Endothelial dysfunction correlates with exaggerated exercise pressor response during whole body maximal exercise in chronic kidney disease

被引:38
作者
Downey, Ryan M. [1 ,2 ]
Liao, Peizhou [3 ]
Millson, Erin C. [4 ]
Quyyumi, Arshed A. [5 ]
Sher, Salman [5 ]
Park, Jeanie [1 ,2 ]
机构
[1] Emory Univ, Sch Med, Dept Med, Div Renal Med, Atlanta, GA 30322 USA
[2] Dept Vet Affairs Med Ctr, Res Serv Line, Decatur, GA USA
[3] Emory Univ, Rollins Sch Publ Hlth, Dept Biostat & Bioinformat, Atlanta, GA 30322 USA
[4] Emory Univ, Sch Med, Atlanta Clin & Translat Sci Inst, Clin Res Network, Atlanta, GA 30322 USA
[5] Emory Univ, Sch Med, Dept Med, Div Cardiol, Atlanta, GA 30322 USA
基金
美国国家卫生研究院;
关键词
chronic kidney disease; endothelial dysfunction; flow-mediated dilation; exercise pressor reflex; exercise; SYMPATHETIC-NERVE ACTIVITY; OXIDE SYNTHASE INHIBITION; HEMODIALYSIS-PATIENTS; AEROBIC EXERCISE; MUSCLE; VASOCONSTRICTION; HYPERTENSION; ASSOCIATION; PREDICTOR; MORTALITY;
D O I
10.1152/ajprenal.00603.2016
中图分类号
Q4 [生理学];
学科分类号
071003 ;
摘要
Chronic kidney disease (CKD) patients have exercise intolerance associated with increased cardiovascular mortality. Previous studies demonstrate that blood pressure (BP) and sympathetic nerve responses to handgrip exercise are exaggerated in CKD. These patients also have decreased nitric oxide (NO) bioavailability and endothelial dysfunction, which could potentially lead to an impaired ability to vasodilate during exercise. We hypothesized that CKD patients have exaggerated BP responses during maximal whole body exercise and that endothelial dysfunction correlates with greater exercise pressor responses in these patients. Brachial artery flow-mediated dilation (FMD) was assessed before maximal treadmill exercise in 56 participants: 38 CKD (56.7 +/- 1.2 yr old, 38 men) and 21 controls (52.8 +/- 1.8 yr old, 20 men). During maximal treadmill exercise, the slope-of-rise in systolic BP (+10.32 vs. +7.75 mmHg/stage, P < 0.001), mean arterial pressure (+3.50 vs. +2.63 mmHg/stage, P = 0.004), and heart rate (+11.87 vs. +10.69 beats.min(-1).stage(-1), P = 0.031) was significantly greater in CKD compared with controls. Baseline FMD was significantly lower in CKD (2.76 +/- 0.42% vs. 5.84 +/- 0.97%, P = 0.008). Lower FMD values were significantly associated with a higher slope-of-rise in systolic BP (+11.05 vs. 8.71 mmHg/stage, P = 0.003) during exercise in CKD, as well as poorer exercise capacity measured as peak oxygen uptake (Vo(2peak); 19.47 +/- 1.47 vs. 24.57 +/- 1.51 ml.min(-1).kg(-1), P < 0.001). These findings demonstrate that low FMD in CKD correlates with augmented BP responses during exercise and lower Vo(2peak), suggesting that endothelial dysfunction may contribute to exaggerated exercise pressor responses and poor exercise capacity in CKD patients.
引用
收藏
页码:F917 / F924
页数:8
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