UREMIC MYOPATHY LIMITS AEROBIC CAPACITY IN HEMODIALYSIS-PATIENTS
UREMIC MYOPATHY LIMITS AEROBIC CAPACITY IN HEMODIALYSIS-PATIENTS
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DOI：
10.1016/s0272-6386(12)70319-0
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发表时间：
1993-08-01
影响因子：
13.2
通讯作者：
MITCHELL, JH
中科院分区：
文献类型：
--
作者：
MOORE, GE;PARSONS, DB;MITCHELL, JH
Eleven end-stage renal disease patients trained by stationary cycling during their hemodialysis treatments. After a 6-week control period, 12 weeks of training began and was increased to 30 to 60 minutes at≥ 70% of peak heart rate. Baseline, pretraining and, posttraining exercise tests were performed. Workload (WL), oxygen uptake (V˙ O 2 p e a k), cardiac output (Q˙), heart rate (HR), and arterial oxygen content (CaO 2) were measured. Stroke volume (SV), arteriovenous oxygen difference ((av) O 2), and mixed-venous oxygen content (CvO 2) were calculated. Rectus femoris biopsies were obtained pretraining and posttraining. At peak exercise, WL increased from 60±4 to 70±6 W (P< 0.05), V˙ O 2 p e a k showed an upward trend from 14.8±0.9 to 16.8±1.3 mL/kg/min (P< 0.1), and Q˙, HR, SV, CaO 2, CvO 2, and (av) O 2 were unchanged. Ten of the 11 patients increased WL, but only six increased V˙ O 2 p e a k (five of 11 patients decreased V˙ O 2 p e a k). The difference between groups (P< 0.02) was attributable to (av) O 2, which increased in those who increased V˙ O 2 p e a k (P< 0.02). There was an upward trend for succinate dehydrogenase activity (P< 0.06), and phosphofructokinase activity increased (P< 0.05). However, the rectus femoris capillary to fiber ratio, type I and II fiber areas, and fiber area variability were unchanged, and neither histomorphologic nor enzymatic activity changes were related to change in V˙ O 2 p e a k. We conclude that not all dialysis patients increase V˙ O 2 p e a k after training, but most can improve exercise capacity. Patients who improved V˙ O 2 p e a k widened their (av) O 2 difference, increasing oxygen extraction and showing that oxygen delivery is not always the limiting factor. Thus, the limitation of V˙ O 2 p e a k in dialysis patients is a complex interaction of central and peripheral factors. Muscle therapies, such as exercise training, are needed in addition to increased oxygen delivery in rehabilitation of dialysis patients.
