Document Detail


Effects of modality change and transplant on peak oxygen uptake in patients with kidney failure.
MedLine Citation:
PMID:  20870330     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Exercise capacity as measured by peak oxygen uptake (Vo₂(peak)) is low in hemodialysis patients. The present study assesses determinants of VO₂(peak) in patients with chronic kidney failure who either changed kidney replacement modality to frequent hemodialysis therapy or received a kidney transplant.
STUDY DESIGN: Cohort study with assessment at baseline and 6 months after modality change.
SETTING & PARTICIPANTS: Participants included nondiabetic individuals receiving conventional hemodialysis who: (1) remained on conventional hemodialysis therapy (n = 13), (2) changed to short daily hemodialysis therapy (n = 10), or (3) received a transplant (n = 5) and (4) individuals who underwent a pre-emptive transplant (n = 15). Additionally, 34 healthy controls were assessed at baseline only.
PREDICTOR: Modality change.
MEASUREMENT & OUTCOMES: Exercise capacity, assessed using the physiologic components of the Fick equation (Vo₂ = cardiac output × a-vo₂(dif), where a-vo₂(dif) is arterial to venous oxygen difference) was determined using measurement of Vo₂(peak) and cardiac output during symptom-limited exercise testing. Analysis of covariance was used to compare differences in changes in Vo₂(peak), cardiac output, heart rate, stroke volume, and a-vo₂(dif) at peak exercise between participants who remained on hemodialysis therapy and those who underwent transplant.
RESULTS: Transplant was the only modality change associated with a significant change in Vo₂(peak), occurring as a result of increased peak cardiac output and reflecting increased heart rate without a change in peak a-vo₂(dif) despite increased hemoglobin levels. There were no differences in participants who changed to daily hemodialysis therapy compared with those who remained on conventional hemodialysis therapy.
LIMITATIONS: Small nonrandomized study.
CONCLUSIONS: Vo₂(peak) increases significantly after kidney transplant, but not with daily hemodialysis; this improvement reflects increased peak cardiac output through increased peak heart rate. Despite statistical significance, the increase in Vo₂(peak) was not clinically significant, suggesting the need for interventions such as exercise training to increase Vo₂(peak) in all patients regardless of treatment modality.
Authors:
Patricia Painter; Joanne B Krasnoff; Michael Kuskowski; Lynda Frassetto; Kirsten L Johansen
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-09-25
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  57     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-27     Completed Date:  2011-01-25     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  113-22     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
University of Minnesota, Minneapolis, 55455, USA. tpainter@umn.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Urea Nitrogen
Cardiac Output
Creatinine / blood
Exercise Test
Exercise Tolerance*
Female
Heart Rate
Humans
Kidney Failure, Chronic / blood,  physiopathology*,  therapy
Kidney Transplantation*
Male
Middle Aged
Oxygen / blood
Oxygen Consumption*
Renal Dialysis / methods*
Stroke Volume
Grant Support
ID/Acronym/Agency:
R01 NR008286-04/NR/NINR NIH HHS; R01-NR008286/NR/NINR NIH HHS
Chemical
Reg. No./Substance:
60-27-5/Creatinine; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
Am J Kidney Dis. 2011 May;57(5):803   [PMID:  21496727 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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