Abstract
BackgroundCardiovascular (CV) morbidity and mortality are higher in chronic kidney disease (CKD) than in the general population. Reduced heart rate recovery (HRR) is an independent risk factor for CV disease. The aim of the study was to determine the prognostic role of HRR in a homogenous group of CKD patients.MethodsOne hundred and twenty-five IgA nephropathy patients (82 male, 43 female, age 54.7 ± 13 years) with CKD stage 1–4 were investigated and followed for average 70 months. We performed a graded exercise treadmill stress test. HRR was derived from the difference of the peak heart rate and the heart rate at 1 min after exercise. Patients were divided into two groups by the mean HRR value (22.9 beats/min). The composite (CV and renal) endpoints included all-cause mortality and any CV event such as stroke, myocardial infarction, revascularisation (CV) and end-stage renal disease, renal replacement therapy (renal).ResultsPatients with reduced HRR (< 23 bpm) had significantly more end point events (22/62 patients vs. 9/53 patients, p = 0.013) compared to the higher HRR (≥23 bpm). Of the secondary the endpoints (CV or renal separately) rate of the renal endpoint was significantly higher in the lower HRR group (p = 0.029), while there was no significant difference in the CV endpoint between the two HRR groups (p = 0.285). Independent predictors of survival were eGFR and diabetes mellitus by using Cox regression analysis. Kaplan-Meier curves showed significant differences in metabolic syndrome and non-metabolic syndrome when examined at the combined endpoints (cardiovascular and renal) or at each endpoint separately. The primary endpoint rate was increased significantly with the increased number of metabolic syndrome component (Met.sy. comp. 0 vs. Met. sy. comp. 2+, primary endpoints, p = 0.012).ConclusionOur results showed that reduced HRR measured by treadmill exercise test has a predictive value for the prognosis of IgA nephropathy. The presence of metabolic syndrome may worsen the prognosis of IgA nephropathy.
Highlights
For predicting cardiovascular (CV) risk, the treadmill exercise test seems to be a more suitable non-invasive tool than routinely assessing the functional capacity bySági et al BMC Nephrology (2021) 22:390 the first or second minutes after the peak exercise at the end of the stress test which is a validated method [6].The prevalence of chronic kidney disease (CKD) is high all over the world [7]
Patients were treated with angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers (BBL), and statins
We found that IgA nephropathy patients with reduced heart rate recovery (HRR) values have a significantly increased rate of adverse primary CV and renal events compared to those who presented with higher HRR values
Summary
For predicting cardiovascular (CV) risk, the treadmill exercise test seems to be a more suitable non-invasive tool than routinely assessing the functional capacity bySági et al BMC Nephrology (2021) 22:390 the first or second minutes after the peak exercise at the end of the stress test which is a validated method [6].The prevalence of chronic kidney disease (CKD) is high all over the world [7]. Previous studies had demonstrated the prognostic role of HRR in patients with various heart diseases. In a cross-sectional study, we have earlier shown that inverse relationship exists between HRR and renal function and this study was conducted in patients with IgA nephropathy [16]. The aim of the present study was to investigate the prognostic role of HRR on major CV (myocardial infarction, stroke, revascularisation, cardiac death) and renal outcomes (ESRD) in patients with IgA nephropathy with longer follow-up. Cardiovascular (CV) morbidity and mortality are higher in chronic kidney disease (CKD) than in the general population. The aim of the study was to determine the prognostic role of HRR in a homogenous group of CKD patients
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