Benefits of Cardiac Rehabilitation in Cardio-Renal Patients With Heart Failure With Reduced Ejection Fraction.
Journal
Journal of cardiopulmonary rehabilitation and prevention
ISSN: 1932-751X
Titre abrégé: J Cardiopulm Rehabil Prev
Pays: United States
ID NLM: 101291247
Informations de publication
Date de publication:
01 11 2023
01 11 2023
Historique:
medline:
30
10
2023
pubmed:
10
3
2023
entrez:
9
3
2023
Statut:
ppublish
Résumé
Chronic kidney disease (CKD) is common in heart failure (HF). Chronic kidney disease often worsens the prognosis and impairs the management of patients with HF. Chronic kidney disease is frequently accompanied by sarcopenia, which limits the benefits of cardiac rehabilitation (CR). The aim of this study was to evaluate the impact of CR on cardiorespiratory fitness in HF patients with reduced ejection fraction (HFrEF) according to the CKD stage. We conducted a retrospective study including 567 consecutive patients with HFrEF, who underwent a 4-wk CR program, and who were evaluated by cardiorespiratory exercise test before and after the program. Patients were stratified according to their estimated glomerular filtration rate (eGFR). We performed multivariate analysis looking for factors associated with an improvement of 10% in peak oxygen uptake (V˙ o2peak ). Thirty-eight percent of patients had eGFR <60 mL/min/1.73m². With decreasing eGFR, we observed deterioration in V˙ o2peak , first ventilatory threshold (VT1) and workload and an increase in brain natriuretic peptide levels at baseline. After CR, there was an improvement in V˙ O2peak (15.3 vs 17.8 mL/kg/min, P < .001), VT1 (10.5 vs 12.4 mL/kg/min, P < .001), workload (77 vs 94 W, P < .001), and brain natriuretic peptide (688 vs 488 pg/mL, P < .001). These improvements were statistically significant for all stages of CKD. In a multivariate analysis predicting factors associated with V˙ o2peak improvement, renal function did not interfere with results. Cardiac rehabilitation is beneficial in patients with HFrEF with CKD regardless of CKD stage. The presence of CKD should not prevent the prescription of CR in patients with HFrEF.
Identifiants
pubmed: 36892848
doi: 10.1097/HCR.0000000000000781
pii: 01273116-990000000-00079
doi:
Substances chimiques
Natriuretic Peptide, Brain
114471-18-0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
444-452Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Seferovic PM, Ponikowski P, Anker SD, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21(10):1169–1186.
Löfman I, Szummer K, Hagerman I, Dahlström U, Lund LH, Jernberg T. Prevalence and prognostic impact of kidney disease on heart failure patients. Open Heart. 2016;3(1):e000324.
Damman K, Valente MAE, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J. 2014;35(7):455–469.
Ronco C, McCullough P, Anker SD, et al. Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J. 2010;31(6):703–711.
Schefold JC, Filippatos G, Hasenfuss G, Anker SD, von Haehling S. Heart failure and kidney dysfunction: epidemiology, mechanisms and management. Nat Rev Nephrol. 2016;12(10):610–623.
Banerjee D, Wang AYM. Personalizing heart failure management in chronic kidney disease patients. Nephrol Dial Transplant. 2022;37(11):2055–2062.
Jenkins R, Mandarano L, Gugathas S, Kaski JC, Anderson L, Banerjee D. Impaired renal function affects clinical outcomes and management of patients with heart failure: kidney failure in heart failure patients. ESC Heart Fail. 2017;4(4):576–584.
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–3726.
Long L, Mordi IR, Bridges C, et al. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 2019;1:CD003331.
Taylor RS, Walker S, Smart NA, et al. Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta-analysis of randomised trials. Eur J Heart Fail. 2018;20(12):1735–1743.
O'Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. J Am Med Assoc. 2009;301(14):1439–1450.
Kamiya K, Sato Y, Takahashi T, et al. Multidisciplinary cardiac rehabilitation and long-term prognosis in patients with heart failure. Circ Heart Fail. 2020;13(10):e006798.
Gabet A, De Peretti C, Iliou MC, Nicolau J, Olié V. National trends in admission for cardiac rehabilitation after a myocardial infarction in France from 2010 to 2014. Arch Cardiovasc Dis. 2018;111(11):625–633.
McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med. 2017;27(6):420–425.
Piepoli MF, Binno S, Coats AJS, et al. Regional differences in exercise training implementation in heart failure: findings from the Exercise Training in Heart Failure (ExTraHF) survey. Eur J Heart Fail. 2019;21(9):1142–1148.
Löfman I, Szummer K, Dahlström U, Jernberg T, Lund LH. Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction. Eur J Heart Fail. 2017;19(12):1606–1614.
Giallauria F, Fattirolli F, Tramarin R, et al. Clinical characteristics and course of patients entering cardiac rehabilitation with chronic kidney disease: data from the Italian Survey on Cardiac Rehabilitation. ISRN Rehabil. 2013;2013:1–10.
Scrutinio D, Agostoni P, Gesualdo L, et al. Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction. Circ J. 2015;79(3):583–591.
Thompson S, Wiebe N, Arena R, et al. Effectiveness and utilization of cardiac rehabilitation among people with CKD. Kidney Int Rep. 2021;6(6):1537–1547.
Roshanravan B, Gamboa J, Wilund K. Exercise and CKD: skeletal muscle dysfunction and practical application of exercise to prevent and treat physical impairments in CKD. Am J Kidney Dis. 2017;69(6):837–852.
Macdonald JH, Fearn L, Jibani M, Marcora SM. Exertional fatigue in patients with CKD. Am J Kidney Dis. 2012;60(6):930–939.
Wilkinson TJ, Clarke AL, Nixon DGD, et al. Prevalence and correlates of physical activity across kidney disease stages: an observational multicentre study. Nephrol Dial Transplant. 2021;36(4):641–649.
Kuo CP, Tsai MT, Lee KH, et al. Dose–response effects of physical activity on all-cause mortality and major cardiorenal outcomes in chronic kidney disease. Eur J Prev Cardiol. 2022;29(3):452–461.
Zhang L, Wang Y, Xiong L, Luo Y, Huang Z, Yi B. Exercise therapy improves eGFR, and reduces blood pressure and BMI in non-dialysis CKD patients: evidence from a meta-analysis. BMC Nephrol. 2019;20(1):398.
Vanden Wyngaert K, Van Craenenbroeck AH, Van Biesen W, et al. The effects of aerobic exercise on eGFR, blood pressure and VO2peak in patients with chronic kidney disease stages 3-4: a systematic review and meta-analysis. PLoS One. 2018;13(9):e0203662.
Heiwe S, Jacobson SH. Exercise training in adults with CKD: a systematic review and meta-analysis. Am J Kidney Dis. 2014;64(3):383–393.
Howden EJ, Coombes JS, Strand H, Douglas B, Campbell KL, Isbel NM. Exercise training in CKD: efficacy, adherence, and safety. Am J Kidney Dis. 2015;65(4):583–591.
Ting SMS, Hamborg T, McGregor G, et al. Reduced cardiovascular reserve in chronic kidney failure: a matched cohort study. Am J Kidney Dis. 2015;66(2):274–284.
Nelson A, Otto J, Whittle J, et al. Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease. Open Heart. 2016;3(1):e000370.
Kirkman DL, Muth BJ, Stock JM, Townsend RR, Edwards DG. Cardiopulmonary exercise testing reveals subclinical abnormalities in chronic kidney disease. Eur J Prev Cardiol. 2018;25(16):1717–1724.
Tedeschi A, Agostoni P, Pezzuto B, et al. Role of comorbidities in heart failure prognosis part 2: chronic kidney disease, elevated serum uric acid. Eur J Prev Cardiol. 2020;27(2 suppl):35–45.
Iso Y, Kitai H, Kowaita H, et al. Association of aging with glomerular filtration changes in cardiac rehabilitation participants with chronic kidney disease. Int J Cardiol. 2015;187:283–285.
Sato T, Kohzuki M, Ono M, et al. Association between physical activity and change in renal function in patients after acute myocardial infarction. PLoS One. 2019;14(2):e0212100.
Hama T, Ushijima A, Goto T, et al. Effect of cardiac rehabilitation on glomerular filtration rate using serum cystatin c concentration in patients with cardiovascular disease and renal dysfunction. J Cardiopulm Rehabil Prev. 2022;42(2):E15–E22.
Takaya Y, Kumasaka R, Arakawa T, et al. Impact of cardiac rehabilitation on renal function in patients with and without chronic kidney disease after acute myocardial infarction. Circ J. 2014;78(2):377–384.
Venkataraman R, Sanderson B, Bittner V. Outcomes in patients with chronic kidney disease undergoing cardiac rehabilitation. Am Heart J. 2005;150(6):1140–1146.
McCullough PA, Franklin BA, Leifer E, Fonarow GC. Impact of reduced kidney function on cardiopulmonary fitness in patients with systolic heart failure. Am J Nephrol. 2010;32(3):226–233.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461–470.
Tabet JY, Metra M, Thabut G, Logeart D, Cohen-Solal A. Prognostic value of cardiopulmonary exercise variables in chronic heart failure patients with or without beta-blocker therapy. Am J Cardiol. 2006;98(4):500–503.
Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–381.
Arena R, Guazzi M, Myers J, et al. The prognostic utility of cardiopulmonary exercise testing stands the test of time in patients with heart failure. J Cardiopulm Rehabil Prev. 2012;32(4):198–202.
Sagar VA, Davies EJ, Briscoe S, et al. Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart. 2015;2(1):e000163.
Völler H, Gitt A, Jannowitz C, et al. Treatment patterns, risk factor control and functional capacity in patients with cardiovascular and chronic kidney disease in the cardiac rehabilitation setting. Eur J Prev Cardiol. 2014;21(9):1125–1133.
Rossi AP, Burris DD, Lucas FL, Crocker GA, Wasserman JC. Effects of a renal rehabilitation exercise program in patients with CKD: a randomized, controlled trial. Clin J Am Soc Nephrol. 2014;9(12):2052–2058.
Qiu Z, Zheng K, Zhang H, Feng J, Wang L, Zhou H. Physical exercise and patients with chronic renal failure: a meta-analysis [published online ahead of print February 20, 2017]. BioMed Res Int. 2017;2017:7191826.
Howden EJ, Leano R, Petchey W, Coombes JS, Isbel NM, Marwick TH. Effects of exercise and lifestyle intervention on cardiovascular function in CKD. Clin J Am Soc Nephrol. 2013;8(9):1494–1501.
Keteyian SJ, Leifer ES, Houston-Miller N, et al. Relation between volume of exercise and clinical outcomes in patients with heart failure. J Am Coll Cardiol. 2012;60(19):1899–1905.
Listerman J, Bittner V, Sanderson BK, Brown TM. Cardiac rehabilitation outcomes: impact of comorbidities and age. J Cardiopulm Rehabil Prev. 2011;31(6):342–348.
Nonoyama ML, Kin SMR, Brooks D, Oh P. Comparison of cardiac rehabilitation outcomes in individuals with respiratory, cardiac or no comorbidities: a retrospective review. Can J Respir Ther. 2016;52(2):43–49.
Sietsema KE, Amato A, Adler SG, Brass EP. Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney Int. 2004;65(2):719–724.
Tucker WJ, Lijauco CC, Hearon CM, et al. Mechanisms of the improvement in peak VO 2 with exercise training in heart failure with reduced or preserved ejection fraction. Heart Lung Circ. 2018;27(1):9–21.
Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with severe left ventricular dysfunction. Hemodynamic and metabolic effects. Circulation. 1988;78(3):506–515.
Barcellos FC, Santos IS, Umpierre D, Bohlke M, Hallal PC. Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review. Clin Kidney J. 2015;8(6):753–765.
Ezekowitz J, McAlister FA, Humphries KH, et al. The association among renal insufficiency, pharmacotherapy, and outcomes in 6,427 patients with heart failure and coronary artery disease. J Am Coll Cardiol. 2004;44(8):1587–1592.
Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004;351(13):1285–1295.
Kutner NG, Zhang R, Huang Y, Herzog CA. Cardiac rehabilitation and survival of dialysis patients after coronary bypass. J Am Soc Nephrol JASN. 2006;17(4):1175–1180.
Greenwood SA, Castle E, Lindup H, et al. Mortality and morbidity following exercise-based renal rehabilitation in patients with chronic kidney disease: the effect of programme completion and change in exercise capacity. Nephrol Dial Transplant. 2019;34(4):618–625.