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Gradual reduction in exercise capacity in chronic kidney disease is associated with systemic oxygen delivery factors.

Journal article
Authors Helena Wallin
Anna M Asp
Carin Wallquist
Eva Jansson
Kenneth Caidahl
Britta Hylander Rössner
Stefan H Jacobson
Anette Rickenlund
Maria J Eriksson
Published in PloS one
Volume 13
Issue 12
Pages e0209325
ISSN 1932-6203
Publication year 2018
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages e0209325
Language en
Links dx.doi.org/10.1371/journal.pone.020...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Clinical Laboratory Medicine, Urology and Nephrology

Abstract

The cause of reduced exercise capacity (ExCap) in chronic kidney disease (CKD) is multifactorial. The aim of this study was to investigate determinants of aerobic ExCap in patients with mild to severe CKD not undergoing dialysis.We included 52 individuals with CKD stage 2-3, 47 with stage 4-5, and 54 healthy controls. Peak workload and peak heart rate (HR) were assessed by a maximal cycle exercise test. Cardiac function including stroke volume (SV) and vascular stiffness were evaluated by ultrasound at rest. Handgrip strength, body composition, haemoglobin level and self-reported physical activity were assessed.Peak workload (221±60, 185±59, 150±54 W for controls, CKD 2-3 and CKD 4-5 respectively), peak HR (177±11, 161±24, 144±31 beats/min) and haemoglobin level (14.2±1.2, 13.5±1.4, 12.2±1.3 g/dL) were all three significantly lower in CKD 2-3 than in controls, (p = 0.001, 0.001 and 0.03 respectively) and were even lower in stages 4-5 CKD than in CKD 2-3 (p = 0.01, 0.001 and <0.001 respectively). Resting SV and lean body mass did not differ between groups and handgrip strength was significantly lower only in CKD 4-5 compared to controls (p = 0.02). Peak workload was strongly associated with the systemic oxygen delivery factors: SV, peak HR and haemoglobin level. These three factors along with age, sex and height2 explained 82% of variation in peak workload. Peak HR contributed most to the variation; the peripheral variables handgrip strength and vascular stiffness did not improve the explanatory value in regression analysis.In this cross-sectional study of CKD patients not on dialysis, aerobic ExCap decreased gradually with disease severity. ExCap was associated mainly with systemic oxygen delivery factors, in particular peak HR. Neither muscle function and mass, nor vascular stiffness were independent determinants of aerobic ExCap in this group of CKD patients.

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