Rosemary; Fletcher, Simon; Krishnan, Nithya; Higgins, Robert; Townend, Jonathan N.; Banerjee, Prithwish; Zehnder, Daniel

doi:10.1053/j.ajkd.2015.02.335

Cited by 32 publications

(55 citation statements)

References 41 publications

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“…Essential hypertension itself reduces quality of life measures [ 25 ] and impairs exercise tolerance [ 26 ] when compared to healthy individuals. Significantly reduced quality of life measures in CKD compared to HTN patients were reflected in much lower measures of cardiovascular function in CKD patients as previously described[ 14 , 27 , 28 ].…”

Section: Discussionsupporting

confidence: 63%

“…Our scores were somewhat higher than other dialysis cohorts[ 8 , 10 ] probably due to our inclusion of CKD patients fit enough to undergo a renal transplant. Hypertension is prevalent in CKD and modulates cardiovascular function [ 14 ]. Therefore we selected patients with treated essential hypertension as a control group to the CKD population to investigate the potential role of uremia itself on the interaction between subjective and objective functional measures in CKD.…”

Section: Discussionmentioning

confidence: 99%

“…The capacity to transport oxygen is determined by cardiovascular function and hemoglobin concentration. Reduced cardiovascular capacity and hemoglobin concentration have been shown to determine morbidity, mortality and HRQoL for patients with CKD[ 13 , 14 , 35 – 37 ]. For HTN patients HRQoL was improved when blood pressure was controlled [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients

et al. 2017

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BackgroundPatients with advanced chronic kidney disease (CKD) experience complex functional and structural changes of the cardiopulmonary and musculoskeletal system. This results in reduced exercise tolerance, quality of life and ultimately premature death. We investigated the relationship between subjective measures of health related quality of life and objective, standardised functional measures for cardiovascular and pulmonary health.MethodsBetween April 2010 and January 2013, 143 CKD stage-5 or CKD5d patients (age 46.0±1.1y, 62.2% male), were recruited prospectively. A control group of 83 healthy individuals treated for essential hypertension (HTN; age 53.2±0.9y, 48.22% male) were recruited at random. All patients completed the SF-36 health survey questionnaire, echocardiography, vascular tonometry and cardiopulmonary exercise testing.ResultsPatients with CKD had significantly lower SF-36 scores than the HTN group; for physical component score (PCS; 45.0 vs 53.9, p<0.001) and mental component score (MCS; 46.9 vs. 54.9, p<0.001). CKD subjects had significantly poorer exercise tolerance and cardiorespiratory performance compared with HTN (maximal oxygen uptake; VO2peak 19.9 vs 25.0ml/kg/min, p<0.001). VO2peak was a significant independent predictor of PCS in both groups (CKD: b = 0.35, p = 0.02 vs HTN: b = 0.27, p = 0.001). No associations were noted between PCS scores and echocardiographic characteristics, vascular elasticity and cardiac biomarkers in either group. No associations were noted between MCS and any variable.The interaction effect of study group with VO2peak on PCS was not significant (ΔB = 0.08; 95%CI -0.28–0.45, p = 0.7). However, overall for a given VO2peak, the measured PCS was much lower for patients with CKD than for HTN cohort, a likely consequence of systemic uremia effects.ConclusionIn CKD and HTN, objective physical performance has a significant effect on quality of life; particularly self-reported physical health and functioning. Therefore, these quality of life measures are indeed a good reflection of physical health correlating highly with objective physical performance measures.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients

et al. 2017

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“…Co‐morbidities are frequent in HFrEF, and are of great importance since they influence the cardiorespiratory response to exercise and (sometimes) outcome . In chronic obstructive pulmonary disease (COPD), if concomitant pulmonary vascular disease is excluded, the exertional CPET response is characterized by a normal VAT, a reduced breathing reserve and oxyhaemoglobin desaturation during and at the end of exercise.…”

Section: The Patientmentioning

confidence: 99%

Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology

Corrà

Agostoni

Anker

et al. 2017

European J of Heart Fail

169

125

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Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle-aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co-morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom-limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed.

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“…Pulmonary involvement is common in CKD. The most obvious condition is pulmonary edema as a result of the variable combination of volume overload, low oncotic pressure due to hypoalbuminemia, reduced cardiovascular reserve and coexistent overt heart failure . At variance from cardiogenic edema, the uremic pulmonary edema is rich in protein .…”

Section: Kidney–lung Interaction In Older Copd Patientsmentioning

confidence: 99%

Chronic kidney disease: A likely underestimated component of multimorbidity in older patients with chronic obstructive pulmonary disease

Corsonello

Aucella

Pedone

et al. 2017

Geriatrics Gerontology Int

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The coexistence of chronic kidney disease and chronic obstructive pulmonary disease, two age-related conditions, has important clinical and prognostic implications. Respiratory failure is associated with important changes in glomerular and tubulointerstitial function. In contrast, renal failure can affect lung function, mainly by adding a restrictive component or causing complications, such as uremic pulmonary edema and pleural effusion. The effect of age on renal and pulmonary function adds to the complexity of the interplay between the kidney and the lung in these patients. Chronic kidney disease also represents an important risk factor for adverse drug reactions in older chronic obstructive pulmonary disease patients in which multimorbidity and polypharmacy are highly prevalent. Finally, an additive effect of chronic kidney disease and chronic obstructive pulmonary disease might also contribute to the pathophysiology of sarcopenia. Nevertheless, several gaps in our knowledge of the lung-kidney interplay still exist, thus suggesting further basic and clinical research on this topic. Geriatr Gerontol Int 2017; 17: 1770-1788.

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Reduced Cardiovascular Reserve in Chronic Kidney Failure: A Matched Cohort Study

Cited by 32 publications

References 41 publications

Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients

Quality of life measures predict cardiovascular health and physical performance in chronic renal failure patients

Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology

Chronic kidney disease: A likely underestimated component of multimorbidity in older patients with chronic obstructive pulmonary disease

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