title: Decreased maximal aerobic capacity in pediatric chronic kidney disease.
abstract: Adult and pediatric patients with ESRD have impaired maximum oxygen consumption (VO(2) max), a reflection of the cardiopulmonary system's ability to meet increased metabolic demands. We sought to determine factors associated with decreased VO(2) max in pediatric patients with different stages of CKD. VO(2) max was measured using a standardized exercise testing protocol in patients with stage 2 to 4 chronic kidney disease (CKD) (n = 46), in renal transplant recipients (n = 22), in patients treated with maintenance hemodialysis (n = 12), and in age-matched healthy controls (n = 33). VO(2) max was similar between children with stage 2 CKD and controls, whereas lower VO(2) max was observed among children with stage 3 to 4 CKD, those treated with hemodialysis, and transplant recipients. In univariate analysis, VO(2) max was significantly associated with body mass index, resting heart rate, C-reactive protein, serum triglycerides, serum creatinine, and measures of diastolic function; no significant associations with left ventricular structure or systolic function were identified. In multivariate regression analysis, patient category versus control and the presence of diastolic dysfunction were independent predictors of lower VO(2) max. These results suggest that aerobic capacity is decreased in the early stages of CKD in children and that lower VO(2) max can be predicted by the presence of diastolic dysfunction, even if systolic function is normal.
authors.affiliation: Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, MLC 7022, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Weaver
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Kimball
authors.forename: Timothy
authors.initials: T
authors.lastname: Knilans
authors.forename: Wayne
authors.initials: W
authors.lastname: Mays
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Knecht
authors.forename: Yvette M
authors.initials: YM
authors.lastname: Gerdes
authors.forename: Sandy
authors.initials: S
authors.lastname: Witt
authors.forename: Betty J
authors.initials: BJ
authors.lastname: Glascock
authors.forename: Janis
authors.initials: J
authors.lastname: Kartal
authors.forename: Philip
authors.initials: P
authors.lastname: Khoury
authors.forename: Mark M
authors.initials: MM
authors.lastname: Mitsnefes
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D015999:Multivariate Analysis; D010101:Oxygen Consumption / Q000502:physiology*; D012044:Regression Analysis; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology*