Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity.
Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity.
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DOI：
10.1161/jaha.122.025656
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发表时间：
2022-07-19
影响因子：
5.4
通讯作者：
Lim, Kenneth
中科院分区：
文献类型：
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作者：
Arroyo, Eliott;Umukoro, Peter E.;Burney, Heather N.;Li, Yang;Li, Xiaochun;Lane, Kathleen A.;Sher, S. Jawad;Lu, Tzong-shi;Moe, Sharon M.;Moorthi, Ranjani;Coggan, Andrew R.;McGregor, Gordon;Hiemstra, Thomas F.;Zehnder, Daniel;Lim, Kenneth
关键词：
在慢性肾脏疾病患者中，过渡到透析期会显著增加心血管风险。尽管如此，在这种转变过程中心血管功能能力的变化在很大程度上是未知的。因此，本研究试图评估患者在开始透析后1 内的呼吸机运动反应措施。我们对241名慢性肾脏疾病5期患者进行了横断面研究，这些患者来自CAPER(肾功能衰竭的心肺运动试验)研究和传统透析中低频电刺激试点随机对照试验队列。患者接受心肺运动试验和超声心动图检查。在241例患者中(年龄48.9[15.0]岁；154例[63.9%]男性)，42例透析前(平均估计肾小球滤过率为14 ·m L·−1·1.73m−2)，54例透析12个月，145例透析12个月(≤；12 )。与透析前(22.7[5.2]mL. −1·kg−1；P<；0.001)相比，透析前12个月的透析患者的心血管功能显著受损，评估指标为高峰运动时的摄氧量(18.7[5.8]mL.−1·kg−1)。与透析前相比，≤12 月透析期间峰值工作量减少，峰值心率减慢，循环功率降低，左心室重量指数增加(P<；0.05)。排除有肾移植史的患者后，透析12个月组高峰运动时的摄氧量(17.0[4.9mL. −1·kg−1])低于透析组12个月(18.9[5.9]mL.≤1.kg 1；P=0.033)。开始透析与运动高峰时的摄氧量显著降低以及通气性和血流动力学运动反应的总体降低有关，这使患者容易出现功能依赖。这些变化的幅度相当于低风险纽约心脏协会I级和高风险纽约心脏协会II级至IV级心力衰竭之间的差异。
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. 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−1·1.73 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). 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.