Exercise capacity in pediatric patients with end-stage renal disease

To evaluate the correlation between exercise capacity and hemoglobin in pediatric patients with end-stage renal disease (ESRD) treated with automated peritoneal dialysis (APD) and hemodialysis.

Prospective case-control study and retrospective review.

Dialysis summer camp and Children's Mercy Hospital exercise laboratory.

Prospective evaluation conducted with 14 patients (9 males, mean age 14.5 +/- 2.5 years) who received either home APD (5 patients) or in-center hemodialysis (9 patients), and 8 healthy age-matched controls. Retrospective data derived from 10 children (7 males, mean age 12.3 +/- 3.3 years), all of whom received APD.

Maximal treadmill evaluation conducted with each patient and control. The hemoglobin value of each patient was also assessed.

Comparison of the following data generated during treadmill protocol: peak heart rate, blood pressure, oxygen saturation, treadmill time, oxygen consumption (VO2), ventilation (Ve), oxygen consumption at anaerobic threshold (VO2AT), and respiratory exchange ratio.

The hemoglobin value of the current patient group (12.8 +/- 1.6 g/dL) was significantly greater than the previously studied patients (10.5 +/- 1.1 g/dL) (p = 0.001). Treadmill time, VO2, and VO2AT were significantly lower in both groups of dialysis patients compared to the control subjects (p < 0.05). No differences were noted in any of these variables when comparing these two groups of dialysis patients only.

The exercise capacity of pediatric dialysis patients is significantly poorer than that of healthy children, an outcome apparently related to factors other than normalization of the hemoglobin value.