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    Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease. 
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    Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease.

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    Published version (651.3Kb)
    Volume
    3
    Pagination
    e000370 - ?
    DOI
    10.1136/openhrt-2015-000370
    Journal
    Open Heart
    Issue
    1
    ISSN
    2053-3624
    Metadata
    Show full item record
    Abstract
    OBJECTIVE: Reduced exercise capacity is well documented in end-stage chronic kidney disease (CKD), preceded by changes in cardiac morphology in CKD stage 3. However, it is unknown whether subclinical cardiopulmonary dysfunction occurs in CKD stage 3 independently of heart failure. METHODS: Prospective observational cross-sectional study of exercise capacity assessed by cardiopulmonary exercise testing in 993 preoperative patients. Primary outcome was peak oxygen consumption (VO2peak). Anaerobic threshold (AT), oxygen pulse and exercise-evoked measures of autonomic function were analysed, controlling for CKD stage 3, age, gender, diabetes mellitus and hypertension. RESULTS: CKD stage 3 was present in 93/993 (9.97%) patients. Diabetes mellitus (RR 2.49 (95% CI 1.59 to 3.89); p<0.001), and hypertension (RR 3.20 (95% CI 2.04 to 5.03); p<0.001)) were more common in CKD stage 3. Cardiac failure (RR 0.83 (95% CI 0.30 to 2.24); p=0.70) and ischaemic heart disease (RR 1.40 (95% CI 0.97 to 2.02); p=0.09) were not more common in CKD stage 3. Patients with CKD stage 3 had lower predicted VO2peak (mean difference: 6% (95% CI 1% to 11%); p=0.02), lower peak heart rate (mean difference:9 bpm (95% CI 3 to 14); p=0.03)), lower AT (mean difference: 1.1 mL/min/kg (95% CI 0.4 to 1.7); p<0.001) and impaired heart rate recovery (mean difference: 4 bpm (95% CI 1 to 7); p<0.001)). CONCLUSIONS: Subclinical cardiopulmonary dysfunction in CKD stage 3 is common. This study suggests that maladaptive cardiovascular/autonomic dysfunction may be established in CKD stage 3, preceding pathophysiology reported in end-stage CKD.
    Authors
    Nelson, A; Otto, J; Whittle, J; Stephens, RCM; Martin, DS; Prowle, JR; Ackland, GL
    URI
    http://qmro.qmul.ac.uk/xmlui/handle/123456789/12835
    Collections
    • Centre for Translational Medicine & Therapeutics [657]
    Language
    eng
    Licence information
    CC-BY-NC
    Copyright statements
    © 2016, British Medical Journal Publishing Group
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