The cardiovascular determinants of physical function in patients with end-stage kidney disease on haemodialysis
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ORIGINAL PAPER
The cardiovascular determinants of physical function in patients with end‑stage kidney disease on haemodialysis Sherna F. Adenwalla1,2,3 · Roseanne E. Billany1,2,3 · Daniel S. March1,2,3 · Gaurav S. Gulsin1,3 · Hannah M. L. Young4,5 · Patrick Highton1,7 · Darren C. Churchward1 · Robin Young6 · Alysha Careless1 · Clare L. Tomlinson1 · Gerry P. McCann1,3 · James O. Burton1,2,7 · Matthew P. M. Graham‑Brown1,2,3 Received: 3 August 2020 / Accepted: 20 November 2020 © The Author(s) 2020
Abstract Patients with end-stage kidney disease (ESKD) are often sedentary and decreased functional capacity associates with mortality. The relationship between cardiovascular disease (CVD) and physical function has not been fully explored. Understanding the relationships between prognostically relevant measures of CVD and physical function may offer insight into how exercise interventions might target specific elements of CVD. 130 patients on haemodialysis (mean age 57 ± 15 years, 73% male, dialysis vintage 1.3 years (0.5, 3.4), recruited to the CYCLE-HD trial (ISRCTN11299707), underwent cardiovascular phenotyping with cardiac MRI (left ventricular (LV) structure and function, pulse wave velocity (PWV) and native T1 mapping) and cardiac biomarker assessment. Participants completed the incremental shuttle walk test (ISWT) and sit-to-stand 60 (STS60) as field-tests of physical function. Linear regression models identified CV determinants of physical function measures, adjusted for age, gender, BMI, diabetes, ethnicity and systolic blood pressure. Troponin I, PWV and global native T1 were univariate determinants of ISWT and STS60 performance. NT pro-BNP was a univariate determinant of ISWT performance. In multivariate models, NT pro-BNP and global native T1 were independent determinants of ISWT and STS60 performance. LV ejection fraction was an independent determinant of ISWT distance. However, age and diabetes had the strongest relationships with physical function. In conclusion, NT pro-BNP, global native T1 and LV ejection fraction were independent CV determinants of physical function. However, age and diabetes had the greatest independent influence. Targeting diabetic care may ameliorate deconditioning in these patients and a multimorbidity approach should be considered when developing exercise interventions. Keywords Physical activity · MRI · ESKD · Global native T1 · Cardiovascular function
Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s10554-020-02112-z ) contains supplementary material, which is available to authorized users.
Abbreviations CV Cardiovascular CVD Cardiovascular disease CMR Cardiovascular magnetic resonance CKD Chronic kidney disease
* Matthew P. M. Graham‑Brown [email protected]
4
Department of Respiratory Sciences, University of Leicester, Leicester, UK
Sherna F. Adenwalla [email protected]
5
Research and Innovation Department, University Hospitals Leicester NHS Trust, Leicester, UK
6
Robertson Centre for Biostatistics, Un
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