Exercise Capacity in Polycystic Kidney Disease

• Published in: American journal of kidney diseases Vol. 64; no. 2; pp. 239 - 246
• Main Authors: Reinecke, Natália Lopes, MSc, Cunha, Thulio Marquez, MD, PhD, Heilberg, Ita Pfeferman, MD, PhD, Higa, Elisa Mieko Suemitsu, MD, PhD, Nishiura, José Luiz, MD, PhD, Neder, José Alberto, MD, PhD, Almeida, Waldemar Silva, MD, PhD, Schor, Nestor, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2014; Elsevier
• Subjects: Adult; asymmetric dimethylarginine (ADMA); Autosomal dominant polycystic kidney disease (ADPKD); Biological and medical sciences; Blood Pressure - physiology; cardiopulmonary exercise testing; Cohort Studies; cystic diseases; exercise; Exercise - physiology; Exercise Tolerance - physiology; Female; Follow-Up Studies; Heart Rate - physiology; Humans; Kidneys; Male; Malformations of the urinary system; Medical sciences; Nephrology; Nephrology. Urinary tract diseases; nitric oxide; physical capacity; polycystic kidney; Polycystic Kidney, Autosomal Dominant - diagnosis; Polycystic Kidney, Autosomal Dominant - physiopathology; Prospective Studies; Young Adult; asymmetric dimethylarginine (ADMA); nitric oxide; physical capacity; Autosomal dominant polycystic kidney disease (ADPKD); exercise; polycystic kidney; cardiopulmonary exercise testing; cystic diseases; Kidney disease; Physical exercise; Nephrology; Urinary system disease; Polycystic kidney; Cardiopulmonary; Cystic disease; Autosome; Medical screening; Urology; Genetic disease; Physical fitness; Autosomal character; Nitric oxide; Cyst; Dominant character; Benign neoplasm
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2014.03.014

Background Reports about exercise performance in autosomal dominant polycystic kidney disease (ADPKD) are scarce. We aimed to evaluate exercise capacity and levels of nitric oxide and asymmetric dimethylarginine (ADMA) in normotensive patients with ADPKD. Study Design Prospective controlled cohort study. Setting & Participants 26 patients with ADPKD and 30 non-ADPKD control participants (estimated glomerular filtration rate > 60 mL/min/1.73 m2 , aged 19-39 years, and blood pressure [BP] < 140/85 mm Hg). We excluded smokers, obese people, and individuals with associated diseases. Predictor ADPKD versus control. Outcomes Exercise capacity and nitric oxide and ADMA levels in response to exercise. Measurements Cardiopulmonary exercise testing and serum and urinary nitric oxide, plasma ADMA, and BP levels before and after exercise. Results Mean basal systolic and diastolic BP, estimated glomerular filtration rate, and age did not differ between the ADPKD and control groups (116 ± 12 vs 110 ± 11 mm Hg, 76 ± 11 vs 71 ± 9 mm Hg, 113 ± 17 vs 112 ± 9.6 mL/min/1.73 m2 , and 30 ± 8 vs 28.9 ± 7.3 years, respectively). Peak oxygen uptake and anaerobic threshold were significantly lower in the ADPKD group than in controls (22.2 ± 3.3 vs 31 ± 4.8 mL/kg/min [ P < 0.001] and 743.6 ± 221 vs 957.4 ± 301 L/min [ P = 0.01], respectively). Postexercise serum and urinary nitric oxide levels in patients with ADPKD were not significantly different from baseline (45 ± 5.1 vs 48.3 ± 4.6 μmol/L and 34.7 ± 6.5 vs 39.8 ± 6.8 μmol/mg of creatinine, respectively), contrasting with increased postexercise values in controls (63.1 ± 1.9 vs 53.9 ± 3.1 μmol/L [ P = 0.01] and 61.4 ± 10.6 vs 38.7 ± 5.6 μmol/mg of creatinine [ P = 0.01], respectively). Similarly, whereas postexercise ADMA level did not change in the ADPKD group compared to those at rest (0.47 ± 0.04 vs 0.45 ± 0.02 μmol/L [ P = 0.6]), it decreased in controls (0.39 ± 0.02 vs 0.47 ± 0.02 μmol/L [ P = 0.006]), as expected. A negative correlation between nitric oxide and ADMA levels after exercise was found in only the control group ( r = −0.60; P < 0.01). Limitations Absence of measurements of flow-mediated dilatation and oxidative status. Conclusions We found lower aerobic capacity in young normotensive patients with ADPKD with preserved kidney function and inadequate responses of nitric oxide and ADMA levels to acute exercise, suggesting the presence of early endothelial dysfunction in this disease.