Abstract 19296: Impact of Cardiac Rehabilitation on Renal Function in Patients with Acute Myocardial Infarction complicated with Chronic Kidney Disease.
Background: Although there is a general fear that exercise training might deteriorate renal function in patients with chronic kidney disease (CKD), the impact of exercise training on renal function in patients with acute myocardial infarction (AMI) complicated with CKD has not been fully investigated.
Methods: We studied a total of 490 AMI patients who participated in a 3-month cardiac rehabilitation (CR) program. The CR program consisted of supervised exercise sessions (walking, bicycle ergometer and calisthenics) combined with home exercise at an intensity of 40-60% heart rate reserve 3-5 times a week. Patients were divided into 2 groups according to estimated glomerular filtration rate (eGFR) calculated by Cockcroft-Gault equation: Normal group (eGFR>=60 ml/min/1.73m2, n=334) and CKD group (eGFR <60 ml/min/1.73 m2, n=156). Exercise capacity and clinical data including renal function were assessed at the beginning and the end of the 3-month exercise training in CR.
Results: In Normal group, peak VO2 increased (22.4 to 24.6 ml/min/kg, p<0.001) and plasma BNP concentration decreased (157 to 85 pg/ml, p<0.001) after CR without a change in eGFR (78 to 78 ml/min/1.73 m2, NS). In CKD group, eGFR (51 to 56 ml/min/1.73 m2, p<0.001) significantly improved along with improvements in peak VO2 (19.6 to 21.7 ml/min/kg, p<0.01) and plasma BNP concentration (267 to 151 pg/ml, p<0.001). Moreover, in severe CKD patients (eGFR <30 ml/min/1.73 m2, n=43), peak VO2 increased (17.5 to 20.0 ml/min/kg, p<0.05) and plasma BNP concentration decreased (362 to 198 pg/ml, p<0.05) without deteriorating with eGFR (24 to 26 ml/min/1.73 m2, NS). In addition, eGFR improved in CKD patients with hypertension (48 to 53 ml/min/1.73m2, p<0.01, n=117) or with diabetes mellitus (48 to 53 ml/min/1.73m2, p<0.05, n=63), which are the risk factors of progression to end-stage renal failure. Further, analysis using the Japanese version of the MDRD (Modification of Diet in Renal Disease) equation issued by the Japanese Society of Nephrology showed similar results.
Conclusion: In AMI patients complicated with CKD, exercise training in CR was associated with increased peak VO2, decreased plasma BNP concentration, and improved or unchanged eGFR.
- © 2010 by American Heart Association, Inc.