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Abstract: PO2118

Cardiovascular Determinants of Physical Function in Patients with ESKD on Hemodialysis

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Adenwalla, Sherna F., University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
  • Gulsin, Gaurav S., University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
  • Billany, Roseanne, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
  • March, Daniel Scott, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
  • Young, Robin, University of Glasgow Robertson Centre for Biostatistics, Glasgow, Glasgow, United Kingdom
  • Careless, Alysha, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
  • Tomlinson, Clare L., University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
  • Mccann, Gerry Patrick, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
  • Burton, James, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
  • Graham-Brown, Matthew, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Leicester, United Kingdom
Background

Patients with end-stage kidney disease (ESKD) are often sedentary and decreased functional capacity associates with mortality. The relationship between physical function and cardiovascular disease (CVD) has not been fully explored. Understanding the relationships between prognostically relevant measures of CVD and physical function and capacity may offer insight into whether exercise interventions could target specific elements of CVD.

Methods

130 patients on haemodialysis underwent cardiovascular phenotyping with cardiac MRI (left ventricular (LV) structure and function, pulse wave velocity and native T1 mapping) and cardiac biomarker assessment. Participants completed the incremental shuttle walk test (ISWT) and sit-to-stand 60 (STS60) as field-tests of physical function and capacity. Separate linear regression analyses identified CV determinants of physical function measures. Multivariate models were adjusted for age, gender, BMI and diabetes.

Results

Mean age was 57±15 years, 73% were male and median dialysis vintage was 1.3 years (0.5, 3.4). In multivariate models, NT pro-BNP and global native T1 were independent determinants of ISWT and STS60 performance. LV ejection fraction was also an independent determinant of ISWT distance. However, age, gender and diabetes had the strongest relationship with physical function. Cardiovascular markers that were signficant in multivariate models are shown in Table 1.

Conclusion

Markers of CV health could be targeted in exercise interventions to improve outcomes in patients with ESKD. NT pro-BNP, global native T1 and LV ejection fraction were independent CV determinants of physical function. The influence of age and diabetes on performance had the strongest relationship. Improving strategies for prevention and management of diabetes may ameliorate deconditioning in these patients.

Table 1
 B (SE)βp-value
ISWT
NT pro-BNP
Age
Gender
BMI
Diabetes
-20.71 (8.9)
-4.65 (0.9)
-61.47 (28.8)
-2.04 (2.6)
-89.70 (8.9)
-0.19
-0.43
-0.17
-0.07
-0.19
0.02
<0.01
0.03
0.43
0.02
STS60
NT pro-BNP (ng/L)
Age
Gender
BMI
Diabetes
-1.35 (0.6)
-0.32 (0.1)
-1.42 (1.9)
-0.27 (0.2)
-4.75 (1.9)
-0.19
-0.44
-0.06
-0.14
-0.21
0.03
<0.01
0.45
0.11
0.01
ISWT
LV ejection fraction (%)
Age
Gender
BMI
Diabetes
3.50 (1.4)
-4.92 (0.9)
-93.18 (30.1)
-1.24 (2.3)
-94.65 (28.0)
0.20
-0.44
-0.24
-0.04
-0.27
0.01
<0.01
<0.01
0.58
<0.01
ISWT
Global Native T1 (ms)
Age
Gender
BMI
Diabetes
-1.21 (0.3)
-4.67 (0.9)
-73.58 (28.5)
-0.66 (2.2)
-102.97 (27.4)
-0.28
-0.42
-0.19
-0.02
-0.29
<0.01
<0.01
0.01
0.77
<0.01
STS60
Global Native T1 (ms)
Age
Gender
BMI
Diabetes
-0.06 (0.02)
-0.31 (0.1)
-2.10 (2.0)
-0.14 (0.2)
-5.73 (2.0)
-0.19
-2.85
-0.08
-0.07
-0.24
0.02
<0.01
0.30
0.39
<0.01

Funding

  • Government Support - Non-U.S.