Patients with chronic kidney disease frequently exhibit abnormal heart rate and blood pressure recovery following exercise, indicating potential autonomic dysfunction and increased cardiovascular risk.
Answers are grounded in this paper and cite their sources.
Abnormal post-exercise recovery is common in CKD; hypothesis-generating for autonomic dysfunction and CV risk but should not yet change practice.
An abnormal heart rate recovery (HRR) and blood pressure recovery (BPR) from exercise is related to autonomic dysfunction (AD), and has been found to be associated with the presence of coronary artery disease (CAD) and increased mortality. PURPOSE: The present study evaluated HRR and BPR in patients with chronic kidney disease (CKD) to determine if increased risk exists in this population. SUBJECTS: The subjects (N=22) included 13 females and 9 males with CKD (glomerular filtration rate (GFR) 40.9+24.3 mL/min/1.73m2). There were 10 diabetics (DM) and 12 nondiabetics (NDM), age 53.3+15.4 yrs, BMI 32.6+5.9 kg/m2. METHODS: Subjects underwent a symptom-limited graded exercise test (GXT) using the modified Bruce protocol. HRR was determined as the difference between the peak HR reached during GXT (HRpeak) and the HR at min 1 and min 2 of recovery (HRR1 and HRR2, respectively). BPR was assessed as the ratio of the systolic blood pressure (SBP) at min 3 of recovery to the SBP at min 1 of recovery and to the peak SBP (SBPpeak) reached during GXT (SBP31 and SBP3p, respectively). RESULTS: Results are reported as the mean+SD. SBPpeak was 177.8+25.8 mmHG. HRpeak was 124.0+26.9 bpm and VO2peak was 17.3+4.7 ml/kg/min. In other populations, a SBP31 > 1.00, a SBP3p >.90, a HRR1 < 12 bpm, and a HRR2 < 42 bpm has been associated with the presence of CAD and increased mortality. SBP31 > 1.00 was seen in 18% of kidney patients. A SBP3p >.90 was seen in 50%. A HRR1 < 12 bpm was seen in 41%, while 64% demonstrated a HRR2 < 42 bpm. SBP3p (.91+.17) was greater than.90. HRR1 (21.8+19.4) was greater than 12 bpm, however HRR2 (33.4+16.4) was less than 42 bpm. Independent Groups t tests were performed to compare DM and NDM. There were no significant differences (p >.05) in BPR ratios or HRR measurements between DM and NDM. CONCLUSIONS: Kidney patients demonstrated SBP3p >.90 and HRR2 < 42 bpm, values associated with increased risk of CAD and increased mortality. Supported by a grant from Western New England Renal & Transplant Associates
No takes yet. Share an insight, caveat, or question.
Gregory et al. (2009) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: