| Effects of modality change and transplant on peak oxygen uptake in patients with kidney failure. | |
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MedLine Citation:
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PMID: 20870330 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Patricia Painter; Joanne B Krasnoff; Michael Kuskowski; Lynda Frassetto; Kirsten L Johansen |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2010-09-25 |
Journal Detail:
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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:
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Created Date: 2010-12-27 Completed Date: 2011-01-25 Revised Date: 2012-01-04 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 113-22 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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University of Minnesota, Minneapolis, 55455, USA. tpainter@umn.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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R01 NR008286-04/NR/NINR NIH HHS; R01-NR008286/NR/NINR NIH HHS |
| Chemical | |
Reg. No./Substance:
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60-27-5/Creatinine; 7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
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Am J Kidney Dis. 2011 May;57(5):803
[PMID:
21496727
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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