Cardiopulmonary reserve examined with cardiopulmonary exercise testing in individuals with chronic kidney disease: A systematic review and meta-analysis

2022 ◽  
Vol 65 (5) ◽  
pp. 101588
Eva Pella ◽  
Marieta P. Theodorakopoulou ◽  
Afroditi K Boutou ◽  
Maria-Eleni Alexandrou ◽  
Dimitra-Rafailia Bakaloudi ◽  
2021 ◽  
Vol 36 (Supplement_1) ◽  
Eva Pella ◽  
Marieta Theodorakopoulou ◽  
Afroditi Boutou ◽  
Maria Eleni Alexandrou ◽  
Dimitra Bakaloudi ◽  

Abstract Background and Aims Patients with chronic kidney disease (CKD) often present with reduced physical activity and exercise performance due to a number of factors relevant to co-existing disturbances of the cardiac, nervous and muscular systems. Cardiopulmonary exercise testing (CPET) is widely applied in daily clinical practice used for clinical evaluation of exercise intolerance and related symptoms (i.e. dyspnea, fatigue), as well risk stratification, and other applications in several medical fields. Method This is a systematic review and meta-analysis of studies which used CPET technology in adult patients with CKD to examine cardiopulmonary reserve in individuals with versus individuals without CKD. The primary outcome was peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases; manual search of article references and of grey literature was also performed. Newcastle-Ottawa Scale was applied to evaluate the quality of retrieved studies. Results From an initial 4944 literature records, we identified 29 studies fulfilling the inclusion criteria; of these, 25 studies with complete data including 2213 participants were included in final meta-analysis. Peak oxygen uptake (VO2peak) was significantly lower in CKD patients compared to controls without CKD (standardized-mean-difference, SMD:-1.40, 95%CI[-1.68, -1.13]) (Figure). Oxygen consumption at anaerobic threshold (VO2AT) (SMD:-1.06, 95%CI[-1.34, -0.79]), maximum workload (weighted-mean-difference, WMD:-58.26, 95%CI[-74.14, -42.38]) and respiratory exchange ratio (RER) (WMD:-0.02, 95%CI[-0.05, 0.01]) were also impaired in CKD patients compared to non-CKD individuals. In 3 studies comparing patients with CKD versus patients with heart failure without CKD VO2peak was higher in the former (WMD:6.60, 95%CI[3.02, 10.18]). Sensitivity analyses confirmed the robustness of these findings. Conclusion VO2peak and other commonly analyzed CPET variables were lower in CKD patients compared to controls, indicating reduced functional cardiopulmonary reserve in the former. In contrast, CKD patients performed better when compared patients with heart failure.

2018 ◽  
Vol 25 (16) ◽  
pp. 1717-1724 ◽  
Danielle L Kirkman ◽  
Bryce J Muth ◽  
Joseph M Stock ◽  
Raymond R Townsend ◽  
David G Edwards

Background Reductions in exercise capacity associated with exercise intolerance augment cardiovascular disease risk and predict mortality in chronic kidney disease. This study utilized cardiopulmonary exercise testing to (a) investigate mechanisms of exercise intolerance; (b) unmask subclinical abnormalities that may precede cardiovascular disease in chronic kidney disease. Design The design of this study was cross-sectional. Methods Cardiopulmonary exercise testing was carried out in 31 Stage 3–4 chronic kidney disease patients (60 ± 11 years; estimated glomerular filtration rate 43 ± 13 ml/min/1.73 m2) and 21 matched healthy individuals (healthy controls; 56 ± 5 years; estimated glomerular filtration rate>90 ml/min/1.73 m2) on a cycle ergometer with workload increased by 15 W every minute until volitional fatigue. Breath-by-breath respiratory gas analysis was performed with an automated gas analyzer and averaged over 10 s intervals. Results Peak oxygen uptake was reduced in chronic kidney disease compared to healthy controls (17.43 ± 1.03 vs 28 ± 2.05 ml/kg/min; p < 0.01), as was oxygen uptake at the ventilatory threshold (9.44 ± 0.53 vs15.55 ± 1.34 ml/kg/min; p < 0.01). A steeper minute ventilation rate/carbon dioxide production slope (32 ± 0.8 vs 28 ± 1; p < 0.01) and a lower expired carbon dioxide pressure in chronic kidney disease (27 ± 0.6 vs 31 ± 0.9 vs 0.9; p < 0.01) indicated ventilation perfusion mismatching in these patients. The ventilatory cost of oxygen uptake was higher in chronic kidney disease (37 ± 0.8 vs 33 ± 1; p < 0.01). Maximum heart rate (134 ± 5 vs 159 ± 3 bpm) and one-minute heart rate recovery (15 ± 1 vs 20 ± 2 bpm) were reduced in chronic kidney disease ( p < 0.01). Conclusion This study suggests that both central and peripheral limitations likely contribute to reduced exercise capacity in non-dialysis chronic kidney disease. Additionally, cardiopulmonary exercise testing revealed subclinical cardiopulmonary abnormalities in these patients in the absence of overt cardiovascular disease. Cardiopulmonary exercise testing could potentially be a tool for unmasking cardiopulmonary abnormalities preceding cardiovascular disease in chronic kidney disease.

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