Department of Nephrology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Nephrol Dial Transplant. 2018 Mar 1;33(3):450-458. doi: 10.1093/ndt/gfx064.
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.
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.
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.
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.
心力衰竭（HF）在慢性肾脏病（CKD）中患病率很高，与死亡率高相关。然而，CKD 中心脏功能障碍的病理生理学，尤其是在早期无症状阶段，尚不清楚。我们通过评估峰值心功能来研究无症状 CKD 患者（无合并心脏疾病或糖尿病）的亚临床心脏功能障碍。
在一项横断面研究（n=130）中，我们研究了 70 名非糖尿病 CKD 男性患者（21 名 CKD 2-3a 期，27 名 CKD 3b-4 期和 22 名 CKD 5 期），采用专门的心肺运动测试来无创测量峰值心输出量和心功率输出。为了进行比较，还获得了 35 名年龄匹配的健康男性志愿者的数据。此外，作为阳性对照，还获得了 25 名年龄匹配的纽约心脏协会（NYHA）心功能 II 级和 III 级 HF 男性患者的数据。
研究对象的峰值心功率呈梯度下降，对照组为 6.13±1.11 W，CKD 2-3a 期为 5.02±0.78 W，CKD 3b-4 期为 4.59±0.53 W，CKD 5 期为 4.02±0.73 W，尽管不如 HF 严重，为 2.34±0.63 W（均 P<0.005 与对照组相比）。CKD 中心脏损伤的中心血液动力学特征与 HF 相似，表现为流量和压力生成能力降低、变时储备减少和收缩功能受损。
该研究首次证明无症状 CKD 患者存在峰值心功能和心脏功能储备受损。在无合并心脏疾病和糖尿病的情况下存在心肌功能障碍的证据，需要进一步评估 CKD 中心血管疾病的当前病理生理学概念。
