Abstract 15081: Determinants of Improvement in Renal Function Among Patients With Chronic Kidney Disease Who Participated in Cardiac Rehabilitation
Background: The safety and efficacy of cardiac rehabilitation (CR) in patients with chronic kidney disease (CKD) have not been established. There are conflicting reports about the effects of exercise on renal function in CKD patients, and there have been no studies about the determinants of change in renal function. The aims of this study are 1) to clarify the effect of CR and 2) to investigate the determinants of change in renal function in cardiac patients with CKD.
Methods: A total of 759 consecutive cardiac patients with CKD (estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2) who participated in CR were studied. All patients underwent measurements of eGFR and peak oxygen uptake (PVO2) before and 3 months after CR. Patients were divided into quartiles based on their change in eGFR. We compared the characteristics of patients in the first quartile (improved eGFR group) and the fourth quartile (worsened eGFR group).
Results: Overall, after 3-months CR program, eGFR (47.4 to 49.8 ml/min/1.73 m2, p<0.0001) and PVO2 (1108 to 1237 ml/min, p<0.0001) increased and BNP decreased (253 to 195pg/ml, p<0.0001) significantly. The improved eGFR patients (n=190, eGFR 48.4 to 62.3 ml/min/1.73m2) were younger (65.5 vs. 71.4 years, p<0.0001). They also had higher body mass index (BMI, 23.2 vs. 22.3 kg/m2, p<0.0001), higher LVEF (44% vs 39%, p<0.001), higher PVO2 (73.2% vs. 65.4%, p<0.0001), and lower BNP (206 pg/ml vs. 297 pg/ml, p<0.0001) than the worsened eGFR group (n=190, eGFR 48.4 to 41.6 ml/min/1.73 m2). A lower proportion of the improved eGFR group had heart failure (13% vs. 39%, p<0.001). There were similar levels of statistically significant improvement in PVO2 after CR in both groups. In the multiple regression analysis, younger age, higher BMI, higher baseline PVO2, lower baseline eGFR, and greater improvement in PVO2 after CR were independent determinants of eGFR improvement.
Conclusion: In cardiac patients with CKD, CR improved exercise tolerance without worsening renal function. Greater improvement in PVO2 was associated with greater improvement in eGFR after CR, suggesting that CR has a protective effect on the kidney in these patients.
Author Disclosures: T. Arakawa: None. R. Kumasaka: None. M. Nakanishi: None. K. Nakao: None. S. Fukui: None. T. Ohara: None. M. Yanase: None. T. Noguchi: None. S. Yasuda: None. H. Ogawa: None. Y. Goto: None.
- © 2015 by American Heart Association, Inc.