Exercise capacity in polycystic kidney disease.
BACKGROUND
Reports about exercise performance in autosomal dominant polycystic kidney disease (ADPKD) are scarce. We aimed to evaluate exercise capacity and levels of nitric oxide and asymmetric dimethylarginine (ADMA) in normotensive patients with ADPKD.


METHODS
Prospective controlled cohort study.


METHODS
26 patients with ADPKD and 30 non-ADPKD control participants (estimated glomerular filtration rate>60 mL/min/1.73 m2, aged 19-39 years, and blood pressure [BP]<140/85 mmHg). We excluded smokers, obese people, and individuals with associated diseases.


METHODS
ADPKD versus control.


RESULTS
Exercise capacity and nitric oxide and ADMA levels in response to exercise.


METHODS
Cardiopulmonary exercise testing and serum and urinary nitric oxide, plasma ADMA, and BP levels before and after exercise.


RESULTS
Mean basal systolic and diastolic BP, estimated glomerular filtration rate, and age did not differ between the ADPKD and control groups (116±12 vs. 110±11 mmHg, 76±11 vs 71±9 mmHg, 113±17 vs. 112±9.6 mL/min/1.73 m2, and 30±8 vs. 28.9±7.3 years, respectively). Peak oxygen uptake and anaerobic threshold were significantly lower in the ADPKD group than in controls (22.2±3.3 vs. 31±4.8 mL/kg/min [P<0.001] and 743.6±221 vs. 957.4±301 L/min [P=0.01], respectively). Postexercise serum and urinary nitric oxide levels in patients with ADPKD were not significantly different from baseline (45±5.1 vs. 48.3±4.6 μmol/L and 34.7±6.5 vs. 39.8±6.8 μmol/mg of creatinine, respectively), contrasting with increased postexercise values in controls (63.1±1.9 vs. 53.9±3.1 μmol/L [P=0.01] and 61.4±10.6 vs. 38.7±5.6 μmol/mg of creatinine [P=0.01], respectively). Similarly, whereas postexercise ADMA level did not change in the ADPKD group compared to those at rest (0.47±0.04 vs. 0.45±0.02 μmol/L [P=0.6]), it decreased in controls (0.39±0.02 vs. 0.47±0.02 μmol/L [P=0.006]), as expected. A negative correlation between nitric oxide and ADMA levels after exercise was found in only the control group (r = -0.60; P<0.01).


CONCLUSIONS
Absence of measurements of flow-mediated dilatation and oxidative status.


CONCLUSIONS
We found lower aerobic capacity in young normotensive patients with ADPKD with preserved kidney function and inadequate responses of nitric oxide and ADMA levels to acute exercise, suggesting the presence of early endothelial dysfunction in this disease.
Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Natália Lopes
NL
Reinecke
Pneumology Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Thulio Marquez
TM
Cunha
Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Ita Pfeferman
IP
Heilberg
Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Elisa Mieko Suemitsu
EM
Higa
Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
José Luiz
JL
Nishiura
Pneumology Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
José Alberto
JA
Neder
Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Waldemar Silva
WS
Almeida
Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil. Electronic address: nestor@nefro.epm.br.
Nestor
N
Schor
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D015444:Exercise / Q000502:physiology*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D016891:Polycystic Kidney, Autosomal Dominant / Q000175:diagnosis / Q000503:physiopathology*; D011446:Prospective Studies; D055815:Young Adult
Autosomal dominant polycystic kidney disease (ADPKD); asymmetric dimethylarginine (ADMA); cardiopulmonary exercise testing; cystic diseases; exercise; nitric oxide; physical capacity; polycystic kidney