Kidney Center, Turku University Hospital and University of Turku, Turku, Finland.
Department of Clinical Physiology, Turku University Hospital and University of Turku, Turku, Finland.
Kidney Blood Press Res. 2022;47(1):72-80. doi: 10.1159/000520103. Epub 2021 Nov 25.
Chronic kidney disease (CKD) is associated with impaired maximal exercise capacity (MEC). However, data are scarce on the development of MEC in CKD stage 4-5 patients transitioning to renal replacement therapy (RRT).
We explored the change in MEC measured in watts (Wlast4) with 2 consecutive maximal bicycle stress ergometry tests in 122 CKD stage 4-5 patients transitioning to dialysis and transplantation in an observational follow-up study.
Mean age was 58.9 ± 13.9 years and 43 (35.2%) were female. Mean time between the baseline and follow-up ergometry tests was 1,012 ± 327 days and 29 (23.8%) patients had not initiated RRT, 50 (41.0%) were undergoing dialysis, and 43 (35.2%) had received a kidney transplant at the time of the follow-up ergometry test. The mean Wlast4 was 91 ± 37 W and 84 ± 37 W for the baseline and follow-up ergometry tests, respectively (p < 0.001). The mean Wlast4 declined between the baseline and follow-up ergometry tests in patients not requiring RRT (p = 0.001) and transplant recipients (p = 0.005), but not in dialysis patients (p = 0.478). There were no differences in the ratio of Wlast4 of the follow-up to the baseline ergometry tests (∆Wlast4) between patients on different treatment modalities at the time of the follow-up test (p = 0.097). Mean capillary blood bicarbonate was significantly associated with ∆Wlast4 after adjusting for age and treatment modality in the multivariate linear regression analysis (β = 0.226, p = 0.012).
MEC declined or remained poor in advanced CKD patients transitioning to RRT or continuing conservative care in this observational study. Mean capillary blood bicarbonate was independently associated with the development of MEC.
慢性肾脏病（CKD）与最大运动能力（MEC）受损有关。然而，关于接受肾脏替代治疗（RRT）的 CKD 4-5 期患者的 MEC 发展的数据很少。
我们在一项观察性随访研究中，探索了 122 名接受透析和移植的 CKD 4-5 期患者在 2 次连续最大自行车压力测功试验中 MEC 的变化，以瓦特（Wlast4）表示。
平均年龄为 58.9 ± 13.9 岁，43 名（35.2%）为女性。基线和随访测功试验之间的平均时间为 1012 ± 327 天，29 名（23.8%）患者尚未开始 RRT，50 名（41.0%）正在接受透析，43 名（35.2%）在随访测功试验时已接受肾脏移植。Wlast4 的平均值为基线测功试验的 91 ± 37 W 和随访测功试验的 84 ± 37 W（p < 0.001）。在不需要 RRT 的患者（p = 0.001）和移植受者（p = 0.005）中，Wlast4 从基线测功试验到随访测功试验的平均值下降，但在透析患者中没有（p = 0.478）。在随访测试时处于不同治疗方式的患者之间，Wlast4 的随访与基线测功试验的比值（∆Wlast4）没有差异（p = 0.097）。在多元线性回归分析中，调整年龄和治疗方式后，毛细血管血碳酸氢盐的平均值与 ∆Wlast4 显著相关（β = 0.226，p = 0.012）。
在这项观察性研究中，接受 RRT 的或继续保守治疗的晚期 CKD 患者的 MEC 下降或仍然很差。毛细血管血碳酸氢盐的平均值与 MEC 的发展独立相关。
