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

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

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: Patients with chronic kidney failure (CKF) experience impaired functional cardiovascular reserve with reduced oxygen consumption at peak exercise (VO(2peak)). No studies have examined whether this is related to impaired cardiovascular compliance as a consequence of loss of adaptive structural alterations, resulting from chronic uremia or hypertension.

STUDY DESIGN: Prospective matched-cohort study.

SETTING & PARTICIPANTS: We assessed CKF in parallel with patients with essential hypertension but without cardiovascular disease. Patients with CKF were either scheduled for kidney transplantation or transplant waitlisted. 80 patients with CKF and 80 with essential hypertension matched in age, sex, and body mass index were evaluated. 61 patients with CKF (76.3%) were dialysis dependent.

PREDICTOR: CKF versus essential hypertension without cardiovascular disease.

MEASUREMENTS & OUTCOMES: VO(2peak) was measured during maximal exercise testing. 2-dimensional echocardiography and arterial applanation tonometry were performed prior to exercise testing. To evaluate for the difference in VO(2peak) between study groups, statistically significant predictors of VO(2peak) in multiple regression models were additionally assessed by fitting models comprising the interaction term of patient group with the predictor variable of interest.

RESULTS: VO(2peak) was significantly lower in patients with CKF than those with essential hypertension (18.8 vs 24.5 mL/min·kg; P<0.001). Independent predictors of VO(2peak) for CKF included left ventricular (LV) filling pressure (E/mean e'; unstandardized regression coefficient: change in VO(2peak) [in mL/min·kg] per 1-unit change of variable = -5.1) and pulse wave velocity (-4.0); in essential hypertension, these were LV mass index (0.2), LV end-diastolic volume index (0.4), peak heart rate (0.2), and pulse wave velocity (-8.8). The interaction effect of VO(2peak) between patient groups with LV mass index (P<0.001), LV end-diastolic volume index (P<0.001), and peak heart rate (P<0.01) were significantly stronger in the hypertension group, whereby higher values led to greater VO(2peak).

LIMITATIONS: Skeletal muscle strength was not assessed.

CONCLUSION: This study suggests that maladaptive LV changes, as well as blunted chronotropic response, are important mechanistic factors resulting in reduced cardiovascular reserve in patients with CKF, beyond predominantly vascular changes associated with hypertension.

Original languageEnglish
Pages (from-to)274-84
Number of pages11
JournalAmerican journal of kidney diseases : the official journal of the National Kidney Foundation
Volume66
Issue number2
Early online date18 Apr 2015
DOIs
Publication statusPublished - Aug 2015
Externally publishedYes

Keywords

  • Adult
  • Case-Control Studies
  • Cohort Studies
  • Exercise Test
  • Exercise Tolerance
  • Female
  • Humans
  • Hypertension
  • Hypertrophy, Left Ventricular
  • Kidney Failure, Chronic
  • Male
  • Middle Aged
  • Oxygen Consumption
  • Prospective Studies
  • Ventricular Dysfunction, Left
  • Journal Article
  • Research Support, Non-U.S. Gov't

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