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 echocardiography. 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 ·1.73 m ), 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 ·kg ) compared with predialysis (22.7 [5.2] mL·min ·kg ; 12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min ·kg ) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min ·kg ; =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 languageEnglish
    Article numbere025656
    Number of pages18
    JournalJournal of the American Heart Association
    Volume11
    Issue number14
    Early online date5 Jul 2022
    DOIs
    Publication statusPublished - 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.

    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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