Supervisors info:
Φιλίππου Αναστάσιος, Ph.D., Αναπληρωτής καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γράψα Ειρήνη MD, PhD, Αναπληρώτρια καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Πιτταράς Θεόδωρος, MD, PhD, Επίκουρος καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Background: Ambulatory hemodialysis patients have limited physical activity and an increased risk for developing cardiovascular disease. In addition, they show reduced physical function and impaired quality of life. Studies revealed the beneficial effects of exercise (aerobic or resistance) in patients with Chronic Kidney Disease (CKD), which improves muscle strength, cardiorespiratory function, and overall physical and mental well-being. Cardiopulmonary exercise testing (CPET) assesses the participant's cardiorespiratory ability (fitness) and helps to design a personalized rehabilitation program for each patient. Thus, several clinical populations undergo CPET for their cardiorespiratory evaluation and the design of appropriate therapeutic exercise programs. The aim of the present study was to investigate the effect of CPET on the concentration of biochemical markers of renal and hepatic function in ambulatory hemodialysis patients.
Methods: Ten hemodialysis patients with CKD, (6 females and 4 males, age: 59.5±16.6 years, mean duration of hemodialysis treatment: 4.45±2.7 years), who did not exercise systematically, were tested (CPET) on a cycle ergometer, on days between their dialysis sessions. Two blood samples were collected from each participant, one at the day before and one at the day after the CPET (up to 24h later), at the beginning of their dialysis session. The concentrations of biochemical markers such as CPK, CRP, ALT, AST, LDH, GLU, CR, UR, NA, K, before and after KADK were measured and compared.
Results: All patients completed CPET without presenting any complications. Compared to the predicted values, a decrease in the mean value of peak oxygen uptake (VO2peak = 14.4±4.5 ml/kg/min and %VO2peak predicted = 56.1±16.9) and in the anaerobic threshold (AT= 10.93±2.39 ml/kg/min and % AT predicted = 43.5±11.9) was observed. After CPET, an increase in the values of AST (AST before - AST after = -0.60±0.70 U/l, p=0.024) and GLU (GLU before – GLU after = -9.44±11.48 mg/dl, p=0.039) was recorded, along with a reduction in UR (UR before – UR after =23.42±27.38 mg/dl p=0.024). No statistically significant alterations were observed after CPET in the rest of the biochemical variables measured.
Conclusions: Hemodialysis patients with CKD are able to safely perform a CPET, in order their cardiorespiratory function and their ability for exercise to be evaluated. In particular, comparing some hepatic and renal biomarkers before and after CPET, we found an increase in AST and GLU, though being within their normal ranges, as well as a reduction of UR, which was found to lie outside the normal values, both before and after the CPET. Overall, CPET was found not to negativelly affect basic biomarkers of hemodialysis patients with CKD, suggesting that CPET can be safely utilized as a method to measure the cardiorespiratory function of those patients and, subsequently, to design a personalized exercise programs for them.
Keywords:
Chronic kidney disease, CKD, Cardiopulmonary exercise testing, CPET, CPK, CRP, ALT, AST, LDH, GLU, CR, UR, NA, K, Biomarkers, Hemodialysis, Cardiorespiratory function
