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Abstract: SA-PO921

Peak Oxygen Consumption Is Reduced at All Levels of CKD in Chronic Heart Failure Patients

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Langlo, Knut Asbjørn Rise, St. Olavs Hospital HF, Trondheim, Norway
  • Lundgren, Kari Margrethe, NTNU, Trondheim, Norway
  • Cittanti, Elisa, NTNU, Trondheim, Norway
  • Hallan, Stein I., NTNU, Trondheim, Norway
  • Dalen, Havard, NTNU, Trondheim, Norway
Background

There is an increasing body of literature showing reduced Cardiorespiratory Fitness (CRF) in CKD. This is mainly proven in CKD stages 4 and 5, but increasing knowledge suggests that this is the case in earlier stages as well. Chronic heart failure (CHF) is characterized by the hearts inability to meet tissues blood demands, mainly during exercise. We wanted to see if CKD affected peak oxygen consumption (VO2peak) in CHF.

Methods

Participants were enrolled from two regional CHF clinics with similar access for all phenotypes of HF and all levels of renal insufficiency without any upper age limit. Echocardiography was performed at inclusion. Left ventricular and left atrial volumes and ejection fraction (EF) were measured in 4- and 2-chamber view. HF phenotype was classified according to the 2016 European Society of Cardiology Guidelines. All participants underwent testing for VO2peak on a treadmill. Hemoglobin (Hb) was analyzed with a photometric method whereas creatinine was measured enzymatically. Analysis were performed in hospital routines. Estimated Glomerular Filtration Rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. For statistical analysis we used multiple linear regression.

Results

59 participants (10 female) had valid test results for Hb (mean 13.3, SD 1.8), VO2peak (mean 17.9, SD 4.6) and eGFR (mean 57.6, SD 24.2). In a multiple regression analysis, VO2peak showed a strong association with eGFR after correcting for Hb of -0.078 ml/min/kg per 1 ml/min/1.73 m2 drop in eGFR (95% CI -0.031 - -0.123, p=0.001).

Conclusion

Lower eGFR is a major predictor of poor cardiorespiratory fitness even in a chronic heart failure population where VO2peak is already severely reduced. This relation holds for eGFR ranging from ESRD to normal renal function. Whether reduced renal function is caused by the severity of the heart failure and thereby lower VO2peak, or reduced renal function leads to worsening heart failure with lower VO2peak is not known from our cross-sectional design.

Funding

  • Government Support - Non-U.S.