Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity

Eliott  Arroyo; Peter E.  Umukoro; Heather N.  Burney; Yang  Li; Xiaochun  Li; Kathleen A.  Lane; S. Jawad  Sher; Tzong‐shi  Lu; Sharon M. Moe; Ranjani  Moorthi; Andrew R. Coggan; Gordon McGregor; Thomas F Hiemstra; Daniel Zehnder; Kenneth Lim

doi:10.1161/JAHA.122.025656

Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity

Eliott Arroyo, Peter E. Umukoro, Heather N. Burney, Yang Li, Xiaochun Li, Kathleen A. Lane, S. Jawad Sher, Tzong‐shi Lu, Sharon M. Moe, Ranjani Moorthi, Andrew R. Coggan, Gordon McGregor, Thomas F Hiemstra, Daniel Zehnder, Kenneth Lim

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Abstract

BACKGROUND: The transition to dialysis period carries a substantial increased cardiovascular risk in patients with chronic kidney disease. Despite this, alterations in cardiovascular functional capacity during this transition are largely unknown. The present study therefore sought to assess ventilatory exercise response measures in patients within 1 year of initiating dialysis. METHODS AND RESULTS: We conducted a cross-sectional study of 241 patients with chronic kidney disease stage 5 from the CAPER (Cardiopulmonary Exercise Testing in Renal Failure) study and from the intradialytic low-frequency electrical muscle stimulation pilot randomized controlled trial cohorts. Patients underwent cardiopulmonary exercise testing and echocardiog-raphy. Of the 241 patients (age, 48.9 [15.0] years; 154 [63.9%] men), 42 were predialytic (mean estimated glomerular filtration rate, 14 mL·min ^−1·1.73 m ⁻²), 54 had a dialysis vintage ≤12 months, and 145 had a dialysis vintage >12 months. Dialysis vintage ≤12 months exhibited a significantly impaired cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (18.7 [5.8] mL·min ⁻¹·kg ⁻¹) compared with predialysis (22.7 [5.2] mL·min ⁻¹·kg ⁻¹; P<0.001). Dialysis vintage ≤12 months also exhibited reduced peak workload, impaired peak heart rate, reduced circulatory power, and increased left ventricular mass index (P<0.05 for all) compared with predialysis. After excluding those with prior kidney transplant, dialysis vintage >12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min ^{−1·kg −1}) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min ⁻¹·kg ⁻¹; P=0.033). CONCLUSIONS: Initiating dialysis is associated with a significant impairment in oxygen uptake at peak exercise and overall decrements in ventilatory and hemodynamic exercise responses that predispose patients to functional dependence. The magnitude of these changes is comparable to the differences between low-risk New York Heart Association class I and higher-risk New York Heart Association class II to IV heart failure.

Original language	English
Article number	e025656
Number of pages	18
Journal	Journal of the American Heart Association
Volume	11
Issue number	14
Early online date	5 Jul 2022
DOIs	https://doi.org/10.1161/JAHA.122.025656
Publication status	Published - 19 Jul 2022

Bibliographical note

This is an open access article under the terms of the Creative
Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Funder

Funding Information: Dr Lim is the recipient of a National Institutes of Health K23 DK115683 grant, the Paul Teschan Research Fund grant from Dialysis Clinic Inc, the Ralph W. and Grace M. Showalter Research Showalter Trust 2021 Award at Indiana University School of Medicine, and the Indiana University Health Values Fund. The remaining authors have nothing to disclose. Funding Information: This work was supported by a National Institutes of Health K23 DK115683 grant provided to Dr Lim.

Funding

This work was supported by a National Institutes of Health K23 DK115683 grant provided to Dr Lim.

Funders	Funder number
National Institutes of Health	K23 DK115683

Keywords

aerobic capacity
cardiopulmonary exercise testing
dialysis
end-stage renal disease
oxygen uptake at peak exercise

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1161/JAHA.122.025656Licence: CC BY-NC-ND

PublishedFinal published version, 4.07 MBLicence: CC BY-NC-ND

Cite this

Arroyo, E., Umukoro, P. E., Burney, H. N., Li, Y., Li, X., Lane, K. A., Sher, S. J., Lu, T., Moe, S. M., Moorthi, R., Coggan, A. R., McGregor, G., Hiemstra, T. F., Zehnder, D., & Lim, K. (2022). Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity. Journal of the American Heart Association, 11(14), Article e025656. https://doi.org/10.1161/JAHA.122.025656

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title = "Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity",

abstract = "BACKGROUND: The transition to dialysis period carries a substantial increased cardiovascular risk in patients with chronic kidney disease. Despite this, alterations in cardiovascular functional capacity during this transition are largely unknown. The present study therefore sought to assess ventilatory exercise response measures in patients within 1 year of initiating dialysis. METHODS AND RESULTS: We conducted a cross-sectional study of 241 patients with chronic kidney disease stage 5 from the CAPER (Cardiopulmonary Exercise Testing in Renal Failure) study and from the intradialytic low-frequency electrical muscle stimulation pilot randomized controlled trial cohorts. Patients underwent cardiopulmonary exercise testing and echocardiog-raphy. Of the 241 patients (age, 48.9 [15.0] years; 154 [63.9%] men), 42 were predialytic (mean estimated glomerular filtration rate, 14 mL·min −1·1.73 m −2), 54 had a dialysis vintage ≤12 months, and 145 had a dialysis vintage >12 months. Dialysis vintage ≤12 months exhibited a significantly impaired cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (18.7 [5.8] mL·min −1·kg −1) compared with predialysis (22.7 [5.2] mL·min −1·kg −1; P<0.001). Dialysis vintage ≤12 months also exhibited reduced peak workload, impaired peak heart rate, reduced circulatory power, and increased left ventricular mass index (P<0.05 for all) compared with predialysis. After excluding those with prior kidney transplant, dialysis vintage >12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min −1·kg −1) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min −1·kg −1; P=0.033). CONCLUSIONS: Initiating dialysis is associated with a significant impairment in oxygen uptake at peak exercise and overall decrements in ventilatory and hemodynamic exercise responses that predispose patients to functional dependence. The magnitude of these changes is comparable to the differences between low-risk New York Heart Association class I and higher-risk New York Heart Association class II to IV heart failure.",

keywords = "aerobic capacity, cardiopulmonary exercise testing, dialysis, end-stage renal disease, oxygen uptake at peak exercise",

author = "Eliott Arroyo and Umukoro, {Peter E.} and Burney, {Heather N.} and Yang Li and Xiaochun Li and Lane, {Kathleen A.} and Sher, {S. Jawad} and Tzong‐shi Lu and Moe, {Sharon M.} and Ranjani Moorthi and Coggan, {Andrew R.} and Gordon McGregor and Hiemstra, {Thomas F} and Daniel Zehnder and Kenneth Lim",

note = "This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. ",

year = "2022",

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doi = "10.1161/JAHA.122.025656",

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T1 - Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity

AU - Arroyo, Eliott

AU - Umukoro, Peter E.

AU - Burney, Heather N.

AU - Li, Yang

AU - Li, Xiaochun

AU - Lane, Kathleen A.

AU - Sher, S. Jawad

AU - Lu, Tzong‐shi

AU - Moe, Sharon M.

AU - Moorthi, Ranjani

AU - Coggan, Andrew R.

AU - McGregor, Gordon

AU - Hiemstra, Thomas F

AU - Zehnder, Daniel

AU - Lim, Kenneth

N1 - This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

PY - 2022/7/19

Y1 - 2022/7/19

N2 - BACKGROUND: The transition to dialysis period carries a substantial increased cardiovascular risk in patients with chronic kidney disease. Despite this, alterations in cardiovascular functional capacity during this transition are largely unknown. The present study therefore sought to assess ventilatory exercise response measures in patients within 1 year of initiating dialysis. METHODS AND RESULTS: We conducted a cross-sectional study of 241 patients with chronic kidney disease stage 5 from the CAPER (Cardiopulmonary Exercise Testing in Renal Failure) study and from the intradialytic low-frequency electrical muscle stimulation pilot randomized controlled trial cohorts. Patients underwent cardiopulmonary exercise testing and echocardiog-raphy. Of the 241 patients (age, 48.9 [15.0] years; 154 [63.9%] men), 42 were predialytic (mean estimated glomerular filtration rate, 14 mL·min −1·1.73 m −2), 54 had a dialysis vintage ≤12 months, and 145 had a dialysis vintage >12 months. Dialysis vintage ≤12 months exhibited a significantly impaired cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (18.7 [5.8] mL·min −1·kg −1) compared with predialysis (22.7 [5.2] mL·min −1·kg −1; P<0.001). Dialysis vintage ≤12 months also exhibited reduced peak workload, impaired peak heart rate, reduced circulatory power, and increased left ventricular mass index (P<0.05 for all) compared with predialysis. After excluding those with prior kidney transplant, dialysis vintage >12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min −1·kg −1) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min −1·kg −1; P=0.033). CONCLUSIONS: Initiating dialysis is associated with a significant impairment in oxygen uptake at peak exercise and overall decrements in ventilatory and hemodynamic exercise responses that predispose patients to functional dependence. The magnitude of these changes is comparable to the differences between low-risk New York Heart Association class I and higher-risk New York Heart Association class II to IV heart failure.

AB - BACKGROUND: The transition to dialysis period carries a substantial increased cardiovascular risk in patients with chronic kidney disease. Despite this, alterations in cardiovascular functional capacity during this transition are largely unknown. The present study therefore sought to assess ventilatory exercise response measures in patients within 1 year of initiating dialysis. METHODS AND RESULTS: We conducted a cross-sectional study of 241 patients with chronic kidney disease stage 5 from the CAPER (Cardiopulmonary Exercise Testing in Renal Failure) study and from the intradialytic low-frequency electrical muscle stimulation pilot randomized controlled trial cohorts. Patients underwent cardiopulmonary exercise testing and echocardiog-raphy. Of the 241 patients (age, 48.9 [15.0] years; 154 [63.9%] men), 42 were predialytic (mean estimated glomerular filtration rate, 14 mL·min −1·1.73 m −2), 54 had a dialysis vintage ≤12 months, and 145 had a dialysis vintage >12 months. Dialysis vintage ≤12 months exhibited a significantly impaired cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (18.7 [5.8] mL·min −1·kg −1) compared with predialysis (22.7 [5.2] mL·min −1·kg −1; P<0.001). Dialysis vintage ≤12 months also exhibited reduced peak workload, impaired peak heart rate, reduced circulatory power, and increased left ventricular mass index (P<0.05 for all) compared with predialysis. After excluding those with prior kidney transplant, dialysis vintage >12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min −1·kg −1) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min −1·kg −1; P=0.033). CONCLUSIONS: Initiating dialysis is associated with a significant impairment in oxygen uptake at peak exercise and overall decrements in ventilatory and hemodynamic exercise responses that predispose patients to functional dependence. The magnitude of these changes is comparable to the differences between low-risk New York Heart Association class I and higher-risk New York Heart Association class II to IV heart failure.

KW - aerobic capacity

KW - cardiopulmonary exercise testing

KW - dialysis

KW - end-stage renal disease

KW - oxygen uptake at peak exercise

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DO - 10.1161/JAHA.122.025656

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Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity

Abstract

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