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Updated: Mar 22, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Subclinical cardiopulmonary dysfunction in stage 3 chronic kidney disease
Alexander Nelson1, James Otto2, John Whittle3
1UCL Medical School , London , UK.
Insights
Chronic kidney disease (CKD) stage 3 is linked to reduced exercise capacity and cardiopulmonary dysfunction, even without heart failure. This suggests early cardiovascular changes in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Exercise Physiology
Background:
- Reduced exercise capacity is a known complication of end-stage chronic kidney disease (CKD).
- Cardiac morphology changes occur in CKD stage 3, but subclinical cardiopulmonary dysfunction independent of heart failure is not well understood.
Purpose of the Study:
- To investigate the presence of subclinical cardiopulmonary dysfunction in patients with CKD stage 3.
- To determine if cardiopulmonary dysfunction in CKD stage 3 occurs independently of heart failure.
Main Methods:
- A prospective observational cross-sectional study involving 993 preoperative patients.
- Cardiopulmonary exercise testing was used to assess exercise capacity, including peak oxygen consumption (VO2peak) and anaerobic threshold (AT).
- Statistical analysis controlled for CKD stage 3, age, gender, diabetes mellitus, and hypertension.
Main Results:
- CKD stage 3 was identified in 9.97% of patients, with higher prevalence of diabetes and hypertension.
- Patients with CKD stage 3 exhibited significantly lower VO2peak (6% reduction), lower peak heart rate, lower AT, and impaired heart rate recovery.
- No significant difference in cardiac failure or ischemic heart disease was observed between CKD stage 3 patients and others.
Conclusions:
- Subclinical cardiopulmonary dysfunction is prevalent in patients with CKD stage 3.
- These findings suggest that maladaptive cardiovascular and autonomic dysfunction may begin in CKD stage 3, preceding more severe complications seen in end-stage CKD.
Objective:
Reduced exercise capacity is well documented in end-stage chronic kidney disease (CKD), preceded by changes in cardiac morphology in CKD stage 3. However, it is unknown whether subclinical cardiopulmonary dysfunction occurs in CKD stage 3 independently of heart failure.
Methods:
Prospective observational cross-sectional study of exercise capacity assessed by cardiopulmonary exercise testing in 993 preoperative patients. Primary outcome was peak oxygen consumption (VO2peak). Anaerobic threshold (AT), oxygen pulse and exercise-evoked measures of autonomic function were analysed, controlling for CKD stage 3, age, gender, diabetes mellitus and hypertension.
Results:
CKD stage 3 was present in 93/993 (9.97%) patients. Diabetes mellitus (RR 2.49 (95% CI 1.59 to 3.89); p<0.001), and hypertension (RR 3.20 (95% CI 2.04 to 5.03); p<0.001)) were more common in CKD stage 3. Cardiac failure (RR 0.83 (95% CI 0.30 to 2.24); p=0.70) and ischaemic heart disease (RR 1.40 (95% CI 0.97 to 2.02); p=0.09) were not more common in CKD stage 3. Patients with CKD stage 3 had lower predicted VO2peak (mean difference: 6% (95% CI 1% to 11%); p=0.02), lower peak heart rate (mean difference:9 bpm (95% CI 3 to 14); p=0.03)), lower AT (mean difference: 1.1 mL/min/kg (95% CI 0.4 to 1.7); p<0.001) and impaired heart rate recovery (mean difference: 4 bpm (95% CI 1 to 7); p<0.001)).
Conclusions:
Subclinical cardiopulmonary dysfunction in CKD stage 3 is common. This study suggests that maladaptive cardiovascular/autonomic dysfunction may be established in CKD stage 3, preceding pathophysiology reported in end-stage CKD.
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