Does Exercise Training During Hemodialysis Improve Maximal Exercise Capacity In Patients With End-stage Renal Disease ?

Background: Previous data have pointed to the fact that vascular function is significantly impaired in patients with end-stage renal disease (ESRD). We aimed to better characterise vasodilation and exercise capacity in both ESRD and chronic heart failure (CHF) patients. Methods: A total of 30 ESRD patients (23 male; mean age 45.7 ± 9.9 years) were included in a prospective proof-of-concept study at a tertiary care academic centre. The patients underwent forearm venous plethysmography with post-ischaemic peak blood flow (PF) and flow-dependent flow (FDF) testing as well as cardiopulmonary exercise testing during the morning of the day following the last haemodialysis. After matching for age, gender, and body mass index, the data were compared to 30 patients with CHF and 20 age-matched healthy controls. Results: PF in ESRD patients was reduced when compared to that in CHF patients (12.5 ± 4.2 vs. 15.6 ± 6.9 ml/100 ml/min; p = 0.048) and healthy controls (26.4 ± 9.3 ml/100 ml/min; p < 0.001). When compared to controls, FDF was significantly reduced in ESRD patients (7.6 ± 3.1 vs. 6.0 ± 2.5 ml/100 ml/min; p = 0.03), but not in CHF patients, whereas resting blood flow did not differ between the ESRD, CHF, and healthy control groups. In contrast to indices of vasodilative capacity, maximum exercise capacity (peakVO2) was higher in ESRD when compared to CHF patients (23.8 ± 7.3 vs. 18.8 ± 5.2 ml/min/kg), but significantly impaired when compared to controls (32.8 ± 6.7 ml/min/kg; p < 0.001). Conclusion: In this proof-of-concept study, exercise capacity was relatively preserved, while vasodilative capacity was substantially impaired in ESRD patients. Additional studies are warranted to examine the underlying mechanisms and potential clinical implications of our findings.

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Exercise Capacity in Pediatric Patients with End-Stage Renal Disease

Peritoneal Dialysis International ◽

10.1177/089686080402400310 ◽

2004 ◽

Vol 24 (3) ◽

pp. 274-280 ◽

Cited By ~ 31

Author(s):

Anirut Pattaragarn ◽

Bradley A. Warady ◽

Richard J. Sabath

Keyword(s):

Oxygen Consumption ◽

Renal Disease ◽

Exercise Capacity ◽

End Stage Renal Disease ◽

Pediatric Patients ◽

Healthy Children ◽

Dialysis Patients ◽

Stage Renal Disease ◽

End Stage ◽

And Control

Objective To evaluate the correlation between exercise capacity and hemoglobin in pediatric patients with end-stage renal disease (ESRD) treated with automated peritoneal dialysis (APD) and hemodialysis. Design Prospective case-control study and retrospective review. Setting Dialysis summer camp and Children's Mercy Hospital exercise laboratory. Participants Prospective evaluation conducted with 14 patients (9 males, mean age 14.5 ± 2.5 years) who received either home APD (5 patients) or in-center hemodialysis (9 patients), and 8 healthy age-matched controls. Retrospective data derived from 10 children (7 males, mean age 12.3 ± 3.3 years), all of whom received APD. Intervention Maximal treadmill evaluation conducted with each patient and control. The hemoglobin value of each patient was also assessed. Main Outcome Measures Comparison of the following data generated during treadmill protocol: peak heart rate, blood pressure, oxygen saturation, treadmill time, oxygen consumption (VO2), ventilation (Ve), oxygen consumption at anaerobic threshold (VO2 AT), and respiratory exchange ratio. Results The hemoglobin value of the current patient group (12.8 ± 1.6 g/dL) was significantly greater than the previously studied patients (10.5 ± 1.1 g/dL) ( p = 0.001). Treadmill time, VO2, and VO2 AT were significantly lower in both groups of dialysis patients compared to the control subjects ( p < 0.05). No differences were noted in any of these variables when comparing these two groups of dialysis patients only. Conclusion The exercise capacity of pediatric dialysis patients is significantly poorer than that of healthy children, an outcome apparently related to factors other than normalization of the hemoglobin value.

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