Shanmugakumar Chinnappa1,2, Edward White3, Nigel Lewis4, Omer Baldo5, Yu-Kang Tu6, Griet Glorieux7, Raymond Vanholder7, Meguid El Nahas8, Andrew Mooney2,9. 1. Department of Nephrology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 2. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. 3. School of Biomedical Sciences, University of Leeds, Leeds, UK. 4. Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 5. Department of Urology, Airedale NHS Foundation Trust, Keighley, UK. 6. Institute of Epidemiology and Preventive Medicine, College of Public Health, National University of Taiwan, Taiwan. 7. Department of Nephrology, Ghent University Hospital, Ghent, Belgium. 8. Department of Nephrology, University of Sheffield, Sheffield, UK. 9. Department of Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Abstract
Background: Heart failure (HF) is highly prevalent and associated with high mortality in chronic kidney disease (CKD). However, the pathophysiology of cardiac dysfunction in CKD, especially in the early asymptomatic stage, is not well understood. We studied subclinical cardiac dysfunction in asymptomatic CKD patients without comorbid cardiac disease or diabetes mellitus by evaluating peak cardiac performance. Methods: In a cross-sectional study (n = 130) we investigated 70 male non-diabetic CKD patients (21 CKD stage 2-3a, 27 CKD stage 3b-4 and 22 CKD stage 5) employing specialized cardiopulmonary exercise testing to measure peak cardiac output and cardiac power output non-invasively. Data from 35 age-matched healthy male volunteers were obtained for comparison. In addition, as a positive control, data from 25 age-matched male HF patients in New York Heart Association class II and III were also obtained. Results: The study subjects showed a graded reduction in peak cardiac power, with 6.13 ± 1.11 W in controls, 5.02 ± 0.78 W in CKD 2-3a, 4.59 ± 0.53 W in CKD 3b-4 and 4.02 ± 0.73 W in CKD 5, although not as impaired as in HF, with 2.34 ± 0.63 W (all P < 0.005 versus control). The central haemodynamic characteristics of the cardiac impairment in CKD mirrored that of HF, with reduced flow and pressure-generating capacities, reduced chronotropic reserve and impaired contractility. Conclusions: The study demonstrates for the first time impaired peak cardiac performance and cardiac functional reserve in asymptomatic CKD patients. The evidence of myocardial dysfunction in the absence of comorbid cardiac disease and diabetes warrants further evaluation of current pathophysiological concepts of cardiovascular disease in CKD.
Background: Heart failure (HF) is highly prevalent and associated with high mortality in chronic kidney disease (CKD). However, the pathophysiology of cardiac dysfunction in CKD, especially in the early asymptomatic stage, is not well understood. We studied subclinical cardiac dysfunction in asymptomatic CKD patients without comorbid cardiac disease or diabetes mellitus by evaluating peak cardiac performance. Methods: In a cross-sectional study (n = 130) we investigated 70 male non-diabetic CKDpatients (21 CKD stage 2-3a, 27 CKD stage 3b-4 and 22 CKD stage 5) employing specialized cardiopulmonary exercise testing to measure peak cardiac output and cardiac power output non-invasively. Data from 35 age-matched healthy male volunteers were obtained for comparison. In addition, as a positive control, data from 25 age-matched male HF patients in New York Heart Association class II and III were also obtained. Results: The study subjects showed a graded reduction in peak cardiac power, with 6.13 ± 1.11 W in controls, 5.02 ± 0.78 W in CKD 2-3a, 4.59 ± 0.53 W in CKD 3b-4 and 4.02 ± 0.73 W in CKD 5, although not as impaired as in HF, with 2.34 ± 0.63 W (all P < 0.005 versus control). The central haemodynamic characteristics of the cardiac impairment in CKD mirrored that of HF, with reduced flow and pressure-generating capacities, reduced chronotropic reserve and impaired contractility. Conclusions: The study demonstrates for the first time impaired peak cardiac performance and cardiac functional reserve in asymptomatic CKD patients. The evidence of myocardial dysfunction in the absence of comorbid cardiac disease and diabetes warrants further evaluation of current pathophysiological concepts of cardiovascular disease in CKD.
Authors: O A Efremova; L A Kamyshnikova; S E Veysalov; M S Sviridova; N I Obolonkova; M A Gayvoronskaya; M Wuraola Journal: Arch Razi Inst Date: 2022-02-28
Authors: Onju Ham; William Jin; Lei Lei; Hui Hui Huang; Kenji Tsuji; Ming Huang; Jason Roh; Anthony Rosenzweig; Hua A Jenny Lu Journal: Sci Rep Date: 2018-10-31 Impact factor: 4.379
Authors: Helena Wallin; Anna M Asp; Carin Wallquist; Eva Jansson; Kenneth Caidahl; Britta Hylander Rössner; Stefan H Jacobson; Anette Rickenlund; Maria J Eriksson Journal: PLoS One Date: 2018-12-19 Impact factor: 3.240