Author/Authors :
Khoshdel, Ali Reza AJA University of Medical Sciences, Tehran, Iran , Carney, Shane The University of Newcastle, NSW, Australia , White, Saxon The University of Newcastle, NSW, Australia , Gillies, Alastair The University of Newcastle, NSW, Australia
Abstract :
Introduction. Kidney disease increases the risk of cardiovascular
disease. The corollary of that observation should be that cardiovascular
disease would not only increase the risk of kidney dysfunction,
but also cause kidney damage, a concept not previously proposed.
Materials and Methods. Hemodynamic response to a graded
exercise stress test was measured in 70 candidates to evaluate the
association of heart rate and blood pressure change, heart rate
reserve, chronotropic incompetence (percentage of achievement
of maximal predicted heart rate), and circulatory power with
development of kidney failure (glomerular filtration rate < 30 mL/
min/1.73 m2) during 123 months of follow-up period.
Results. Kidney failure was more likely to develop in patients
with lower heart rate change, heart rate reserve, percentage of
achievement of maximal predicted heart rate, and circulatory
power (P = .002, P = .01, P = .02, and P = .008, respectively), even
after adjustment for age, resting pulse pressure, hypertension,
diabetes mellitus, and exercise test result (hazard ratios, 5.9, 2.9,
3.3, and 2.9, respectively). A resting pulse pressure of 60 mm Hg
and higher was accompanied by 7.4 times (95% confidence interval,
1.8 to 30.9) greater risk of developing kidney failure, independent
of age and resting systolic blood pressure (P = .006).
Conclusions. Hemodynamic responses to a standard graded
exercise stress test independently predicted the development of
kidney failure. Also, arterial stiffness (represented by resting pulse
pressure) could be a factor linking ventricular and kidney function.
Early diagnosis of kidney disease should include a cardiovascular
assessment and vice versa.
