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Chronic kidney disease is associated with decreased exercise capacity and impaired ventilatory efficiency in heart transplantation patients

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Abstract
PURPOSE: Chronic kidney disease (CKD) is common after heart transplantation (HTx). This study assessed the influence of CKD on exercise capacity and ventilatory efficiency after HTx. METHODS: This cross-sectional study included 79 HTx patients (age 64 +/- 10 years, 66 men) at 8.1 +/- 4.3 years post-HTx who underwent maximal exercise testing, cardiac function assessment, and blood analysis. According to estimated glomerular filtration rate (eGFR, ml/min/1.73 m(2)), patients were categorized as having severe (Group 1, GFR < or = 30; n = 15), moderate (Group 2, GFR 30-60; n = 40), and mild (Group 3, GFR > 60; n = 24) renal impairment. RESULTS: Patients in Group 1 were older, had lower peakVO(2) and impaired ventilatory efficiency compared with Groups 2 and 3 (all p < 0.05) Peak Watts, peak ventilation, and peak heart rate were lower in Group 1 compared with Group 3 (all p < 0.05). Exercise-derived variables did not differ significantly between Groups 2 and 3. GFR correlated with peakVO(2)/kg (r = 0.47; p < 0.01) and peak Watts (r = 0.34, p < 0.01). GFR (adjusted r(2) = 0.34), mean arterial pulmonary pressure, and age were the strongest independent predictors of peakVO(2). The proposed model explained 48% of variability in peakVO(2). By receiver operator characteristic analysis, eGFR was superior in distinguishing patients with impaired from those with preserved exercise capacity (peakVO(2) < 18 vs > 18 ml/kg/min). CONCLUSION: Chronic KD after HTx is associated with impaired maximal exercise capacity and decreased ventilatory efficiency. GFR is a strong independent non-exercise-derived predictor of peak VO(2) in these patients.
Keywords
INFLAMMATION, NEPHROPATHY, RECIPIENTS, CYCLOSPORINE, PERIPHERAL LIMITATIONS, CHRONIC-RENAL-FAILURE, CARDIAC TRANSPLANTATION, PROTEOLYSIS, DIFFUSION, ACIDOSIS

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Chicago
Van Laethem, Christophe, Jozef Bartunek, Mark Goethals, Sofie Verstreken, Mark Walravens, Mark De Proft, Chilla Keppens, Patrick Calders, and Mark Vanderheyden. 2009. “Chronic Kidney Disease Is Associated with Decreased Exercise Capacity and Impaired Ventilatory Efficiency in Heart Transplantation Patients.” Journal of Heart and Lung Transplantation 28 (5): 446–452.
APA
Van Laethem, C., Bartunek, J., Goethals, M., Verstreken, S., Walravens, M., De Proft, M., Keppens, C., et al. (2009). Chronic kidney disease is associated with decreased exercise capacity and impaired ventilatory efficiency in heart transplantation patients. JOURNAL OF HEART AND LUNG TRANSPLANTATION, 28(5), 446–452.
Vancouver
1.
Van Laethem C, Bartunek J, Goethals M, Verstreken S, Walravens M, De Proft M, et al. Chronic kidney disease is associated with decreased exercise capacity and impaired ventilatory efficiency in heart transplantation patients. JOURNAL OF HEART AND LUNG TRANSPLANTATION. 2009;28(5):446–52.
MLA
Van Laethem, Christophe, Jozef Bartunek, Mark Goethals, et al. “Chronic Kidney Disease Is Associated with Decreased Exercise Capacity and Impaired Ventilatory Efficiency in Heart Transplantation Patients.” JOURNAL OF HEART AND LUNG TRANSPLANTATION 28.5 (2009): 446–452. Print.
@article{1095218,
  abstract     = {PURPOSE: Chronic kidney disease (CKD) is common after heart transplantation (HTx). This study assessed the influence of CKD on exercise capacity and ventilatory efficiency after HTx.
METHODS: This cross-sectional study included 79 HTx patients (age 64 +/- 10 years, 66 men) at 8.1 +/- 4.3 years post-HTx who underwent maximal exercise testing, cardiac function assessment, and blood analysis. According to estimated glomerular filtration rate (eGFR, ml/min/1.73 m(2)), patients were categorized as having severe (Group 1, GFR {\textlangle} or = 30; n = 15), moderate (Group 2, GFR 30-60; n = 40), and mild (Group 3, GFR {\textrangle} 60; n = 24) renal impairment.
RESULTS: Patients in Group 1 were older, had lower peakVO(2) and impaired ventilatory efficiency compared with Groups 2 and 3 (all p {\textlangle} 0.05) Peak Watts, peak ventilation, and peak heart rate were lower in Group 1 compared with Group 3 (all p {\textlangle} 0.05). Exercise-derived variables did not differ significantly between Groups 2 and 3. GFR correlated with peakVO(2)/kg (r = 0.47; p {\textlangle} 0.01) and peak Watts (r = 0.34, p {\textlangle} 0.01). GFR (adjusted r(2) = 0.34), mean arterial pulmonary pressure, and age were the strongest independent predictors of peakVO(2). The proposed model explained 48\% of variability in peakVO(2). By receiver operator characteristic analysis, eGFR was superior in distinguishing patients with impaired from those with preserved exercise capacity (peakVO(2) {\textlangle} 18 vs {\textrangle} 18 ml/kg/min).
CONCLUSION: Chronic KD after HTx is associated with impaired maximal exercise capacity and decreased ventilatory efficiency. GFR is a strong independent non-exercise-derived predictor of peak VO(2) in these patients.},
  author       = {Van Laethem, Christophe and Bartunek, Jozef and Goethals, Mark and Verstreken, Sofie and Walravens, Mark  and De Proft, Mark and Keppens, Chilla and Calders, Patrick and Vanderheyden, Mark},
  issn         = {1053-2498},
  journal      = {JOURNAL OF HEART AND LUNG TRANSPLANTATION},
  keyword      = {INFLAMMATION,NEPHROPATHY,RECIPIENTS,CYCLOSPORINE,PERIPHERAL LIMITATIONS,CHRONIC-RENAL-FAILURE,CARDIAC TRANSPLANTATION,PROTEOLYSIS,DIFFUSION,ACIDOSIS},
  language     = {eng},
  number       = {5},
  pages        = {446--452},
  title        = {Chronic kidney disease is associated with decreased exercise capacity and impaired ventilatory efficiency in heart transplantation patients},
  url          = {http://dx.doi.org/10.1016/j.healun.2009.01.022},
  volume       = {28},
  year         = {2009},
}

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