Kidney Week

Abstract: SA-PO0479

Chronotropic Incompetence Is Associated with Cardiovascular Functional Impairment and Reduced Physical Function in Patients on Hemodialysis

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Campos, Monique Opuszcka, Indiana University School of Medicine, Indianapolis, Indiana, United States

Monique Opuszcka Campos, PhD

• Beuter, Ashlie Rose, Indiana University School of Medicine, Indianapolis, Indiana, United States

Ashlie Rose Beuter

• Carlton, Loran Olivia, Indiana University School of Medicine, Indianapolis, Indiana, United States

Loran Olivia Carlton, MD

• Narayanan, Gayatri, Indiana University School of Medicine, Indianapolis, Indiana, United States

Gayatri Narayanan, MS

• Stafford, Lauren H., Indiana University School of Medicine, Indianapolis, Indiana, United States

Lauren H. Stafford, MS

• Dillman, Drake, Indiana University School of Medicine, Indianapolis, Indiana, United States

Drake Dillman, MS

• Lim, Kenneth, Indiana University School of Medicine, Indianapolis, Indiana, United States

Kenneth Lim, MD, PhD, FASN

Background

Chronotropic incompetence (CI), defined as an inadequate heart rate response to stress, is a major feature in patients with heart failure (HF) and has been increasingly recognized in hemodialysis (HD) patients. The presence of CI is associated with an increased risk of cardiovascular (CV) events such as sudden cardiac death. However, its relevance in HD patients, particularly its contribution to impaired CV functional capacity (the cardinal manifestation of HF) is largely unknown. Herein, we sought to determine the role of CI in HD patients and its association with exercise-derived ventilatory measures of CV functional capacity.

Methods

We conducted a cross-sectional analysis of baseline data from 54 patients on thrice-weekly HD in the ongoing Redefining Cardiovascular Risk Assessment in Dialysis Patients (ROCK-D) cohort. All participants completed cardiopulmonary exercise testing, cardiac magnetic resonance imaging and physical function assessments, including the 6-minute walk test (6MWD) and Short Physical Performance Battery (SPPB) the day following dialysis.

Results

Patients were dichotomized by chronotropic index at the sample median (≤0.3467 vs >0.3467), defining severe and moderate CI, respectively. CI was present in 96% (52/54) of the cohort. Groups were well matched for sex, BMI and dialysis vintage (all P's>0.05). Patients in the severe CI group were older (55.9 vs. 48.3 years;P=0.02), with no differences in comorbidities(P>0.05). Notably, VO₂Peak (gold-standard of CV functional capacity) was significantly lower in patients with severe CI (9.8 ± 2.0 vs 14.0 ± 3.8 mL/kg/min; P<0.001). These patients also had lower 6MWD (332.0 ± 89.2 vs 447.5 ± 94.7m, P<0.001), and SPPB (9.0 [8.0–11.0] vs 11.0 [10.0–12.0], P<0.01). There were no differences in left ventricular ejection fraction (LVEF) and left ventricular mass index. CI correlated with VO₂Peak (r=0.64), 6MWD (r=0.52),and SPPB (r=0.34; all P's<0.01). Additionally, CI remained independently associated with VO₂Peak (P<0.0001) and 6MWD (P=0.0002) after adjustment for age, sex, dialysis vintage, and LVEF.

Conclusion

CI is highly prevalent and independently associated with CV functional impairment and reduced physical function, highlighting its role as a major determinant of functional limitations in HD patients.

Funding

• Other NIH Support