Bullock R E, Amer H A, Simpson I, Ward M K, Hall R J
Br Med J (Clin Res Ed). 1984 Dec 1;289(6457):1479-84. doi: 10.1136/bmj.289.6457.1479.
The exercise tolerance of the survivors of a consecutive group of 100 patients in a renal dialysis and transplant programme was compared with the prevalence of cardiac abnormalities detected by exercise testing, echocardiography, and radionuclide angiography. Fifty four patients attended for investigation 27 (SD 7) months after starting renal replacement therapy. Forty three of them (80%) were receiving antihypertensive treatment. Their performance on a bicycle ergometer exercise test was compared with that of 62 normal subjects and the patients divided into five groups of decreasing ability. The exercise tolerance of the patients was very poor, only 17 performing within the normal range. Impairment in exercise capacity was not explained by the type or quality of renal replacement therapy. Fourteen patients developed ischaemic electrocardiographic changes on exercise. Left ventricular ejection fraction was assessed by gated blood pool scanning in 37 patients; all nine of the patients with an abnormally low radionuclide ejection fraction also had abnormal exercise tolerance. Satisfactory M mode echocardiograms were obtained from 45 of the patients, and only two were normal. Left ventricular hypertrophy was detected in 25 (56%) of the echocardiograms, and abnormalities indicating impaired left ventricular function were common and widespread. Grouping all the abnormal cardiac features together for the patients in each exercise group showed a striking linear trend of increasing proportion of cardiac abnormalities with worsening exercise tolerance among the five exercise groups (p less than 0.001). The proportion of patients becoming unemployed within one year of starting renal replacement therapy similarly increased, from nil to 60% from the best exercise group to the most incapacitated. Twenty nine of the original cohort of 100 patients subsequently died, cardiovascular disease accounting for 12 (41%) of these deaths. Diminished exercise tolerance in patients receiving renal replacement therapy is strongly associated with cardiac abnormalities and reduced employment prospects.
对一组连续的100例接受肾透析及移植治疗的患者的运动耐量，与通过运动试验、超声心动图及放射性核素血管造影检测出的心脏异常患病率进行了比较。54例患者在开始肾脏替代治疗后27（标准差7）个月接受了检查。其中43例（80%）正在接受抗高血压治疗。将他们在自行车测力计运动试验中的表现与62名正常受试者进行比较，并将患者分为能力逐渐下降的五组。患者的运动耐量非常差，只有17例在正常范围内。运动能力受损无法用肾脏替代治疗的类型或质量来解释。14例患者在运动时出现缺血性心电图改变。通过门控血池扫描对37例患者的左心室射血分数进行了评估；放射性核素射血分数异常低的所有9例患者运动耐量也均异常。45例患者获得了满意的M型超声心动图，只有2例正常。25例（56%）超声心动图检测到左心室肥厚，提示左心室功能受损的异常情况常见且广泛。将每个运动组患者的所有心脏异常特征综合起来分组显示，在五个运动组中，随着运动耐量恶化，心脏异常比例呈显著的线性增加趋势（p<0.001）。开始肾脏替代治疗后一年内失业的患者比例也同样增加，从最佳运动组的零增加到最无能力组的60%。最初的100例患者中有29例随后死亡，心血管疾病占这些死亡病例的12例（41%）。接受肾脏替代治疗患者的运动耐量降低与心脏异常及就业前景降低密切相关。
