Asymptomatic non-diabetic men with CKD showed a graded reduction in peak cardiac power output compared to healthy controls (from 5.02 W in CKD 2-3a to 4.02 W in CKD 5 vs 6.13 W; P<0.005).
Cross-Sectional (n=130)
Is asymptomatic chronic kidney disease associated with impaired peak cardiac performance in patients without comorbid cardiac disease or diabetes?
Asymptomatic CKD patients without diabetes or known cardiac disease exhibit a graded reduction in peak cardiac power and functional reserve, mirroring early heart failure.
p-value: p=<0.005
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Chinnappa et al. (Wed,) conducted a cross-sectional in Chronic kidney disease (n=130). Chronic kidney disease vs. Healthy volunteers and heart failure patients was evaluated on Peak cardiac power output (p=<0.005). Asymptomatic non-diabetic men with CKD showed a graded reduction in peak cardiac power output compared to healthy controls (from 5.02 W in CKD 2-3a to 4.02 W in CKD 5 vs 6.13 W; P<0.005).