Special populations
Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease Alexander Nelson,1 James Otto,2 John Whittle,3 Robert C M Stephens,4 Daniel S Martin,2 John R Prowle,5 Gareth L Ackland5
To cite: Nelson A, Otto J, Whittle J, et al. Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease. Open Heart 2016;3:e000370. doi:10.1136/openhrt-2015000370
▸ Additional material is available. To view please visit the journal (http://dx.doi.org/ 10.1136/openhrt-2015000370). Received 24 November 2015 Revised 9 January 2016 Accepted 12 January 2016
1
UCL Medical School, London, UK 2 Royal Free London NHS Foundation Trust, London, UK 3 Division of Medicine, Department of Clinical Physiology, University College London, London, UK 4 Department of Anaesthesia, University College London Hospitals NHS Trust, London, UK 5 William Harvey Research Institute, Queen Mary University of London, London, UK Correspondence to Dr Gareth L Ackland; [email protected]
ABSTRACT Objective: Reduced exercise capacity is well documented in end-stage chronic kidney disease (CKD), preceded by changes in cardiac morphology in CKD stage 3. However, it is unknown whether subclinical cardiopulmonary dysfunction occurs in CKD stage 3 independently of heart failure. Methods: Prospective observational cross-sectional study of exercise capacity assessed by cardiopulmonary exercise testing in 993 preoperative patients. Primary outcome was peak oxygen consumption (VO2peak). Anaerobic threshold (AT), oxygen pulse and exercise-evoked measures of autonomic function were analysed, controlling for CKD stage 3, age, gender, diabetes mellitus and hypertension. Results: CKD stage 3 was present in 93/993 (9.97%) patients. Diabetes mellitus (RR 2.49 (95% CI 1.59 to 3.89); p
Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease Alexander Nelson,1 James Otto,2 John Whittle,3 Robert C M Stephens,4 Daniel S Martin,2 John R Prowle,5 Gareth L Ackland5
To cite: Nelson A, Otto J, Whittle J, et al. Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease. Open Heart 2016;3:e000370. doi:10.1136/openhrt-2015000370
▸ Additional material is available. To view please visit the journal (http://dx.doi.org/ 10.1136/openhrt-2015000370). Received 24 November 2015 Revised 9 January 2016 Accepted 12 January 2016
1
UCL Medical School, London, UK 2 Royal Free London NHS Foundation Trust, London, UK 3 Division of Medicine, Department of Clinical Physiology, University College London, London, UK 4 Department of Anaesthesia, University College London Hospitals NHS Trust, London, UK 5 William Harvey Research Institute, Queen Mary University of London, London, UK Correspondence to Dr Gareth L Ackland; [email protected]
ABSTRACT Objective: Reduced exercise capacity is well documented in end-stage chronic kidney disease (CKD), preceded by changes in cardiac morphology in CKD stage 3. However, it is unknown whether subclinical cardiopulmonary dysfunction occurs in CKD stage 3 independently of heart failure. Methods: Prospective observational cross-sectional study of exercise capacity assessed by cardiopulmonary exercise testing in 993 preoperative patients. Primary outcome was peak oxygen consumption (VO2peak). Anaerobic threshold (AT), oxygen pulse and exercise-evoked measures of autonomic function were analysed, controlling for CKD stage 3, age, gender, diabetes mellitus and hypertension. Results: CKD stage 3 was present in 93/993 (9.97%) patients. Diabetes mellitus (RR 2.49 (95% CI 1.59 to 3.89); p
