Cardiac dysfunction in dialysing adults with end‐stage kidney disease is associated with exercise intolerance: A pilot observational study

• Published in: Physiological reports 2024-09, Vol.12 (17), p.e70050-n/a
• Main Authors: Antoun, Joe, Shepherd, Anthony I., Corbett, Jo, Sangala, Nicholas C., Lewis, Robert J., Lane, Emma, Saynor, Zoe L.
• Format: Article
• Language: English
• Subjects: Adult; aerobic fitness; Aged; Biomarkers; cardiorespiratory; Cardiorespiratory fitness; chronic disease; Coronary artery disease; Enzymes; Exercise; Exercise Test - methods; Exercise Tolerance - physiology; Female; Gas exchange; Gases; Heart diseases; Hemodialysis; Humans; Kidney diseases; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Male; Middle Aged; Muscle strength; Original; Oxygen Consumption; Physical fitness; Physiology; Pilot Projects; Regular Manuscript; Renal Dialysis - adverse effects; Renal function; Sarcopenia; Spectrum analysis; Structure-function relationships; Thorax
• ISSN: 2051-817X; 2051-817X
• DOI: 10.14814/phy2.70050

People with end‐stage kidney disease (ESKD) often exhibit impaired cardiac structure and function, which may contribute to poor exercise capacity. This study used multimodal exercise testing to investigate the central and peripheral mechanisms of exercise limitation in adults with ESKD, also comparing in‐centre hemodialysis (ICHD) to home hemodialysis (HHD). Seventeen adults (55.5 ± 14.5 years; n = 14 male; n = 12 HHD) participated. Resting cardiac examinations, followed by submaximal cycling cardiopulmonary exercise testing (CPET) and functional exercise testing, revealed cardiac structural abnormalities (increased left ventricular mass) and cardiac injury. Aerobic fitness in adults with ESKD was low, with pulmonary oxygen uptake (V̇O2) at the gas exchange threshold (GET) occuring at 39 ± 8% predicted V̇O2peak. O2 pulse, an estimate of stroke volume (SV), was higher in HHD at rest (p = 0.05, ES = 0.58) and during unloaded cycling (p = 0.05, ES = 0.58) compared to ICHD. However, thoracic bioreactance derived SV at the GET was significantly higher in adults receiving ICHD versus HHD (p = 0.01, ES = 0.74). In adults with ESKD, cardiac output was positively associated with V̇O2 at the GET (r = 0.61, p = 0.04). This study highlights prevalent exercise dysfunction in adults with ESKD undergoing dialysis, with potential distinct differences between in‐centre and home hemodialysis, mechanistically linked to underlying cardiac abnormalities.