Westphal Ladfors Susanne, Bergdahl Ebba, Hermannsson Oli, Kristjansson Julius, Linnér Tina, Brandström Per, Hansson Sverker, Dangardt Frida
Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Front Sports Act Living. 2021 Aug 16;3:688383. doi: 10.3389/fspor.2021.688383. eCollection 2021.
Children with chronic kidney disease, including those treated with kidney transplantation (KT), have an increased risk of cardiovascular disease. The aim of this study was to examine the cardiopulmonary exercise capacity after KT compared to matched controls, to relate the results to physical activity, blood pressure and biochemical findings and to follow exercise capacity over time. Patients with KT ( = 38, age 7.7-18 years), with a mean time from transplantation of 3.7 years (0.9-13.0) and mean time in dialysis 0.8 years, were examined at inclusion and annually for up to three years. Healthy controls ( = 17, age 7.3-18.6 years) were examined once. All subjects underwent a cardiopulmonary exercise test, resting blood pressure measurement, anthropometry and activity assessment. Patients also underwent echocardiography, dual-energy X-ray absorptiometry (DXA), 24-h ambulatory BP measurements (ABPM), assessment of glomerular filtration rate (GFR) and blood sampling annually. As compared to healthy controls, KT patients showed decreased exercise capacity measured both as VO (34.5 vs. 43.9 ml/kg/min, < 0.001) and maximal load (2.6 vs. 3.5 W/kg, < 0.0001), similarly as when results were converted to z-scores. No significant difference was found in weight, but the KT patients were shorter and had higher BMI z-score than controls, as well as increased resting SBP and DBP z-scores. The patient or parent reported physical activity was significantly lower in the KT group compared to controls ( < 0.001) In the combined group, the major determinants for exercise capacity z-scores were activity score and BMI z-score (β = 0.79, < 0.0001 and β = -0.38, = 0.007, respectively). Within the KT group, low exercise capacity was associated with high fat mass index (FMI), low activity score, low GFR and high blood lipids. In the multivariate analysis FMI and low GFR remained predictors of low exercise capacity. The longitudinal data for the KT patients showed no change in exercise capacity z-scores over time. Patients with KT showed decreased exercise capacity and increased BP as compared to healthy controls. Exercise capacity was associated to GFR, physical activity, FMI and blood lipids. It did not improve during follow-up.
患有慢性肾病的儿童，包括接受肾移植（KT）治疗的儿童，患心血管疾病的风险增加。本研究的目的是检查肾移植后与匹配对照组相比的心肺运动能力，将结果与身体活动、血压和生化检查结果相关联，并随时间跟踪运动能力。对38例肾移植患者（年龄7.7 - 18岁）进行了研究，移植后的平均时间为3.7年（0.9 - 13.0年），透析平均时间为0.8年，在纳入研究时进行检查，并每年检查一次，为期三年。对17例健康对照者（年龄7.3 - 18.6岁）进行了一次检查。所有受试者均接受了心肺运动试验、静息血压测量、人体测量和活动评估。患者还每年接受超声心动图、双能X线吸收法（DXA）、24小时动态血压测量（ABPM）、肾小球滤过率（GFR）评估和血液采样。与健康对照组相比，肾移植患者的运动能力下降，以VO₂（34.5 vs. 43.9 ml/kg/min，P < 0.001）和最大负荷（2.6 vs. 3.5 W/kg，P < 0.0001）衡量，结果转换为z分数时情况类似。体重方面未发现显著差异，但肾移植患者比对照组更矮，BMI z分数更高，静息收缩压和舒张压z分数也更高。肾移植组患者或家长报告的身体活动明显低于对照组（P < 0.001）。在综合组中，运动能力z分数的主要决定因素是活动评分和BMI z分数（β = 0.79，P < 0.0001和β = -0.38，P = 0.007，分别）。在肾移植组内，低运动能力与高脂肪质量指数（FMI）、低活动评分、低GFR和高血脂有关。在多变量分析中，FMI和低GFR仍然是低运动能力的预测因素。肾移植患者的纵向数据显示运动能力z分数随时间没有变化。与健康对照组相比，肾移植患者的运动能力下降且血压升高。运动能力与GFR、身体活动、FMI和血脂有关。随访期间运动能力没有改善。
