Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing.
Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing.
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DOI：
10.3389/fphys.2020.572355
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发表时间：
2020
影响因子：
4
通讯作者：
Moe SM
中科院分区：
文献类型：
--
作者：
Lim K;McGregor G;Coggan AR;Lewis GD;Moe SM
肾损害期间心血管疾病的发展涉及到涵盖整个氧转运系统的多层次、多维度的复杂改变。慢性肾脏病（CKD）中靶器官系统之间的复杂相互作用涉及心脏、血管、肌肉骨骼和呼吸系统的改变，共同导致心血管功能受损。这些系统性变化对我们的诊断和治疗工作提出了挑战，特别是考虑到静息时的心脏结构成像，而不是运动应激下的确定，可能无法准确反映CKD中过早死亡的风险。CKD患者心血管疾病的多系统性质为采用综合方法评估该人群的心血管变化提供了强有力的依据。最先进的心肺运动试验（CPET）是一种强大的动态技术，能够全面评估心血管功能变化，并反映形成氧转运系统的综合运动反应和复杂机制。CPET提供了大量的数据，从一个单一的评估机制，生理和预后效用。这是一项未充分利用的技术，用于肾脏疾病患者的护理，有可能帮助推进心肾病学领域。本文综述了心肾损害的综合生理学和病理生理学，来自CPET技术的重要新见解，以及CPET技术在肾脏疾病患者中潜在应用的当代证据。
The development of cardiovascular disease during renal impairment involves striking multi-tiered, multi-dimensional complex alterations encompassing the entire oxygen transport system. Complex interactions between target organ systems involving alterations of the heart, vascular, musculoskeletal and respiratory systems occur in Chronic Kidney Disease (CKD) and collectively contribute to impairment of cardiovascular function. These systemic changes have challenged our diagnostic and therapeutic efforts, particularly given that imaging cardiac structure at rest, rather than ascertainment under the stress of exercise, may not accurately reflect the risk of premature death in CKD. The multi-systemic nature of cardiovascular disease in CKD patients provides strong rationale for an integrated approach to the assessment of cardiovascular alterations in this population. State-of-the-art cardiopulmonary exercise testing (CPET) is a powerful, dynamic technology that enables the global assessment of cardiovascular functional alterations and reflects the integrative exercise response and complex machinery that form the oxygen transport system. CPET provides a wealth of data from a single assessment with mechanistic, physiological and prognostic utility. It is an underutilized technology in the care of patients with kidney disease with the potential to help advance the field of cardio-nephrology. This article reviews the integrative physiology and pathophysiology of cardio-renal impairment, critical new insights derived from CPET technology, and contemporary evidence for potential applications of CPET technology in patients with kidney disease.
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DOI：
10.1161/circheartfailure.114.001825
发表时间：
2015-03
期刊：
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影响因子：
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